bid_id	contract_year	cs_in_c0056	cs_in_c0057	cs_in_c0058	cs_in_c0059	cs_in_c0060	cs_in_c0061	cs_in_c0062	cs_in_c0063	cs_in_c0064	cs_in_c0065	cs_in_d0012	cs_in_e0056	cs_in_e0057	cs_in_e0058	cs_in_e0059	cs_in_e0060	cs_in_e0061	cs_in_e0062	cs_in_e0063	cs_in_e0064	cs_in_e0065	cs_in_f0025	cs_in_f0026	cs_in_f0027	cs_in_f0028	cs_in_f0029	cs_in_f0030	cs_in_f0031	cs_in_f0032	cs_in_f0033	cs_in_f0034	cs_in_f0035	cs_in_f0036	cs_in_f0037	cs_in_f0038	cs_in_f0039	cs_in_f0040	cs_in_f0041	cs_in_f0042	cs_in_f0043	cs_in_f0044	cs_in_f0045	cs_in_f0046	cs_in_f0047	cs_in_f0048	cs_in_f0049	cs_in_f0050	cs_in_f0051	cs_in_f0052	cs_in_f0053	cs_in_f0054	cs_in_f0055	cs_in_f0056	cs_in_f0057	cs_in_f0058	cs_in_f0059	cs_in_f0060	cs_in_f0061	cs_in_f0062	cs_in_f0063	cs_in_f0064	cs_in_f0065	cs_in_g0012	cs_in_g0025	cs_in_g0026	cs_in_g0027	cs_in_g0028	cs_in_g0029	cs_in_g0030	cs_in_g0031	cs_in_g0032	cs_in_g0033	cs_in_g0034	cs_in_g0035	cs_in_g0036	cs_in_g0037	cs_in_g0038	cs_in_g0039	cs_in_g0040	cs_in_g0041	cs_in_g0042	cs_in_g0043	cs_in_g0044	cs_in_g0045	cs_in_g0046	cs_in_g0047	cs_in_g0048	cs_in_g0049	cs_in_g0050	cs_in_g0051	cs_in_g0052	cs_in_g0053	cs_in_g0054	cs_in_g0055	cs_in_g0056	cs_in_g0057	cs_in_g0058	cs_in_g0059	cs_in_g0060	cs_in_g0061	cs_in_g0062	cs_in_g0063	cs_in_g0064	cs_in_g0065	cs_in_g0066	cs_in_h0025	cs_in_h0026	cs_in_h0027	cs_in_h0028	cs_in_h0029	cs_in_h0030	cs_in_h0031	cs_in_h0032	cs_in_h0033	cs_in_h0034	cs_in_h0035	cs_in_h0036	cs_in_h0037	cs_in_h0038	cs_in_h0039	cs_in_h0040	cs_in_h0041	cs_in_h0042	cs_in_h0043	cs_in_h0044	cs_in_h0045	cs_in_h0046	cs_in_h0047	cs_in_h0048	cs_in_h0049	cs_in_h0050	cs_in_h0051	cs_in_h0052	cs_in_h0053	cs_in_h0054	cs_in_h0055	cs_in_h0056	cs_in_h0057	cs_in_h0058	cs_in_h0059	cs_in_h0060	cs_in_h0061	cs_in_h0062	cs_in_h0063	cs_in_h0064	cs_in_h0065	cs_in_i0025	cs_in_i0026	cs_in_i0027	cs_in_i0028	cs_in_i0029	cs_in_i0030	cs_in_i0031	cs_in_i0032	cs_in_i0033	cs_in_i0034	cs_in_i0035	cs_in_i0036	cs_in_i0037	cs_in_i0038	cs_in_i0039	cs_in_i0040	cs_in_i0041	cs_in_i0042	cs_in_i0043	cs_in_i0044	cs_in_i0045	cs_in_i0046	cs_in_i0047	cs_in_i0048	cs_in_i0049	cs_in_i0050	cs_in_i0051	cs_in_i0052	cs_in_i0053	cs_in_i0054	cs_in_i0055	cs_in_i0056	cs_in_i0057	cs_in_i0058	cs_in_i0059	cs_in_i0060	cs_in_i0061	cs_in_i0062	cs_in_i0063	cs_in_i0064	cs_in_i0065	cs_in_k0025	cs_in_k0026	cs_in_k0027	cs_in_k0028	cs_in_k0029	cs_in_k0030	cs_in_k0031	cs_in_k0032	cs_in_k0033	cs_in_k0034	cs_in_k0035	cs_in_k0036	cs_in_k0037	cs_in_k0038	cs_in_k0039	cs_in_k0040	cs_in_k0041	cs_in_k0042	cs_in_k0043	cs_in_k0044	cs_in_k0045	cs_in_k0046	cs_in_k0047	cs_in_k0048	cs_in_k0049	cs_in_k0050	cs_in_k0051	cs_in_k0052	cs_in_k0053	cs_in_k0054	cs_in_k0055	cs_in_k0056	cs_in_k0057	cs_in_k0058	cs_in_k0059	cs_in_k0060	cs_in_k0061	cs_in_k0062	cs_in_k0063	cs_in_k0064	cs_in_k0065	cs_in_l0012	cs_in_l0025	cs_in_l0026	cs_in_l0027	cs_in_l0028	cs_in_l0029	cs_in_l0030	cs_in_l0031	cs_in_l0032	cs_in_l0033	cs_in_l0034	cs_in_l0035	cs_in_l0036	cs_in_l0037	cs_in_l0038	cs_in_l0039	cs_in_l0040	cs_in_l0041	cs_in_l0042	cs_in_l0043	cs_in_l0044	cs_in_l0045	cs_in_l0046	cs_in_l0047	cs_in_l0048	cs_in_l0049	cs_in_l0050	cs_in_l0051	cs_in_l0052	cs_in_l0053	cs_in_l0054	cs_in_l0055	cs_in_l0056	cs_in_l0057	cs_in_l0058	cs_in_l0059	cs_in_l0060	cs_in_l0061	cs_in_l0062	cs_in_l0063	cs_in_l0064	cs_in_l0065	cs_in_l0067	cs_in_m0025	cs_in_m0026	cs_in_m0027	cs_in_m0028	cs_in_m0029	cs_in_m0030	cs_in_m0031	cs_in_m0032	cs_in_m0033	cs_in_m0034	cs_in_m0035	cs_in_m0036	cs_in_m0037	cs_in_m0038	cs_in_m0039	cs_in_m0040	cs_in_m0041	cs_in_m0042	cs_in_m0043	cs_in_m0044	cs_in_m0045	cs_in_m0046	cs_in_m0047	cs_in_m0048	cs_in_m0049	cs_in_m0050	cs_in_m0051	cs_in_m0052	cs_in_m0053	cs_in_m0054	cs_in_m0055	cs_in_m0056	cs_in_m0057	cs_in_m0058	cs_in_m0059	cs_in_m0060	cs_in_m0061	cs_in_m0062	cs_in_m0063	cs_in_m0064	cs_in_m0065	cs_in_m0066	cs_in_n0025	cs_in_n0026	cs_in_n0027	cs_in_n0028	cs_in_n0029	cs_in_n0030	cs_in_n0031	cs_in_n0032	cs_in_n0033	cs_in_n0034	cs_in_n0035	cs_in_n0036	cs_in_n0037	cs_in_n0038	cs_in_n0039	cs_in_n0040	cs_in_n0041	cs_in_n0042	cs_in_n0043	cs_in_n0044	cs_in_n0045	cs_in_n0046	cs_in_n0047	cs_in_n0048	cs_in_n0049	cs_in_n0050	cs_in_n0051	cs_in_n0052	cs_in_n0053	cs_in_n0054	cs_in_n0055	cs_in_n0056	cs_in_n0057	cs_in_n0058	cs_in_n0059	cs_in_n0060	cs_in_n0061	cs_in_n0062	cs_in_n0063	cs_in_n0064	cs_in_n0065	cs_in_n0066
H0104_001_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	P	V											0																																										-	1091.12	18.77	733.82	0	306.94	23.55	1.64	302.62	308.8	0	0	0	11.34	572.22	0	0	167.87	214.62	0	8821.11	6.19	590.65	0	0	369.26	0	150.33	0	0	0	0											225 / day up to 4 days.	225 / day up to 4 days.	50 / day		100 copay	20 coinsurance	20 coinsurance	50 copay	175 copay				25 copay	25 copay			40 copay	25 copay		20 PCP copay/25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	20 copay			20 copay		20 copay															225	225	50	0	100	20	20	50	175	0	0	0	25	25	0	0	40	20.75	0	22.62	20	20	0	0	20	0	20	0	0	0	0												225	225	50	0	100	20	20	50	175	0	0	0	25	25	0	0	40	20.75	0	22.62	20	20	0	0	20	0	20	0	0	0	0												20.46	0.35	3.06	-	2.56	4.71	0.33	1.26	4.5	-	-	-	0.02	1.19	-	-	0.56	0.37	-	16.62	1.24	0.98	-	-	0.62	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.09	20.46	0.35	3.06	-	2.56	4.71	0.33	1.26	4.5	-	-	-	0.02	1.19	-	-	0.56	0.37	-	16.62	1.24	0.98	-	-	0.62	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.09
H0104_002_0	2006											2500											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	P	V											2500																																										-	1091.12	18.77	733.82	0	306.94	23.55	1.64	302.62	308.8	0	0	0	11.34	572.22	0	0	167.87	214.62	0	8821.11	6.19	590.65	0	0	369.26	0	150.33	0	0	0	0											225 / day up to 4 days.	225 / day up to 4 days.	50 / day		100 copay	20 coinsurance	20 coinsurance	50 copay	175 copay				25 copay	25 copay			40 copay	25 copay		20 PCP copay/25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	20 copay			20 copay		20 copay															225	225	50	0	100	20	20	50	175	0	0	0	25	25	0	0	40	20.75	0	22.62	20	20	0	0	20	0	20	0	0	0	0												128.85	165.17	39.81	0	88.84	16.7	16.7	50	147.68	0	0	0	22.91	15.45	0	0	37.16	18.36	0	20.52	16.7	17.66	0	0	17.26	0	18.04	0	0	0	0												11.72	0.26	2.43	-	2.27	3.93	0.27	1.26	3.8	-	-	-	0.02	0.74	-	-	0.52	0.33	-	15.08	1.03	0.87	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.3	11.72	0.26	2.43	-	2.27	3.93	0.27	1.26	3.8	-	-	-	0.02	0.74	-	-	0.52	0.33	-	15.08	1.03	0.87	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.3
H0104_003_0	2006											2500											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	P	V											2500																																										-	1334.93	25.61	733.82	0	306.94	23.55	1.64	302.62	308.8	0	0	0	11.34	572.22	0	0	167.87	221.77	0	9377.28	6.19	629.94	0	0	393.96	0	160.43	0	0	0	0											125 / day up to 6 days.	125 / day up to 6 days.	50 / day		100 copay	20 coinsurance	20 coinsurance	50 copay	75 copay				15 copay	15 copay			40 copay	15 copay		10 PCP copay/15 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	10 copay			10 copay		10 copay															125	125	50	0	100	20	20	50	75	0	0	0	15	15	0	0	40	15	0	12.62	20	10	0	0	10	0	10	0	0	0	0												90.85	105.98	45.66	0	95.25	18.6	18.6	50	63.37	0	0	0	14.11	10.93	0	0	38.79	13.98	0	11.73	18.6	9	0	0	8.83	0	9.16	0	0	0	0												10.11	0.23	2.79	-	2.44	4.38	0.31	1.26	1.63	-	-	-	0.01	0.52	-	-	0.54	0.26	-	9.17	1.15	0.47	-	-	0.29	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.68	10.11	0.23	2.79	-	2.44	4.38	0.31	1.26	1.63	-	-	-	0.01	0.52	-	-	0.54	0.26	-	9.17	1.15	0.47	-	-	0.29	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.68
H0104_004_0	2006											2500											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	P	V											2500																																										-	1334.93	25.61	733.82	0	306.94	23.55	1.64	302.62	308.8	0	0	0	11.34	572.22	0	0	167.87	221.77	0	9377.28	6.19	629.94	0	0	393.96	0	160.43	0	0	0	0											125 / day up to 6 days.	125 / day up to 6 days.	50 / day		100 copay	20 coinsurance	20 coinsurance	50 copay	75 copay				15 copay	15 copay			40 copay	15 copay		10 PCP copay/15 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	10 copay			10 copay		10 copay															125	125	50	0	100	20	20	50	75	0	0	0	15	15	0	0	40	15	0	12.62	20	10	0	0	10	0	10	0	0	0	0												90.85	105.98	45.66	0	95.25	18.6	18.6	50	63.37	0	0	0	14.11	10.93	0	0	38.79	13.98	0	11.73	18.6	9	0	0	8.83	0	9.16	0	0	0	0												10.11	0.23	2.79	-	2.44	4.38	0.31	1.26	1.63	-	-	-	0.01	0.52	-	-	0.54	0.26	-	9.17	1.15	0.47	-	-	0.29	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.68	10.11	0.23	2.79	-	2.44	4.38	0.31	1.26	1.63	-	-	-	0.01	0.52	-	-	0.54	0.26	-	9.17	1.15	0.47	-	-	0.29	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.68
H0104_005_0	2006											2500											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	P	V											2500																																										-	1334.93	25.61	733.82	0	306.94	23.55	1.64	302.62	308.8	0	0	0	11.34	572.22	0	0	167.87	221.77	0	9377.28	6.19	629.94	0	0	393.96	0	160.43	0	0	0	0											125 / day up to 6 days.	125 / day up to 6 days.	50 / day		100 copay	20 coinsurance	20 coinsurance	50 copay	75 copay				15 copay	15 copay			40 copay	15 copay		10 PCP copay/15 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	10 copay			10 copay		10 copay															125	125	50	0	100	20	20	50	75	0	0	0	15	15	0	0	40	15	0	12.62	20	10	0	0	10	0	10	0	0	0	0												90.85	105.98	45.66	0	95.25	18.6	18.6	50	63.37	0	0	0	14.11	10.93	0	0	38.79	13.98	0	11.73	18.6	9	0	0	8.83	0	9.16	0	0	0	0												10.11	0.23	2.79	-	2.44	4.38	0.31	1.26	1.63	-	-	-	0.01	0.52	-	-	0.54	0.26	-	9.17	1.15	0.47	-	-	0.29	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.68	10.11	0.23	2.79	-	2.44	4.38	0.31	1.26	1.63	-	-	-	0.01	0.52	-	-	0.54	0.26	-	9.17	1.15	0.47	-	-	0.29	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.68
H0104_006_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	P	V											0																																										-	1601.45	30.49	0	0	369.85	28.45	2	374.36	0	0	0	0	14.04	707.85	0	0	226.87	283.61	0	11850.36	7.65	0	0	0	0	0	0	0	0	0	0											0 / day up to 6 days.	0 / day up to 6 days.			50 copay	0 coinsurance	0 coinsurance	50 copay					10 copay	10 copay			10 copay	10 copay		5 PCP copay/10 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible																					0	0	0	0	50	0	0	50	0	0	0	0	10	10	0	0	10	10	0	7.65	20	0	0	0	0	0	0	0	0	0	0												0	0	0	0	50	0	0	50	0	0	0	0	10	10	0	0	10	10	0	7.65	20	0	0	0	0	0	0	0	0	0	0												-	-	-	-	1.54	-	-	1.56	-	-	-	-	0.01	0.59	-	-	0.19	0.24	-	7.56	1.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.21	-	-	-	-	1.54	-	-	1.56	-	-	-	-	0.01	0.59	-	-	0.19	0.24	-	7.56	1.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.21
H0104_801_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	P	V											0																																										-	1164.62	19.93	881.41	0	330.26	24.88	1.73	322.62	329.18	0	0	0	12.13	609.95	0	0	179.63	229.74	0	9206.83	6.4	617.3	0	0	0	0	0	0	0	0	0											225 / day up to 4 days.	225 / day up to 4 days.	50 / day		100 copay	20 coinsurance	20 coinsurance	50 copay	175 copay				25 copay	25 copay			40 copay	25 copay		20 PCP copay/25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	20 copay																				225	225	50	0	100	20	20	50	175	0	0	0	25	25	0	0	40	20.09	0	22.63	20	20	0	0	0	0	0	0	0	0	0												225	225	50	0	100	20	20	50	175	0	0	0	25	25	0	0	40	20.09	0	22.63	20	20	0	0	0	0	0	0	0	0	0												21.84	0.37	3.67	-	2.75	4.98	0.35	1.34	4.8	-	-	-	0.03	1.27	-	-	0.6	0.38	-	17.37	1.28	1.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.06	21.84	0.37	3.67	-	2.75	4.98	0.35	1.34	4.8	-	-	-	0.03	1.27	-	-	0.6	0.38	-	17.37	1.28	1.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.06
H0104_802_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	P	V											0																																										-	1164.62	19.93	881.41	0	330.26	24.88	1.73	322.62	329.18	0	0	0	12.13	609.95	0	0	179.63	229.74	0	9206.83	6.4	617.3	0	0	0	0	0	0	0	0	0											225 / day up to 4 days.	225 / day up to 4 days.	50 / day		100 copay	20 coinsurance	20 coinsurance	50 copay	175 copay				25 copay	25 copay			40 copay	25 copay		20 PCP copay/25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	20 copay																				225	225	50	0	100	20	20	50	175	0	0	0	25	25	0	0	40	20.09	0	22.63	20	20	0	0	0	0	0	0	0	0	0												225	225	50	0	100	20	20	50	175	0	0	0	25	25	0	0	40	20.09	0	22.63	20	20	0	0	0	0	0	0	0	0	0												21.84	0.37	3.67	-	2.75	4.98	0.35	1.34	4.8	-	-	-	0.03	1.27	-	-	0.6	0.38	-	17.37	1.28	1.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.06	21.84	0.37	3.67	-	2.75	4.98	0.35	1.34	4.8	-	-	-	0.03	1.27	-	-	0.6	0.38	-	17.37	1.28	1.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.06
H0104_804_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	P	V											0																																										-	1164.62	19.93	881.41	0	330.26	24.88	1.73	322.62	329.18	0	0	0	12.13	609.95	0	0	179.63	229.74	0	9206.83	6.4	617.3	0	0	0	0	0	0	0	0	0											225 / day up to 4 days.	225 / day up to 4 days.	50 / day		100 copay	20 coinsurance	20 coinsurance	50 copay	175 copay				25 copay	25 copay			40 copay	25 copay		20 PCP copay/25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	20 copay																				225	225	50	0	100	20	20	50	175	0	0	0	25	25	0	0	40	20.09	0	22.63	20	20	0	0	0	0	0	0	0	0	0												225	225	50	0	100	20	20	50	175	0	0	0	25	25	0	0	40	20.09	0	22.63	20	20	0	0	0	0	0	0	0	0	0												21.84	0.37	3.67	-	2.75	4.98	0.35	1.34	4.8	-	-	-	0.03	1.27	-	-	0.6	0.38	-	17.37	1.28	1.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.06	21.84	0.37	3.67	-	2.75	4.98	0.35	1.34	4.8	-	-	-	0.03	1.27	-	-	0.6	0.38	-	17.37	1.28	1.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.06
H0150_001_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	1256.02		327.16		83.94	6.68		197.1	184.98					724.16	6722.56	2240.85					14.81	0.55				139.2																170 per day for 1st 10 days	170 per day for 1st 10 days	95 for days 1 to 100		160 per trip	20 coinsurance	20 coinsurance	50 per visit	300 per visit		15 per service		15 per visit	15 per service	6 per visit	15 per visit	15 per visit	15 per visit	15 per visit	15 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		15 per visit	100 limit on eyewear					15 per visit											170	170	95		160	0.2	0.2	50	300		15		15	15	6	15	15	15	15	15	0.1	0.1			15	100					15											2000	170	170	95		160	0.2	0.2	50	300		15		15	15	6	15	15	15	15	15	0.1	0.1			15	100					15												17.79	-	2.59	-	1.12	1.34	-	0.82	4.62	-	-	-	-	0.91	3.36	2.8	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.05	17.79	-	2.59	-	1.12	1.34	-	0.82	4.62	-	-	-	-	0.91	3.36	2.8	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.05
H0150_006_0	2006																						D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	1256.02		327.16		83.94	6.68		197.1	184.98					724.16	6722.56	2240.85					14.81	0.55				139.2																170 per day for 1st 10 days	170 per day for 1st 10 days	95 for days 1 to 100		160 per trip	20 coinsurance	20 coinsurance	50 per visit	325 per visit		30 per service		30 per visit	30 per visit	15 per visit	30 per visit	30 per visit	30 per visit	30 per visit	30 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		30 per visit	100 limit on eyewear					30 per visit											170	125	95		160	0.2	0.2	50	325		30		30	30	15	30	30	30	30	30	0.1	0.1			30	100					30												170	125	95		160	0.2	0.2	50	325		30		30	30	15	30	30	30	30	30	0.1	0.1			30	100					30												17.79	-	2.59	-	1.12	1.34	-	0.82	5.01	-	-	-	-	1.81	8.4	5.6	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.18	17.79	-	2.59	-	1.12	1.34	-	0.82	5.01	-	-	-	-	1.81	8.4	5.6	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.18
H0150_007_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H0150_010_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	1224.62		318.98		81.84	6.51		192.17	180.36					706.06	6554.49	2184.83					14.44	0.54				135.72																225 per day for 1st 10 days	225 per day for 1st 10 days	25 for days 1 to 100		160 per trip	20 coinsurance	20 coinsurance	50 per visit	350 per visit		30 per service		30 per visit	30 per visit	13 per visit	30 per visit	30 per visit	30 per visit	30 per visit	30 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		30 per visit	100 limit on eyewear																225	225	25		160	0.2	0.2	50	350		30		30	30	13	30	30	30	30	30	0.1	0.1			30	100																2000	225	225	25		160	0.2	0.2	50	350		30		30	30	13	30	30	30	30	30	0.1	0.1			30	100																	22.96	-	0.66	-	1.09	1.3	-	0.8	5.26	-	-	-	-	1.77	7.1	5.46	-	-	-	-	1.44	0.05	-	-	-	1.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.04	22.96	-	0.66	-	1.09	1.3	-	0.8	5.26	-	-	-	-	1.77	7.1	5.46	-	-	-	-	1.44	0.05	-	-	-	1.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.04
H0150_012_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	1256.02		327.16		83.94	6.68		197.1	184.98					724.16	6722.56	2240.85					14.81	0.55				139																125 per day for 1st 10 days	125 per day for 1st 10 days	95 for days 1 to 100		150 per trip	20 coinsurance	20 coinsurance	50 per visit	200 per visit		30 per service		30 per visit	30 per visit	10 per visit	30 per visit	30 per visit	30 per visit	30 per visit	30 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		30 per visit	100 limit on eyewear					30 per visit											125	125	95		150	0.2	0.2	50	200		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100					30											2000	125	125	95		150	0.2	0.2	50	200		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100					30												13.08	-	2.59	-	1.05	1.34	-	0.82	3.08	-	-	-	-	1.81	5.6	5.6	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.67	13.08	-	2.59	-	1.05	1.34	-	0.82	3.08	-	-	-	-	1.81	5.6	5.6	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.67
H0150_015_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	2386.44		621.6		159.48	12.7		374.49	351.47					1375.91	12772.86	4257.62					28.14	1.04				264.1																115 per day for 1st 10 days	115 per day for 1st 10 days	95 for days 1 to 100		150 per trip	20 coinsurance	20 coinsurance	50 per visit	150 per visit		10 per service		10 per service	10 per service	5 per visit	10 per service	10 per service	10 per service	10 per service	10 per service	10 per Script	10 per Script	0 Co-pay 20 Trips per year		10 per service	100 limit on eyewear					10 per service											115	115	95		150	0.2	0.2	50	150		10		10	10	5	10	10	10	10	10	0.1	0.1			10	100					10											2000	115	115	95		150	0.2	0.2	50	150		10		10	10	5	10	10	10	10	10	0.1	0.1			10	100					10												22.87	-	4.92	-	1.99	2.54	-	1.56	4.39	-	-	-	-	1.15	5.32	3.55	-	-	-	-	2.81	0.1	-	-	-	2.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.41	22.87	-	4.92	-	1.99	2.54	-	1.56	4.39	-	-	-	-	1.15	5.32	3.55	-	-	-	-	2.81	0.1	-	-	-	2.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.41
H0150_017_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	1256.02		327.16		83.94	6.68		197.1	184.98					724.16	6722.56	2240.85					14.81	0.55				139																125 per day for 1st 10 days	125 per day for 1st 10 days	95 for days 1 to 100		150 per trip	20 coinsurance	20 coinsurance	50 per visit	200 per visit		30 per service		30 per visit	30 per visit	10 per visit	30 per visit	30 per visit	30 per visit	30 per visit	30 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		30 per visit	100 limit on eyewear					30 per visit											125	125	95		150	0.2	0.2	50	200		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100					30											2000	125	125	95		150	0.2	0.2	50	200		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100					30												13.08	-	2.59	-	1.05	1.34	-	0.82	3.08	-	-	-	-	1.81	5.6	5.6	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.67	13.08	-	2.59	-	1.05	1.34	-	0.82	3.08	-	-	-	-	1.81	5.6	5.6	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.67
H0150_802_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	1256.02		327.16		83.94	6.68		197.1	184.98					724.16	6722.56	2240.85					14.81	0.55				139																125 per day for 1st 10 days	125 per day for 1st 10 days	95 for days 1 to 100		150 per trip	20 coinsurance	20 coinsurance	50 per visit	200 per visit		30 per service		30 per visit	30 per visit	20 per visit	30 per visit	30 per visit	30 per visit	30 per visit	30 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		30 per visit	100 limit on eyewear					30 per visit											125	125	95		150	0.2	0.2	50	200		30		30	30	20	30	30	30	30	30	0.1	0.1			30	100					30											2000	125	125	95		150	0.2	0.2	50	200		30		30	30	20	30	30	30	30	30	0.1	0.1			30	100					30												13.08	-	2.59	-	1.05	1.34	-	0.82	3.08	-	-	-	-	1.81	11.2	5.6	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.27	13.08	-	2.59	-	1.05	1.34	-	0.82	3.08	-	-	-	-	1.81	11.2	5.6	-	-	-	-	1.48	0.05	-	-	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.27
H0151_001_0	2006											2800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	V	O																																																					-	2512.85	145.05	833.22	0	254.94	16.09	5.99	568.79	40.79	8738.76	38.11	0	0.37	0.37	3832.61	3916.26	573.34	1.75	0	0	26.29	778.93	0	0	189.77	0	248.84	0	0	0	0											265	175	125	0	150	30	30	50	20	10	20-Oct	20 (included in g.)	30	20/40/30	10.00/0.00	20	40/30	20	0	0	30	20.00/0.00	0		20	0	20			0												265	175	125	0	150	0.3	0.3	50	0.2	4	0.13	0	0.3	0.2	10	20	37.5	0.2	0	0	0.3	20	0		20		20			0													133.14	87.92	62.8	0	75.36	0.15	0.17	25.12	0.1	2.01	0.07	0	0.15	0.08	10	20	37.5	0.1	0	0	0.15	20	0	0	20	0	19.07	0	0	0	0												27.88	1.06	4.36	-	1.6	2.42	1.03	1.19	4.1	1.46	2.57	-	0.06	0.03	3.19	6.53	1.79	0.18	-	-	3.96	1.3	-	-	0.32	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.43	27.88	1.06	4.36	-	1.6	2.42	1.03	1.19	4.1	1.46	2.57	-	0.06	0.03	3.19	6.53	1.79	0.18	-	-	3.96	1.3	-	-	0.32	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.43
H0151_013_0	2006											2750											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	Coin	Coin																																																					-	2495.73	144.9	825.66	0	253.07	15.98	5.96	566.39	40.5	8722	37.94	0	0.37	0.37	3819.5	3895.73	573.31	1.73	0	0	26.17	775.89	0	0	188.23	0	248.83	0	0	0	0											295	175	150	0	150	30	30	50	30	10	30-Oct	30 (included in g.)	30	30/40/30	15.00/0.00	30	40/30	30	0	0	30	30.00/0.00	0		30		30			0												295	175	150	0	150	0.3	0.3	50	0.3	4	0.2	0	0.3	0.28	15	30	37.5	0.3	0	0	0.3	30	0		30		30			0													137.7	81.69	70.02	0	70.02	0.14	0.16	23.34	0.14	1.87	0.09	0	0.14	0.1	15	30	37.5	0.14	0	0	0.14	30	0	0	30	0	19.76	0	0	0	0												28.64	0.99	4.82	-	1.48	2.24	0.97	1.1	5.67	1.36	3.56	-	0.05	0.04	4.77	9.74	1.79	0.24	-	-	3.66	1.94	-	-	0.47	-	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.94	28.64	0.99	4.82	-	1.48	2.24	0.97	1.1	5.67	1.36	3.56	-	0.05	0.04	4.77	9.74	1.79	0.24	-	-	3.66	1.94	-	-	0.47	-	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.94
H0151_015_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	Coin	Coin																																																					-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0																																																																																																-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H0151_017_0	2006											1800											D	D	D	P	P	P	P	V	V	V	V	V	P	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	2399.5	170.6			1964.26			197.14																																		150/day	150/Day			75/trip			50																																		150	150			25			50																																			83.54	83.54			13.92			27.85																																			16.7	1.19	-	-	2.28	-	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.63	16.7	1.19	-	-	2.28	-	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.63
H0151_019_0	2006											1700											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	V	O																																																					-	2512.85	145.05	833.22	0	254.94	16.09	5.99	568.79	40.79	8738.76	38.11	0	0.37	0.37	3832.61	3916.26	573.34	1.75	0	0	26.29	778.93	0	0	189.77	0	248.84	0	0	0	0											195	175	95	0	150	20	20	50	10	10	10-Oct	10 (included in g.)	20	10/40/30	5.00/0.00	10	40/30	10	0	0	20	10.00/0.00	0		10	0	10			0												195	175	95	0	150	0.2	0.2	50	0.1	4	0.07	0	0.2	0.12	5	10	37.5	0.1	0	0	0.2	10	0		10		10			0													89.64	80.44	43.67	0	68.95	0.09	0.11	22.98	0.05	1.84	0.03	0	0.09	0.05	5	10	37.5	0.05	0	0	0.09	10	0	0	10	0	10	0	0	0	0												18.77	0.97	3.03	-	1.46	1.48	0.65	1.09	1.88	1.34	1.17	-	0.03	0.02	1.6	3.26	1.79	0.08	-	-	2.42	0.65	-	-	0.16	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.06	18.77	0.97	3.03	-	1.46	1.48	0.65	1.09	1.88	1.34	1.17	-	0.03	0.02	1.6	3.26	1.79	0.08	-	-	2.42	0.65	-	-	0.16	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.06
H0151_020_0	2006											2200											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	Coin	Coin																																																					-	2495.73	144.9	825.66	0	253.07	15.98	5.96	566.39	40.5	8722	37.94	0	0.37	0.37	3819.5	3895.73	573.31	1.73	0	0	26.17	775.89	0	0	188.23	0	248.83	0	0	0	0											265	175	125	0	150	20	20	50	20	10	20-Oct	20 (included in g.)	20	20/40/30	10.00/0.00	20	40/30	20	0	0	20	20.00/0.00	0		20		20			0												265	175	125	0	150	0.2	0.2	50	0.2	4	0.13	0	0.2	0.2	10	20	37.5	0.2	0	0	0.2	20	0		20		20			0													121.14	80	57.14	0	68.57	0.09	0.11	22.86	0.09	1.83	0.06	0	0.09	0.07	10	20	37.5	0.09	0	0	0.09	20	0	0	20	0	19.07	0	0	0	0												25.2	0.97	3.93	-	1.45	1.46	0.64	1.08	3.7	1.33	2.32	-	0.03	0.03	3.18	6.49	1.79	0.16	-	-	2.39	1.29	-	-	0.31	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.16	25.2	0.97	3.93	-	1.45	1.46	0.64	1.08	3.7	1.33	2.32	-	0.03	0.03	3.18	6.49	1.79	0.16	-	-	2.39	1.29	-	-	0.31	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.16
H0151_801_0	2006											2650											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	Coin	Coin																																																					-	2495.73	144.9	825.66	0	253.07	15.98	5.96	566.39	40.5	8722	37.94	0	0.37	0.37	3819.5	3895.73	573.31	1.73	0	0	26.17	775.89	0	0	188.23	0	248.83	0	0	0	0											240	175	125	0	150	30	30	50	20	10	20-Oct	20 (included in g.)	30	20/40/30	10.00/0.00	20	40/30	20	0	0	30	20.00/0.00			20		20			0												240	175	125	0	150	0.3	0.3	50	0.2	8	0.2	0	0.3	0.2	10	20	37.5	0.2	0	0	0.3	20			20		20			0													117.57	85.73	61.24	0	73.48	0.15	0.17	24.49	0.1	3.92	0.1	0	0.15	0.08	10	20	37.5	0.1	0	0	0.15	20	0	0	20	0	19.07	0	0	0	0												24.45	1.04	4.21	-	1.55	2.35	1.01	1.16	3.97	2.85	3.74	-	0.05	0.03	3.18	6.49	1.79	0.17	-	-	3.85	1.29	-	-	0.31	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.88	24.45	1.04	4.21	-	1.55	2.35	1.01	1.16	3.97	2.85	3.74	-	0.05	0.03	3.18	6.49	1.79	0.17	-	-	3.85	1.29	-	-	0.31	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.88
H0154_001_0	2006																						A	A	A		T	Coin	Coin	V	V			O	V	V	V	V	V	V		V	Coin	V			V		V																																																									-	256.18	3.68	48.91		205.81	10.05	10.05	636.7	379.98			6.37	47.76	1052.09	5837.59	6183.21	245.96	921.9		1627.54	4.39	9.53			96.11		43.86															Avg copay per admit of 3000 for transplants and 150 for other IP admissions	150 per admit	Avg per admit copay of 501		100 copay per one-way trip	20 coinsurance	20 coinsurance	50 emergency room copay and 20 urgent care facility copay	150 per visit			20 per day	50 per visit	25 rehab. services (CORF) copay and 25 outpatient substance abuse svcs copay	10 per visit	15 per visit	25 per visit	25 per visit		15 chiropractic copay 15 podiatry copay and 25 other health care services copay	20 coinsurance and 2000 OOP max on Medicare covered chemotherapy drugs	15 per visit			15 per visit		Avg copay of 13 assumes 2/3 of svcs delivered by contracted specialist at 15 copay and 1/3 by PCP at 10 copay															159.59	150	500.98		100	0.2	0.2	40	150			20	50	25	10	15	25	25		15.04	0.2	15			15		13.33																159.59	150	500.98		100	0.2	0.2	40	150			20	50	25	10	15	25	25		15.04	0.14	15			15		13.33																3.41	0.05	2.04	-	1.72	2.01	2.01	2.12	4.75	-	-	0.01	0.2	2.19	4.86	7.73	0.51	1.92	-	2.04	0.61	0.01	-	-	0.12	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.36	3.41	0.05	2.04	-	1.72	2.01	2.01	2.12	4.75	-	-	0.01	0.2	2.19	4.86	7.73	0.51	1.92	-	2.04	0.61	0.01	-	-	0.12	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.36
H0154_008_0	2006																						A	A	A		T	Coin	Coin	V	V			O	V	V	V	V	V	V		V	Coin	V			V		V																																																									-	258.71	3.72	49.4		207.84	10.25	10.25	649.12	387.4			6.49	48.69	1072.62	5906.47	6256.17	248.87	932.77		1646.74	4.47	9.62			225.72		44.29															Avg copay per admit of 3000 for transplants and 100 for other IP admissions	100 per admit	Avg per admit copay of 501		100 copay per one-way trip	20 coinsurance	20 coinsurance	50 emergency room copay and 20 urgent care facility copay	100 per visit			20 per day	50 per visit	25 rehab. services (CORF) copay and 20 outpatient substance abuse svcs copay	5 per visit	10 per visit	20 per visit	25 per visit		10 chiropractic copay 10 podiatry copay and 20 other health care services copay	20 coinsurance and 2000 OOP max on Medicare covered chemotherapy drugs	10 per visit			10 per visit		Avg copay of 8 assumes 2/3 of svcs delivered by contracted specialist at 10 copay and 1/3 by PCP at 5 copay															109.76	100	500.98		100	0.2	0.2	40	100			20	50	24.95	5	10	20	25		10.04	0.2	10			10		8.33																109.76	100	500.98		100	0.2	0.2	40	100			20	50	24.95	5	10	20	25		10.04	0.14	10			10		8.33																2.37	0.03	2.06	-	1.73	2.05	2.05	2.16	3.23	-	-	0.01	0.2	2.23	2.46	5.21	0.41	1.94	-	1.38	0.62	0.01	-	-	0.19	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.39	2.37	0.03	2.06	-	1.73	2.05	2.05	2.16	3.23	-	-	0.01	0.2	2.23	2.46	5.21	0.41	1.94	-	1.38	0.62	0.01	-	-	0.19	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.39
H0302_001_0	2006																						D	D	D	V	T	Coin	Coin	V	V	O	V	Coin	V	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	1251.45	71.52	868.21	0	180.55	9.95	2.61	289.24	142.25	0	875.58	0	10.4	417.85	5607.56	5895.45	186.91	0	0	1.37	17.07	0.07	0	0	329.92	0	242			0	0											100 (days 1-4) / 750 per admission	125 (days1-8)/175 (days31+) / 150 (days1-8)/200 (days31+)	0 (days1-20)/50 (days21-100) / 25 (days1-20)/75 (days21-100)		100 (ground); 15 (air)	0-20	0-20 / 6-12	50	150		0/10/25/75/100/200 / 20		30-Oct	20-Oct	10/20/25/0-125	20/30	20				20	20			20		20															92.43	42.5	3.5	0	97.78	0.16	0.06	45.93	142.16	0	43.39	0	11.46	8.94	11.19	22.41	15.27	0	0	6	0.2	20	0	0	20	0	20	0	0	0	0												92.43	42.5	3.5	0	97.78	0.16	0.06	45.93	142.16	0	43.39	0	11.46	8.94	11.19	22.41	15.27	0	0	6	0.2	20	0	0	20	0	20	0	0	0	0												9.64	0.25	0.25	-	1.47	1.6	0.15	1.11	1.69	-	3.17	-	0.01	0.31	5.23	11.01	0.24	-	-	0	3.41	0	-	-	0.55	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.5	9.64	0.25	0.25	-	1.47	1.6	0.15	1.11	1.69	-	3.17	-	0.01	0.31	5.23	11.01	0.24	-	-	0	3.41	0	-	-	0.55	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.5
H0302_004_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	Coin	V	V	V	V	V	V																																																					-	1884.28	51.35	1302.24	0	425.99	17.17	22.5	436.8	402.37	0	444.96	0	1.24	675.63	6849.82	7349.95	241.67	689.51	0	0	41.63	47.43	0	0	0.86	0	242	0	0	0	0											100 (days 1-4)	125 (days1-8)/175 (days31+) / 150 (days1-10)/200 (days31+)	0 (days1-20)/50 (days21-100) / 25 (days1-20)/75 (days21-100)		150 (ground); 15 (air)	0-20	0-20 / 6-12	50	150		0/20/75/150/250		30-Oct	10/20/25/50	20-Oct	4030	40		0/20/20		20	20			80/20		20															92.86	42.87	11.75	0	100.63	0.1	0.06	45.93	150	0	50.7	0	10.5	9.31	10.11	40	20	40	0	0	0.2	20	0	0	0.19	0	20	0	0	0	0												92.86	42.87	11.75	0	100.63	0.1	0.06	45.93	150	0	50.7	0	10.5	9.31	10.11	40	20	40	0	0	0.2	20	0	0	0.19	0	20	0	0	0	0												14.58	0.18	1.28	-	3.57	1.72	1.3	1.67	5.03	-	1.88	-	0	0.52	5.77	24.5	0.4	2.3	-	-	8.33	0.08	-	-	0.17	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.68	14.58	0.18	1.28	-	3.57	1.72	1.3	1.67	5.03	-	1.88	-	0	0.52	5.77	24.5	0.4	2.3	-	-	8.33	0.08	-	-	0.17	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.68
H0303_013_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1365.58	34.98	1264.71	2301.31	278.71	16.1	116.72	369.22	460.5	0	13.62	0	86.48	646.33	5425.81	3588.85	184.22	284.64	2938.75	6507.87	12.31	0	0	0	93.72	261.39	0	0	0	0	278.76											300 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 150; Outpatient Hospital: 150	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 150; Non-Surgical Cases - ASC: 150	10	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											52.26	109.69	49	0	75	0.2	23.52	49.12	150	0	0.2	0	0	132.13	10	30	30	30	15.2	0	0.2	0	0	0	25	20	0	0	0	0	0											0	52.26	109.69	49	0	75	0.2	23.52	49.12	150	0	0.2	0	0	132.13	10	30	30	30	15.2	0	0.2	0	0	0	25	20	0	0	0	0	0												5.95	0.32	5.16	-	1.74	3.22	0.23	1.51	5.76	-	2.72	-	-	7.12	4.52	8.97	0.46	0.71	3.72	-	2.46	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.21	5.95	0.32	5.16	-	1.74	3.22	0.23	1.51	5.76	-	2.72	-	-	7.12	4.52	8.97	0.46	0.71	3.72	-	2.46	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.21
H0303_015_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1328.5	34.03	1090.66	2281.53	276.31	17.43	117.06	370.31	430.36	0	14.74	0	86.73	654.97	5379.16	3557.99	182.64	282.19	2911.71	6451.92	12.28	0	0	0	92.91	259.14	0	0	0	0	276.37											300 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 150; Outpatient Hospital: 150	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 150; Non-Surgical Cases - ASC: 150	10	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											52.26	109.69	49	0	75	0.2	25.39	49.12	150	0	0.2	0	0	132.32	10	30	30	30	15.61	0	0.2	0	0	0	25	20	0	0	0	0	0											0	52.26	109.69	49	0	75	0.2	25.39	49.12	150	0	0.2	0	0	132.32	10	30	30	30	15.61	0	0.2	0	0	0	25	20	0	0	0	0	0												5.79	0.31	4.45	-	1.73	3.49	0.25	1.52	5.38	-	2.95	-	-	7.22	4.48	8.89	0.46	0.71	3.79	-	2.46	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.49	5.79	0.31	4.45	-	1.73	3.49	0.25	1.52	5.38	-	2.95	-	-	7.22	4.48	8.89	0.46	0.71	3.79	-	2.46	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.49
H0303_034_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	P	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1992.75	51.04	1636	3264.13	395.31	20.72	166.83	527.73	645.53	0	908.26	0	123.6	930.16	8965.64	7011.11	308.92	556.06	5783.63	11792.4	18.75	0	0	1538.5	166.31	370.74	304.21	52.6	0	0	395.39											0 per admit	812 Copay;0 [Day(s) 1-60]; 203 [Day(s) 61-90]; 406 [Day(s) 91-190]	0 [Day(s) 1-20]; 50 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	50 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	5 Office Visit2 teeth cleanings/year and preventative care	Exam 5 copay (12 months)	materials copay 5 (12 months)	5 copay for Exam every 12 months	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	98	24	0	50	0.2	21.18	49.12	0	0	29.22	0	0	0	0	0	10	0	2.85	0	0.2	0	0	1.77	5	5	5	0	0	0	0											0	0	98	24	0	50	0.2	21.18	49.12	0	0	29.22	0	0	0	0	0	10	0	2.85	0	0.2	0	0	1.77	5	5	5	0	0	0	0												-	0.42	3.27	-	1.65	4.14	0.29	2.16	-	-	2.21	-	-	-	-	-	0.26	-	1.37	-	3.75	-	-	0.23	0.07	0.15	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.1	-	0.42	3.27	-	1.65	4.14	0.29	2.16	-	-	2.21	-	-	-	-	-	0.26	-	1.37	-	3.75	-	-	0.23	0.07	0.15	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.1
H0303_035_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1328.5	34.03	1198.74	2262.23	273.97	15.6	116.07	367.18	449.08	0	13.19	0	86	649.43	5333.66	3527.9	181.09	279.8	2889.13	6397.35	12.5	0	0	0	92.12	256.95	0	0	0	0	274.03											300 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 150; Outpatient Hospital: 150	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 150; Non-Surgical Cases - ASC: 150	10	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											52.26	109.69	49	0	75	0.2	22.91	49.12	150	0	0.2	0	0	132.32	10	30	30	30	15.14	0	0.2	0	0	0	25	20	0	0	0	0	0											0	52.26	109.69	49	0	75	0.2	22.91	49.12	150	0	0.2	0	0	132.32	10	30	30	30	15.14	0	0.2	0	0	0	25	20	0	0	0	0	0												5.79	0.31	4.89	-	1.71	3.12	0.22	1.5	5.61	-	2.64	-	-	7.16	4.44	8.82	0.45	0.7	3.64	-	2.5	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.14	5.79	0.31	4.89	-	1.71	3.12	0.22	1.5	5.61	-	2.64	-	-	7.16	4.44	8.82	0.45	0.7	3.64	-	2.5	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.14
H0303_036_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1527.77	39.13	1254.26	2623.76	317.76	21.22	134.62	425.86	494.91	0	17.95	0	99.74	753.21	6701.54	4837.47	210.03	324.52	3842.68	8529.68	12.29	0	0	0	106.85	298.01	195.44	42.28	0	0	317.82											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	26.87	49.12	50	0	0.2	0	0	47.05	5	10	30	30	15.29	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	26.87	49.12	50	0	0.2	0	0	47.05	5	10	30	30	15.29	0	0.2	0	0	0	25	20	25	0	0	0	0												1.11	0.36	5.12	-	1.99	4.24	0.3	1.74	2.06	-	3.59	-	-	2.95	2.79	4.03	0.53	0.81	4.9	-	2.46	-	-	-	0.22	0.5	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.11	1.11	0.36	5.12	-	1.99	4.24	0.3	1.74	2.06	-	3.59	-	-	2.95	2.79	4.03	0.53	0.81	4.9	-	2.46	-	-	-	0.22	0.5	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.11
H0303_037_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1570.42	40.23	1454.42	2646.51	320.51	20.13	134.22	424.6	529.58	0	17.03	0	99.45	743.28	6759.65	4879.41	211.85	327.33	3876.2	8603.65	12.5	0	0	0	107.77	300.59	197.13	42.65	0	0	320.58											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	25.57	49.12	50	0	0.2	0	0	47.02	5	10	30	30	15.03	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	25.57	49.12	50	0	0.2	0	0	47.02	5	10	30	30	15.03	0	0.2	0	0	0	25	20	25	0	0	0	0												1.14	0.37	5.94	-	2	4.03	0.29	1.74	2.21	-	3.41	-	-	2.91	2.82	4.07	0.53	0.82	4.86	-	2.5	-	-	-	0.22	0.5	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.75	1.14	0.37	5.94	-	2	4.03	0.29	1.74	2.21	-	3.41	-	-	2.91	2.82	4.07	0.53	0.82	4.86	-	2.5	-	-	-	0.22	0.5	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.75
H0303_038_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1527.77	39.13	1378.55	2601.56	315.07	19.3	133.48	422.26	516.44	0	16.32	0	98.9	746.84	6644.85	4796.55	208.26	321.77	3810.47	8457.54	12.5	0	0	0	105.94	295.49	193.78	41.92	0	0	315.13											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	24.65	49.12	50	0	0.2	0	0	47.05	5	10	30	30	14.93	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	24.65	49.12	50	0	0.2	0	0	47.05	5	10	30	30	14.93	0	0.2	0	0	0	25	20	25	0	0	0	0												1.11	0.36	5.63	-	1.97	3.86	0.27	1.73	2.15	-	3.26	-	-	2.93	2.77	4	0.52	0.8	4.74	-	2.5	-	-	-	0.22	0.49	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.72	1.11	0.36	5.63	-	1.97	3.86	0.27	1.73	2.15	-	3.26	-	-	2.93	2.77	4	0.52	0.8	4.74	-	2.5	-	-	-	0.22	0.49	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.72
H0303_801_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.3	0.35	0.03	0.21	0.59		0.56		0.04	0.46	1.26	2.43	0.15	0.04	0.51	0.26	0.41	0																				7.61	1344.24	34.43	1172	2178.31	12.69	14.92	1.33	12.49	35.92	0	24.22	0	1.81	19.72	54.18	104.22	2.57	1.69	21.77	11.17	17.69	0	0	0	0	0	0	0	0	0	263.86											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.02	0.32	5.47	-	2.54	2.98	0.27	2.5	7.18	-	4.84	-	0.36	3.94	10.84	20.84	1.28	0.34	4.35	2.23	3.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.85	12.02	0.32	5.47	-	2.83	3.33	0.3	2.71	7.78	-	5.41	-	0.4	4.4	12.1	23.28	1.43	0.38	4.86	2.5	3.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.46
H0303_803_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.3	0.35	0.03	0.21	0.59		0.56		0.04	0.46	1.26	2.43	0.15	0.04	0.51	0.26	0.41	0																				7.61	1344.24	34.43	1172	2178.31	12.69	14.92	1.33	12.49	35.92	0	24.22	0	1.81	19.72	54.18	104.22	2.57	1.69	21.77	11.17	17.69	0	0	0	0	0	0	0	0	0	263.86											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.02	0.32	5.47	-	2.54	2.98	0.27	2.5	7.18	-	4.84	-	0.36	3.94	10.84	20.84	1.28	0.34	4.35	2.23	3.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.85	12.02	0.32	5.47	-	2.83	3.33	0.3	2.71	7.78	-	5.41	-	0.4	4.4	12.1	23.28	1.43	0.38	4.86	2.5	3.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.46
H0303_804_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.3	0.35	0.03	0.21	0.59		0.56		0.04	0.46	1.26	2.43	0.15	0.04	0.51	0.26	0.41	0																				7.61	1344.24	34.43	1172	2178.31	12.69	14.92	1.33	12.49	35.92	0	24.22	0	1.81	19.72	54.18	104.22	2.57	1.69	21.77	11.17	17.69	0	0	0	0	0	0	0	0	0	263.86											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.02	0.32	5.47	-	2.54	2.98	0.27	2.5	7.18	-	4.84	-	0.36	3.94	10.84	20.84	1.28	0.34	4.35	2.23	3.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.85	12.02	0.32	5.47	-	2.83	3.33	0.3	2.71	7.78	-	5.41	-	0.4	4.4	12.1	23.28	1.43	0.38	4.86	2.5	3.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.46
H0303_805_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.3	0.35	0.03	0.21	0.59		0.56		0.04	0.46	1.26	2.43	0.15	0.04	0.51	0.26	0.41	0																				7.61	1344.24	34.43	1172	2178.31	12.69	14.92	1.33	12.49	35.92	0	24.22	0	1.81	19.72	54.18	104.22	2.57	1.69	21.77	11.17	17.69	0	0	0	0	0	0	0	0	0	263.86											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.02	0.32	5.47	-	2.54	2.98	0.27	2.5	7.18	-	4.84	-	0.36	3.94	10.84	20.84	1.28	0.34	4.35	2.23	3.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.85	12.02	0.32	5.47	-	2.83	3.33	0.3	2.71	7.78	-	5.41	-	0.4	4.4	12.1	23.28	1.43	0.38	4.86	2.5	3.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.46
H0307_008_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1538.24	11	1058.48	1956.33	273.84	0.89	0.07	832.14	672.43				0	1031.87	5714.98	4288.68					4.45			0	0		0					80.96	0.58	10.11	0	0	0	0				190 per day (1-5)	190 per day (1-5)	0 per day (1-6) 125 per day (7-100)	0	100	20	20	35-50	150				0	0-250	5-150	35-150					20			0	0		0					190 per day (1-5)	190 per day (1-5)	20	0	0	0	0				129.24	129.24	72.73	0	100	0.2	0.2	47	150				0	81.6	7.84	37.26					20			0	0		0					129.24	129.24	0.2	0	0	0	0					129.24	129.24	72.73	0	100	0.2	0.2	47	150				0	81.6	7.84	37.26					20			0	0		0					129.24	129.24	0.2	0	0	0	0				0	16.57	0.12	6.41	-	2.28	0.18	0.01	3.26	8.41	-	-	-	-	7.02	3.74	13.31	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.87	0.01	2.02	-	-	-	-	-	-	-	65.1	16.57	0.12	6.41	-	2.28	0.18	0.01	3.26	8.41	-	-	-	-	7.02	3.74	13.31	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.87	0.01	2.02	-	-	-	-	-	-	-	65.1
H0307_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1523.6	10.9	2096.81	1882.38	259.57	0.88	0.07	788.76	637.38				0	978.07	5498.96	4126.58					4.45			0	0		0					80.19	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.18	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.18	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	25.91	0.19	1.92	-	2.16	0.18	0.01	3.04	10.62	-	-	-	-	4.01	10.33	12.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.36	0.01	-	-	-	-	-	-	-	-	73.45	25.91	0.19	1.92	-	2.16	0.18	0.01	3.04	10.62	-	-	-	-	4.01	10.33	12.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.36	0.01	-	-	-	-	-	-	-	-	73.45
H0307_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1523.6	10.9	2096.81	1882.38	259.57	0.88	0.07	788.76	637.38				0	978.07	5498.96	4126.58					4.45			0	0		0					80.19	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.18	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.18	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	25.91	0.19	1.92	-	2.16	0.18	0.01	3.04	10.62	-	-	-	-	4.01	10.33	12.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.36	0.01	-	-	-	-	-	-	-	-	73.45	25.91	0.19	1.92	-	2.16	0.18	0.01	3.04	10.62	-	-	-	-	4.01	10.33	12.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.36	0.01	-	-	-	-	-	-	-	-	73.45
H0307_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1523.6	10.9	2096.81	1882.38	259.57	0.88	0.07	788.76	637.38				0	978.07	5498.96	4126.58					4.45			0	0		0					80.19	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.18	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.18	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	25.91	0.19	1.92	-	2.16	0.18	0.01	3.04	10.62	-	-	-	-	4.01	10.33	12.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.36	0.01	-	-	-	-	-	-	-	-	73.45	25.91	0.19	1.92	-	2.16	0.18	0.01	3.04	10.62	-	-	-	-	4.01	10.33	12.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.36	0.01	-	-	-	-	-	-	-	-	73.45
H0307_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1523.6	10.9	2096.81	1882.38	259.57	0.88	0.07	788.76	637.38				0	978.07	5498.96	4126.58					4.45			0	0		0					80.19	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.18	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.18	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	25.91	0.19	1.92	-	2.16	0.18	0.01	3.04	10.62	-	-	-	-	4.01	10.33	12.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.36	0.01	-	-	-	-	-	-	-	-	73.45	25.91	0.19	1.92	-	2.16	0.18	0.01	3.04	10.62	-	-	-	-	4.01	10.33	12.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.36	0.01	-	-	-	-	-	-	-	-	73.45
H0315_001_0	2006											2700	Routine Physical Exams	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P	V																																																				-	1444.74	73.47			140.67	11.17	12.35	292.97	354.91	1399.85	661.04	43.79	0.37	1014.6	4130.77	4803.04	262.26	821.58							125.93		218.34					128.28										150	150			100	20	20	35	25	25	25	50	20	50	25	25	35 indiv/25 group	25							25		25					10										150	150			100	0.2	0.2	35	25	25	25	50	0.2	45.01	25	25	32.5	25							25		25					10											109.54	109.54			73.03	0.15	0.15	25.56	18.26	18.26	18.26	36.51	0.15	32.87	18.26	18.26	23.73	18.26							18.26		18.26					7.3											13.19	0.67	-	-	0.86	1.63	1.8	0.62	0.54	2.13	1.01	0.13	0.05	2.78	6.28	7.31	0.52	1.25	-	-	-	-	-	-	0.19	-	0.33	-	-	-	-	0.08	-	-	-	-	-	-	-	-	-	41.38	13.19	0.67	-	-	0.86	1.63	1.8	0.62	0.54	2.13	1.01	0.13	0.05	2.78	6.28	7.31	0.52	1.25	-	-	-	-	-	-	0.19	-	0.33	-	-	-	-	0.08	-	-	-	-	-	-	-	-	-	41.38
H0315_002_0	2006											2700	Routine Physical Exams	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P	V																																																				-	1374.26	69.89			133.8	10.62	11.75	278.68	337.6	1331.57	628.79	41.66	0.35	965.11	3929.27	4572.34	249.47	781.51							125.93		218.34					128.28										150	150			100	20	20	35	25	25	25	50	20	50	25	25	35 indiv/25 group	25							25		25					10										150	150			100	0.2	0.2	35	25	25	25	50	0.2	45.01	25	25	32.5	25							25		25					10											111.05	111.05			74.03	0.15	0.15	25.91	18.51	18.51	18.51	37.02	0.15	33.32	18.51	18.51	24.06	18.51							18.51		18.51					7.4											12.72	0.65	-	-	0.83	1.57	1.74	0.6	0.52	2.05	0.97	0.13	0.05	2.68	6.06	7.05	0.5	1.21	-	-	-	-	-	-	0.19	-	0.34	-	-	-	-	0.08	-	-	-	-	-	-	-	-	-	39.93	12.72	0.65	-	-	0.83	1.57	1.74	0.6	0.52	2.05	0.97	0.13	0.05	2.68	6.06	7.05	0.5	1.21	-	-	-	-	-	-	0.19	-	0.34	-	-	-	-	0.08	-	-	-	-	-	-	-	-	-	39.93
H0316_002_0	2006											2400											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V			P																																																						-	1292.69	67.01	472.06	0	181.57	9.32	12.29	287.96	32.63	0	9.71	1.35	0.14	13.59	4010.93	5747.79	200.92	6.78	27.76	407.47	17.56	0			124		222			0												250	250	150	0	150	30	30	50	25	0	0/25	25	30	25/40/30	May-00	25	40/30	25	0/25	0/25	30	0			25		25			0												250	250	150	0	150	0.3	0.3	50	0.25	0	0.22	0.25	0.3	0.24	5	23.3	37.5	0.25	0.13	0.29	0.3	0			25		25			0													141.67	141.67	85	0	85	0.17	0.17	28.33	0.14	0	0.12	0.14	0.17	0.14	5	23.3	37.5	0.16	0.08	0.29	0.17	0			25		25			0													15.26	0.79	3.34	-	1.29	1.58	2.09	0.68	4.62	-	1.18	0.19	0.02	1.88	1.67	11.16	0.63	1.07	2.11	0.01	2.99	-			0.26		0.46			-												53.3	15.26	0.79	3.34	-	1.29	1.58	2.09	0.68	4.62	-	1.18	0.19	0.02	1.88	1.67	11.16	0.63	1.07	2.11	0.01	2.99	-			0.26		0.46			-												53.3
H0316_003_0	2006											2400											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V			P																																																						-	1292.69	67.01	472.06	0	181.57	9.32	12.29	287.96	32.63	0	9.71	1.35	0.14	13.59	4010.93	5747.79	200.92	6.78	27.76	407.47	17.56	0			124		222			0												265	265	150	0	150	20	20	50	25	0	0/25	25	20	25/40/30	Jul-00	25	40/30	25	0/25	0/25	20	0			25		25			0												265	265	150	0	150	0.2	0.2	50	0.25	0	0.22	0.25	0.2	0.24	7	23.3	37.5	0.25	0.13	0.29	0.2	0			25		25			0													152.1	152.1	86.1	0	86.1	0.11	0.11	28.7	0.14	0	0.12	0.14	0.11	0.14	7	23.3	37.5	0.14	0.08	0.29	0.11	0			25		25			0													16.39	0.85	3.39	-	1.3	1.07	1.41	0.69	4.68	-	1.2	0.19	0.02	1.91	2.34	11.16	0.63	0.97	2.13	0.01	2.02	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.08	16.39	0.85	3.39	-	1.3	1.07	1.41	0.69	4.68	-	1.2	0.19	0.02	1.91	2.34	11.16	0.63	0.97	2.13	0.01	2.02	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.08
H0316_005_0	2006											3000											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V			P																																																						-	1257.91	65.21	459.38	0	176.68	8.83	11.63	280.24	30.9	0	9.19	1.28	0.13	12.87	3904.98	5595.2	195.52	6.42	26.28	396.5	16.63	0			124		222			0												350	350	175	0	150	30	30	50	30	0	0/30	30	30	30/40/30	May-00	25	40/30	30	0/30	0/25	30	0			25		25			0												350	350	175	0	150	0.3	0.3	50	0.3	0	0.26	0.3	0.3	0.29	5	23.3	37.5	0.3	0.16	0.3	0.3	0			25		25			0													202.45	202.45	101.23	0	86.77	0.17	0.17	28.92	0.17	0	0.15	0.17	0.17	0.17	5	23.3	37.5	0.17	0.09	0.3	0.17	0			25		25			0													21.22	1.1	3.88	-	1.28	1.53	2.02	0.68	5.36	-	1.37	0.22	0.02	2.18	1.63	10.87	0.61	1.11	2.44	0.01	2.89	-			0.26		0.46			-												61.14	21.22	1.1	3.88	-	1.28	1.53	2.02	0.68	5.36	-	1.37	0.22	0.02	2.18	1.63	10.87	0.61	1.11	2.44	0.01	2.89	-			0.26		0.46			-												61.14
H0316_010_0	2006											1800											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	P	Coin	P			V		V			P																																																						-	1292.69	67.01	472.06	0	181.57	9.32	12.29	287.96	32.63	0	9.71	1.35	0.14	13.59	4010.93	5747.79	200.92	6.78	27.76	407.47	17.56	0			124		222			0												195	195	95	0	150	20	20	50	15	0	0/15	15	20	15/40/30	May-00	15	40/30	15	0/15	0/15	20	0			15		15			0												195	195	95	0	150	0.2	0.2	50	0.15	0	0.13	0.15	0.2	0.15	5	13.98	37.5	0.15	0.08	0.29	0.2	0			15		15			0													113.28	113.28	55.19	0	87.14	0.12	0.12	29.05	0.09	0	0.07	0.09	0.12	0.09	5	13.98	37.5	0.1	0.05	0.29	0.12	0			15		15			0													12.2	0.63	2.17	-	1.32	1.08	1.43	0.7	2.84	-	0.73	0.12	0.02	1.16	1.67	6.7	0.63	0.66	1.3	0.01	2.04	-	-	-	0.16	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.83	12.2	0.63	2.17	-	1.32	1.08	1.43	0.7	2.84	-	0.73	0.12	0.02	1.16	1.67	6.7	0.63	0.66	1.3	0.01	2.04	-	-	-	0.16	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.83
H0316_011_0	2006											2400											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V			P																																																						-	1257.91	65.21	459.38	0	176.68	8.83	11.63	280.24	30.9	0	9.19	1.28	0.13	12.87	3905.01	5595.23	195.52	6.42	26.28	396.51	16.63	0			124		222			0												295	295	150	0	150	20	20	50	20	0	0/20	20	20	20/40/30	May-00	20	40/30	20	0/20	0/20	20	0			20		20			0												295	295	150	0	150	0.2	0.2	50	0.2	0	0.17	0.2	0.2	0.2	5	18.64	37.5	0.2	0.11	0.3	0.2	0			20		20			0													172.67	172.67	87.8	0	87.8	0.12	0.12	29.27	0.12	0	0.1	0.12	0.12	0.11	5	18.64	37.5	0.12	0.06	0.3	0.12	0			20		20			0													18.1	0.94	3.36	-	1.29	1.03	1.36	0.68	3.62	-	0.93	0.15	0.02	1.48	1.63	8.69	0.61	0.75	1.65	0.01	1.95	-	-	-	0.21	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.82	18.1	0.94	3.36	-	1.29	1.03	1.36	0.68	3.62	-	0.93	0.15	0.02	1.48	1.63	8.69	0.61	0.75	1.65	0.01	1.95	-	-	-	0.21	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.82
H0316_012_0	2006											600											D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	P	T		V	V	V	V		P																																																						-	1483.95	80.35	481.1	0	217.41	10.86	14.32	495.24	710.76	0	531.41	79.04	0.23	991.82	8451.44	6576.53	254.48	902.38	4793.78	464.47	19.48	0	0		124	0	325.07	0		0												25	25	15	0	100	20	20	40	15	0	0/10	15	20	15/10/8/4	Feb-00	4	04-Aug	10	0/10	0/4	20	0	0		05-Apr	0	4	0		0												25	25	15	0	100	0.2	0.2	40	15	0	9.52	15	0.2	13.86	1.28	3.73	7	10	5.36	0.26	0.2	0	0		4.95	0	4	0		0													16.98	16.98	10.19	0	67.9	0.14	0.14	27.16	10.19	0	6.47	10.19	0.14	9.41	1.28	3.73	7	6.79	3.64	0.26	0.14	0	0		4.95	0	4	0		0													2.1	0.11	0.41	-	1.23	1.47	1.94	1.12	0.6	-	0.29	0.07	0.03	0.78	0.9	2.04	0.15	0.51	1.45	0.01	2.65	-	-		0.05	-	0.11	-		-												18.03	2.1	0.11	0.41	-	1.23	1.47	1.94	1.12	0.6	-	0.29	0.07	0.03	0.78	0.9	2.04	0.15	0.51	1.45	0.01	2.65	-	-		0.05	-	0.11	-		-												18.03
H0316_801_0	2006											3800											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1320.61	62.46	461.84	0	180.35	9.33	12.42	291.26	34.02	725.81	12.01	1.41	0.15	13.19	4227.61	6128.41	201.49	7.15	29.03	434.53	18.11	0			133.3		238.65															265	350	175	0	150	30	30	50	30	20	20/30	30	30	30/40/30	35/0	35	40/30	30	0/30	0/35	30	0			35		35															265	350	175	0	150	0.3	0.3	50	0.3	20	0.24	0.3	0.3	0.29	35	32.66	37.5	0.3	0.29	0.28	0.3	0			35		35																168.49	222.53	111.26	0	95.37	0.19	0.19	31.79	0.19	12.72	0.16	0.19	0.19	0.19	35	32.66	37.5	0.19	0.18	0.28	0.19	0			35		35																18.54	1.16	4.28	-	1.43	1.78	2.37	0.77	6.49	0.77	1.87	0.27	0.03	2.46	12.33	16.68	0.63	1.36	5.33	0.01	3.45	-			0.39		0.7															83.1	18.54	1.16	4.28	-	1.43	1.78	2.37	0.77	6.49	0.77	1.87	0.27	0.03	2.46	12.33	16.68	0.63	1.36	5.33	0.01	3.45	-			0.39		0.7															83.1
H0317_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	245.67	5.58	1085.46	505.95	141.83	16.41	1.24	399.66	316.65				17.27	1951.25	6259.9	10917					4.45			7.22	0		0					12.93	0.29	0	0	0	0	0				500 per admit (0-0)	500 per admit (0-0)	0 per day (1-20) 50 per day (21-100)	0	100	20	25	25-50	50				0	0-25	0-25	25					0.2			25 - 75								500 per admit (0-0)	500 per admit (0-0)	0	0	0	0	0				500	500	4.4	0	100	0.2	0.25	40.5	50				0	17.03	0.49	25					0.2			0.35	0		0					500	500	0	0	0	0	0					500	500	4.4	0	100	0.2	0.25	40.5	50				0	17.03	0.49	25					0.2			0.35	0		0					500	500	0	0	0	0	0				0	10.24	0.23	0.4	-	1.18	3.28	0.31	1.35	1.32	-	-	-	-	2.77	0.26	22.74	-	-	-	-	0.89	-	-	2.55	-	-	-	-	-	-	-	0.54	0.01	-	-	-	-	-	-	-	-	48.07	10.24	0.23	0.4	-	1.18	3.28	0.31	1.35	1.32	-	-	-	-	2.77	0.26	22.74	-	-	-	-	0.89	-	-	2.55	-	-	-	-	-	-	-	0.54	0.01	-	-	-	-	-	-	-	-	48.07
H0317_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	248.91	5.66	1090.57	508.33	142.5	16.85	1.27	401.54	318.14				17.35	1960.43	6289.35	10968.37					4.45			0	0		0					13.1	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.55	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.55	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.45	0.28	0.8	0.42	1.19	4.21	0.32	1.51	5.3	-	-	-	-	5.64	13.21	31.99	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.66	0.01	-	-	-	-	-	-	-	-	78.89	12.45	0.28	0.8	0.42	1.19	4.21	0.32	1.51	5.3	-	-	-	-	5.64	13.21	31.99	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.66	0.01	-	-	-	-	-	-	-	-	78.89
H0317_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	248.91	5.66	1090.57	508.33	142.5	16.85	1.27	401.54	318.14				17.35	1960.43	6289.35	10968.37					4.45			0	0		0					13.1	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.55	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.55	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.45	0.28	0.8	0.42	1.19	4.21	0.32	1.51	5.3	-	-	-	-	5.64	13.21	31.99	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.66	0.01	-	-	-	-	-	-	-	-	78.89	12.45	0.28	0.8	0.42	1.19	4.21	0.32	1.51	5.3	-	-	-	-	5.64	13.21	31.99	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.66	0.01	-	-	-	-	-	-	-	-	78.89
H0317_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	248.91	5.66	1090.57	508.33	142.5	16.85	1.27	401.54	318.14				17.35	1960.43	6289.35	10968.37					4.45			0	0		0					13.1	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.55	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.55	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.45	0.28	0.8	0.42	1.19	4.21	0.32	1.51	5.3	-	-	-	-	5.64	13.21	31.99	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.66	0.01	-	-	-	-	-	-	-	-	78.89	12.45	0.28	0.8	0.42	1.19	4.21	0.32	1.51	5.3	-	-	-	-	5.64	13.21	31.99	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.66	0.01	-	-	-	-	-	-	-	-	78.89
H0317_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	248.91	5.66	1090.57	508.33	142.5	16.85	1.27	401.54	318.14				17.35	1960.43	6289.35	10968.37					4.45			0	0		0					13.1	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.55	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.55	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.45	0.28	0.8	0.42	1.19	4.21	0.32	1.51	5.3	-	-	-	-	5.64	13.21	31.99	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.66	0.01	-	-	-	-	-	-	-	-	78.89	12.45	0.28	0.8	0.42	1.19	4.21	0.32	1.51	5.3	-	-	-	-	5.64	13.21	31.99	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.66	0.01	-	-	-	-	-	-	-	-	78.89
H0318_001_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1461.47	14.76	1266.46	788.56	167.73	15.3	1.14	147.27	30.93	268.35	224.01	0.33	222	17.84	3090.93	6878.56	3.22	814.12	176.66		252.12	723.19																				100/d 5	100/d 5	0/day for 1st 20 days100/day days 21-100																																							60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	20.52	30	30	30	10	30	30	30	30		67.5	30								0													60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	20.52	30	30	30	10	30	30	30	30		67.5	30								0													7.39	0.07	4.24	-	1.4	3.06	0.23	0.58	0.53	-	0.38	0	0.56	0.04	2.58	17.2	0.01	2.04	0.44	-	1.42	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.96	7.39	0.07	4.24	-	1.4	3.06	0.23	0.58	0.53	-	0.38	0	0.56	0.04	2.58	17.2	0.01	2.04	0.44	-	1.42	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.96
H0318_002_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1534.5	15.5	1329.74	827.96	176.11	16.06	1.2	154.63	32.47	281.75	235.2	0.34	233.1	18.74	3245.38	7222.26	3.38	854.8	185.49		264.71	759.33																				100/d 5	100/d 5	0/day for 1st 20 days100/day days 21-100																																							60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	34.2	30	30	30	10	30	30	30	30		67.5	30								0													60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	34.2	30	30	30	10	30	30	30	30		67.5	30								0													7.76	0.08	4.45	-	1.47	3.21	0.24	0.61	0.55	-	0.67	0	0.58	0.05	2.7	18.06	0.01	2.14	0.46	-	1.49	1.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.43	7.76	0.08	4.45	-	1.47	3.21	0.24	0.61	0.55	-	0.67	0	0.58	0.05	2.7	18.06	0.01	2.14	0.46	-	1.49	1.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.43
H0318_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1591.58	16.08	1224.36	1195.42	215.06	1.99	0.02	224.51	45.54	839.13	256.92		61.96	39.16	2477.47	9398.41	0.38	639.41	570.57		274.53	681																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	19.06	0.19	10.2	3.49	2.69	0.6	0.01	0.94	0.57	0.57	2.1	-	0.18	0.11	7.23	27.41	0	1.86	1.66	-	1.54	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.4	19.06	0.19	10.2	3.49	2.69	0.6	0.01	0.94	0.57	0.57	2.1	-	0.18	0.11	7.23	27.41	0	1.86	1.66	-	1.54	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.4
H0318_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1591.58	16.08	1224.36	1195.42	215.06	1.99	0.02	224.51	45.54	839.13	256.92		61.96	39.16	2477.47	9398.41	0.38	639.41	570.57		274.53	681																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	19.06	0.19	10.2	3.49	2.69	0.6	0.01	0.94	0.57	0.57	2.1	-	0.18	0.11	7.23	27.41	0	1.86	1.66	-	1.54	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.4	19.06	0.19	10.2	3.49	2.69	0.6	0.01	0.94	0.57	0.57	2.1	-	0.18	0.11	7.23	27.41	0	1.86	1.66	-	1.54	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.4
H0318_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1591.58	16.08	1224.36	1195.42	215.06	1.99	0.02	224.51	45.54	839.13	256.92		61.96	39.16	2477.47	9398.41	0.38	639.41	570.57		274.53	681																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																				0	19.06	0.19	10.2	3.49	2.69	0.6	0.01	0.94	0.57	0.57	2.1	-	0.18	0.11	7.23	27.41	0	1.86	1.66	-	1.54	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.4	19.06	0.19	10.2	3.49	2.69	0.6	0.01	0.94	0.57	0.57	2.1	-	0.18	0.11	7.23	27.41	0	1.86	1.66	-	1.54	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.4
H0319_001_0	2006											200											D	D	D	P	P	P	P	V	V	P	P	V	P	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	1331.83				1309.46																																					25 first 8 days				15 per trip																																					25				5																																						15.62				3.12																																						1.73	-	-	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.07	1.73	-	-	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.07
H0319_002_0	2006											600	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P			P																																																					-	2204.52	506.26	920.36		297.15	28.1	24.74	901.8	361.37	1830.74	900.83	61.7	2.99	2344.22	128.28	3864.83	987.86	491.99							125.93		218.34															25 days 1-24	25 days 1-24	15 days 1-100		100	20	20	40	15	10	10	15	20	15	2	4	8 indiv/4 group	10							4		4															25	25	15		100	0.2	0.2	40	15	10	10	15	0.2	14.37	2	4	7	10							4		4																12.84	12.84	7.93		51.36	0.1	0.1	20.56	7.7	5.14	5.14	7.7	0.1	7.38	1.03	2.05	3.6	5.14							4		2.05																2.36	0.54	0.61	-	1.27	2.89	2.54	1.54	0.23	0.78	0.39	0.04	0.31	1.44	0.01	0.66	0.3	0.21	-	-	-	-	-	-	0.04	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.2	2.36	0.54	0.61	-	1.27	2.89	2.54	1.54	0.23	0.78	0.39	0.04	0.31	1.44	0.01	0.66	0.3	0.21	-	-	-	-	-	-	0.04	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.2
H0320_001_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1291.68	94.34	539.8	1292.7	195.75	6.2	8.06	249.94	31.9	0	12.35	1.32	0.13	14.31	4196.27	5248.88	306.63	1406.39	19.66	0.65	21.48	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170 days 1-5	170 days 1-5	25 days 10-100	10	100	20	35	50	15 NTE 200 ASC; 15 NTE 400 OPH	0	15 Ther: 20	15	15	15	20	35	50 SA: 50	20 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																105.33	123.92	12.87	10	100	0.2	0.24	50	0.15	0	0.16	0.15	0.2	0.11	19.91	35	50	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		105.33	123.92	12.87	10	100	0.2	0.24	50	0.15	0	0.16	0.15	0.2	0.11	19.91	35	50	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		11.34	0.97	0.58	1.08	1.63	1.24	1.92	1.04	4.78	-	1.99	0.2	0.03	1.51	6.96	15.31	1.28	2.34	2.95	0.13	4.3	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.82	11.34	0.97	0.58	1.08	1.63	1.24	1.92	1.04	4.78	-	1.99	0.2	0.03	1.51	6.96	15.31	1.28	2.34	2.95	0.13	4.3	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.82
H0320_002_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1291.68	94.34	539.8	0	195.75	6.2	8.06	249.94	31.9	0	12.35	1.32	0.13	14.31	4196.27	5248.88	306.63	1406.39	19.66	0.65	21.48	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50 days 1-5	50 days 1-5	25 days 10-100	0	100	20	20	50	15 NTE 100 ASC; 15 NTE 200 OPH	0	10 Ther: 20	15	15	15	10	25	35 SA: 20	12 Chiro: 10	0 OF/OP: 10	0 Chemo: 20	20				25	70 Allowance																30.98	92.94	12.87	0	100	0.2	0.2	50	0.12	0	0.12	0.15	0.2	0.1	9.91	25	31.25	11.11	0.1	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		30.98	92.94	12.87	0	100	0.2	0.2	50	0.12	0	0.12	0.15	0.2	0.1	9.91	25	31.25	11.11	0.1	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		3.33	0.73	0.58	-	1.63	1.24	1.61	1.04	3.86	-	1.51	0.2	0.03	1.42	3.47	10.94	0.8	1.3	1.97	0.13	4.3	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.34	3.33	0.73	0.58	-	1.63	1.24	1.61	1.04	3.86	-	1.51	0.2	0.03	1.42	3.47	10.94	0.8	1.3	1.97	0.13	4.3	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.34
H0320_003_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1186.74	67.48	544.04	1213.27	169.01	5.58	7.5	215.22	30.56	0	11.67	1.26	0.14	12.35	4009.03	5064.24	253.57	1376.42	18.97	0.63	19.83	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	200 days 1-5	200 days 1-5	25 days 10-100	10	100	20	35	50	15 NTE 200 ASC; 15 NTE 400 OPH	0	15 Ther: 20	15	15	15	20	35	50 SA: 50	30 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																123.92	123.92	12.87	10	100	0.2	0.24	50	0.15	0	0.16	0.15	0.2	0.13	20	35	46.45	25.58	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		123.92	123.92	12.87	10	100	0.2	0.24	50	0.15	0	0.16	0.15	0.2	0.13	20	35	46.45	25.58	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		12.26	0.7	0.58	1.01	1.41	1.12	1.79	0.9	4.58	-	1.88	0.19	0.03	1.58	6.68	14.77	0.98	2.93	2.85	0.13	3.97	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.58	12.26	0.7	0.58	1.01	1.41	1.12	1.79	0.9	4.58	-	1.88	0.19	0.03	1.58	6.68	14.77	0.98	2.93	2.85	0.13	3.97	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.58
H0321_001_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	V																																																											-	352.19	33.95	31.97		15.99	23.63	26.72	851.31	27.23	19	16.43	1.93	1.15	45.11	21.69	25.25	9.85	4.35	20.12	88.57	19.75	0.12		643.41	84.18																	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		20	20																	0.07	0.07	0.15		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		20	20																		0.07	0.07	0.15		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		20	20																	123	24.35	2.35	4.68	-	3.73	5.51	6.23	3.55	6.34	4.43	3.83	0.45	0.27	10.51	5.05	5.88	2.3	1.01	4.69	20.64	4.6	0.03	-	1.07	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.62	24.35	2.35	4.68	-	3.73	5.51	6.23	3.55	6.34	4.43	3.83	0.45	0.27	10.51	5.05	5.88	2.3	1.01	4.69	20.64	4.6	0.03	-	1.07	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.62
H0321_002_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	V																																																											-	346.29	33.38	31.43		15.72	23.23	26.27	843.75	26.77	18.68	16.15	1.9	1.13	44.35	21.33	24.83	9.69	4.27	19.78	87.08	19.42	0.12		643.41	84.18																	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		20	20																	0.07	0.07	0.15		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		20	20																		0.07	0.07	0.15		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		20	20																	123	24.02	2.32	4.67	-	3.66	5.41	6.12	3.52	6.24	4.35	3.76	0.44	0.26	10.33	4.97	5.78	2.26	1	4.61	20.29	4.52	0.03	-	1.07	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	119.78	24.02	2.32	4.67	-	3.66	5.41	6.12	3.52	6.24	4.35	3.76	0.44	0.26	10.33	4.97	5.78	2.26	1	4.61	20.29	4.52	0.03	-	1.07	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	119.78
H0322_001_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												3000	0	0							0																																	-	1336.63	13.5	1158.28	721.2	153.4	15.9	1.19	134.69	28.28	245.42	204.88	0.3	203.04	16.32	2826.91	6291	2.94	744.58	161.57		230.58	661.42																				100/d 5	100/d 5	0/day for 1st 20 days100/day days 21-100																																							60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	34.2	30	30	30	10	30	30	30	30		67.5	30			0		0			0													60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	34.2	30	30	30	10	30	30	30	30		67.5	30			0		0			0												0	6.76	0.07	3.88	-	1.28	3.18	0.24	0.53	0.48	-	0.58	0	0.51	0.04	2.36	15.73	0.01	1.86	0.4	-	1.3	1.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85	6.76	0.07	3.88	-	1.28	3.18	0.24	0.53	0.48	-	0.58	0	0.51	0.04	2.36	15.73	0.01	1.86	0.4	-	1.3	1.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85
H0322_002_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												3000	0	0							0																																	-	1336.63	13.5	1158.28	721.2	153.4	15.9	1.19	134.69	28.28	245.42	204.88	0.3	203.04	16.32	2826.91	6291	2.94	744.58	161.57		230.58	661.42																				100/d 5	100/d 5	0/day for 1st 20 days100/day days 21-100																																							60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	17.1	30	30	30	10	30	30	30	30		67.5	30			0		30			30													60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	17.1	30	30	30	10	30	30	30	30		67.5	30			0		0			30												0	6.76	0.07	3.88	-	1.28	3.18	0.24	0.53	0.48	-	0.29	0	0.51	0.04	2.36	15.73	0.01	1.86	0.4	-	1.3	1.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.56	6.76	0.07	3.88	-	1.28	3.18	0.24	0.53	0.48	-	0.29	0	0.51	0.04	2.36	15.73	0.01	1.86	0.4	-	1.3	1.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.56
H0322_005_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												3000	0	0							0																																	-	1336.63	13.5	1158.28	721.2	153.4	15.9	1.19	134.69	28.28	245.42	204.88	0.3	203.04	16.32	2826.91	6291	2.94	744.58	161.57		230.58	661.42																				100/d 5	100/d 5	0/day for 1st 20 days100/day days 21-100																																							60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	34.2	30	30	30	10	30	30	30	30		67.5	30			0		0			0													60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	34.2	30	30	30	10	30	30	30	30		67.5	30			0		0			0												0	6.76	0.07	3.88	-	1.28	3.18	0.24	0.53	0.48	-	0.58	0	0.51	0.04	2.36	15.73	0.01	1.86	0.4	-	1.3	1.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85	6.76	0.07	3.88	-	1.28	3.18	0.24	0.53	0.48	-	0.58	0	0.51	0.04	2.36	15.73	0.01	1.86	0.4	-	1.3	1.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85
H0322_006_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												3000	0	0							0																																	-	1336.63	13.5	1158.28	721.2	153.4	15.9	1.19	134.69	28.28	245.42	204.88	0.3	203.04	16.32	2826.91	6291	2.94	744.58	161.57		230.58	661.42																				100/d 5	100/d 5	0/day for 1st 20 days100/day days 21-100																																							60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	34.2	30	30	30	10	30	30	30	30		67.5	30			0		0			0													60.67	60.67	40.15	0	100	0.2	0.2	47.4	205	0	34.2	30	30	30	10	30	30	30	30		67.5	30			0		0			0												0	6.76	0.07	3.88	-	1.28	3.18	0.24	0.53	0.48	-	0.58	0	0.51	0.04	2.36	15.73	0.01	1.86	0.4	-	1.3	1.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85	6.76	0.07	3.88	-	1.28	3.18	0.24	0.53	0.48	-	0.58	0	0.51	0.04	2.36	15.73	0.01	1.86	0.4	-	1.3	1.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85
H0322_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1400.59	14.15	1077.44	1051.97	189.25	1.75	0.02	197.57	40.08	738.43	226.09		54.53	34.46	2180.18	8270.6	0.33	562.68	502.1		241.59	599.28																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	16.77	0.17	8.98	3.07	2.37	0.52	0.01	0.82	0.5	0.5	1.85	-	0.16	0.1	6.36	24.12	0	1.64	1.46	-	1.36	1.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.51	16.77	0.17	8.98	3.07	2.37	0.52	0.01	0.82	0.5	0.5	1.85	-	0.16	0.1	6.36	24.12	0	1.64	1.46	-	1.36	1.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.51
H0322_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1400.59	14.15	1077.44	1051.97	189.25	1.75	0.02	197.57	40.08	738.43	226.09		54.53	34.46	2180.18	8270.6	0.33	562.68	502.1		241.59	599.28																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	16.77	0.17	8.98	3.07	2.37	0.52	0.01	0.82	0.5	0.5	1.85	-	0.16	0.1	6.36	24.12	0	1.64	1.46	-	1.36	1.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.51	16.77	0.17	8.98	3.07	2.37	0.52	0.01	0.82	0.5	0.5	1.85	-	0.16	0.1	6.36	24.12	0	1.64	1.46	-	1.36	1.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.51
H0322_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1400.59	14.15	1077.44	1051.97	189.25	1.75	0.02	197.57	40.08	738.43	226.09		54.53	34.46	2180.18	8270.6	0.33	562.68	502.1		241.59	599.28																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	16.77	0.17	8.98	3.07	2.37	0.52	0.01	0.82	0.5	0.5	1.85	-	0.16	0.1	6.36	24.12	0	1.64	1.46	-	1.36	1.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.51	16.77	0.17	8.98	3.07	2.37	0.52	0.01	0.82	0.5	0.5	1.85	-	0.16	0.1	6.36	24.12	0	1.64	1.46	-	1.36	1.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.51
H0351_014_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	319.37	3.01	907.6	0	196.62	6.3	6.14	432.62	480.2	0	611.88	0	0.14	368.53	3656.76	4757.33	185.29	265.95	0	222.05	2.93	575.56	0	0	0	0	0	0	0	0	0											300 Per Admit	950 Per Admit	100 / Day Days 8-100		100 per trip	30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 35 UC	150 ASC / 150 OP		25 - 200 copay; 20 Rad Ther		20 coin	35 OP SA / 35 Cardiac Rehab	5 PCP	35 SCP / 35 Chiro / 35 Podiatrist	35 MH	35 Therapy		35 Hearing / 0 Preventive	30 coin	35 Vision									Gold Benefits											300	950	38.49	0	100	0.28	0.28	38.61	150	0	67.01	0	0.2	35	5	33.89	35	18.45	0	10.48	0.3	32.68	0	0	0	0	0	0	0	0	0											none	300	950	38.49	0	100	0.28	0.28	38.61	150	0	67.01	0	0.2	35	5	33.89	35	18.45	0	10.48	0.3	32.68	0	0	0	0	0	0	0	0	0											0	7.98	0.24	2.91	-	1.64	1.77	1.74	1.39	6	-	3.42	-	0.03	1.07	1.52	13.44	0.54	0.41	-	0.19	0.88	1.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.75	7.98	0.24	2.91	-	1.64	1.77	1.74	1.39	6	-	3.42	-	0.03	1.07	1.52	13.44	0.54	0.41	-	0.19	0.88	1.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.75
H0351_021_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	315.17	2.98	895.64	0	194.03	6.22	6.06	426.93	473.88	0	603.82	0	0.13	363.68	3608.6	4694.67	182.85	262.45	0	219.13	2.89	567.98	0	0	0	0	0	0	0	0	0											300 Per Admit	950 Per Admit	100 / Day Days 8-100		100 per trip	30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 35 UC	150 ASC / 150 OP		25 - 200 copay; 20 Rad Ther		20 coin	35 OP SA / 35 Cardiac Rehab	5 PCP	35 SCP / 35 Chiro / 35 Podiatrist	35 MH	35 Therapy		35 Hearing / 0 Preventive	30 coin	35 Vision									Gold Benefits											300	950	38.49	0	100	0.28	0.28	38.61	150	0	67.01	0	0.2	35	5	33.89	35	18.45	0	10.48	0.3	32.68	0	0	0	0	0	0	0	0	0											none	300	950	38.49	0	100	0.28	0.28	38.61	150	0	67.01	0	0.2	35	5	33.89	35	18.45	0	10.48	0.3	32.68	0	0	0	0	0	0	0	0	0											0	7.88	0.24	2.87	-	1.62	1.75	1.72	1.37	5.92	-	3.37	-	0.03	1.06	1.5	13.26	0.53	0.4	-	0.19	0.87	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.14	7.88	0.24	2.87	-	1.62	1.75	1.72	1.37	5.92	-	3.37	-	0.03	1.06	1.5	13.26	0.53	0.4	-	0.19	0.87	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.14
H0351_028_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	286.12	2.7	813.1	0	176.14	5.65	5.5	387.58	430.21	0	548.17	0	0.12	330.16	3276.03	4262.01	166	238.26	0	198.93	2.63	515.63	0	2423	368.27	315	0	0	0	0	0											300 Per Admit	950 Per Admit	100 / Day Days 8-100		100 per trip	30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 35 UC	150 ASC / 150 OP		25 - 200 copay; 20 Rad Ther		20 coin	35 OP SA / 35 Cardiac Rehab	5 PCP	35 SCP / 35 Chiro / 35 Podiatrist	35 MH	35 Therapy		35 Hearing / 0 Preventive	30 coin	35 Vision / 25 Vision Hardware																				300	950	38.49	0	100	0.28	0.28	38.61	150	0	67.01	0	0.2	35	5	33.89	35	18.45	0	10.48	0.3	32.68	0	7.92	10	25	0	0	0	0	0											none	300	950	38.49	0	100	0.28	0.28	38.61	150	0	67.01	0	0.2	35	5	33.89	35	18.45	0	10.48	0.3	32.68	0	7.92	10	25	0	0	0	0	0											0	7.15	0.21	2.61	-	1.47	1.59	1.56	1.25	5.38	-	3.06	-	0.02	0.96	1.36	12.04	0.48	0.37	-	0.17	0.79	1.4	-	1.6	0.31	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.45	7.15	0.21	2.61	-	1.47	1.59	1.56	1.25	5.38	-	3.06	-	0.02	0.96	1.36	12.04	0.48	0.37	-	0.17	0.79	1.4	-	1.6	0.31	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.45
H0351_029_0	2006											none											D	D	D	V	T	coin	coin	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	22.44	1016.84	0	248.11	9.6	9.38	271.46	22.14	0	822.81	0	0.2	25.57	0	0	243.58	0	0	16.49	6.47	52.64	0	0	0	0	0	0	0	0	0												1-8: 0/Day 9-90: 203 (not to exceed 956)	1-20: 0/Day 21-100: 50/Day		25 copay	25 DME/Prosthetics; 15 Diabetic Supplies	25 DME/Prosthetics; 15 Diabetic Supplies	50 ER / 0 UC	0 ASC / 0 OP		50 CT Scan; 50 MRI; 100 Nuclear Med; 20 Therapeutic		20 coinsurance	10 OP SA			10 MH			0 Hearing / 0 Preventive	30 coinsurance	0 Vision									0											0	31.37	11.92	0	25	0.23	0.23	33.14	0	0	30.83	0	0.2	10	0	0	10	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0											none	0	31.37	11.92	0	25	0.23	0.23	33.14	0	0	30.83	0	0.2	10	0	0	10	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0											0	-	0.06	1.01	-	0.52	2.22	2.2	0.75	-	-	2.11	-	0.04	0.02	-	-	0.2	-	-	-	1.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.08	-	0.06	1.01	-	0.52	2.22	2.2	0.75	-	-	2.11	-	0.04	0.02	-	-	0.2	-	-	-	1.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.08
H0351_030_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	321.09	3	903.34	0	195.69	6.27	6.11	449.07	477.95	0	609.01	0	0.13	366.8	3755.6	4836.7	184.42	264.7	0	225.32	2.92	572.86	0	0	0	0	0	0	0	0	0											200 Per Admit	950 Per Admit	100 / Day Days 8-100		100 per trip	30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 25 UC	100 ASC / 100 OP		25 - 200 copay; 20 Rad Ther		20 coin	25 OP SA / 25 Cardiac Rehab	5 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	25 Therapy		25 Hearing / 0 Preventive	30 coin	25 Vision									Gold Benefits											200	950	38.49	0	100	0.28	0.28	31.02	100	0	67.01	0	0.2	25	5	24.95	25	18.45	0	8.52	0.3	23.34	0	0	0	0	0	0	0	0	0											none	200	950	38.49	0	100	0.28	0.28	31.02	100	0	67.01	0	0.2	25	5	24.95	25	18.45	0	8.52	0.3	23.34	0	0	0	0	0	0	0	0	0											0	5.35	0.24	2.9	-	1.63	1.77	1.74	1.16	3.98	-	3.4	-	0.03	0.76	1.56	10.06	0.38	0.41	-	0.16	0.88	1.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.52	5.35	0.24	2.9	-	1.63	1.77	1.74	1.16	3.98	-	3.4	-	0.03	0.76	1.56	10.06	0.38	0.41	-	0.16	0.88	1.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.52
H0351_031_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	319.37	3.01	907.6	0	196.62	6.3	6.14	432.62	480.2	0	611.88	0	0.14	368.53	3656.76	4757.33	185.29	265.95	0	222.05	2.93	575.56	0	0	0	0	0	0	0	0	0											300 Per Admit	950 Per Admit	100 / Day Days 8-100		100 per trip	30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 35 UC	150 ASC / 150 OP		25 - 200 copay; 20 Rad Ther		20 coin	35 OP SA / 35 Cardiac Rehab	5 PCP	35 SCP / 35 Chiro / 35 Podiatrist	35 MH	35 Therapy		35 Hearing / 0 Preventive	30 coin	35 Vision									Gold Benefits											300	950	38.49	0	100	0.28	0.28	38.61	150	0	67.01	0	0.2	35	5	33.89	35	18.45	0	10.48	0.3	32.68	0	0	0	0	0	0	0	0	0											none	300	950	38.49	0	100	0.28	0.28	38.61	150	0	67.01	0	0.2	35	5	33.89	35	18.45	0	10.48	0.3	32.68	0	0	0	0	0	0	0	0	0											0	7.98	0.24	2.91	-	1.64	1.77	1.74	1.39	6	-	3.42	-	0.03	1.07	1.52	13.44	0.54	0.41	-	0.19	0.88	1.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.75	7.98	0.24	2.91	-	1.64	1.77	1.74	1.39	6	-	3.42	-	0.03	1.07	1.52	13.44	0.54	0.41	-	0.19	0.88	1.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.75
H0351_801_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	282.89	2.7	820.49	0	175.93	5.64	5.49	366.35	429.69	0	547.51	0	0.12	329.76	3166.22	4170.18	165.8	237.97	0	194.82	2.62	515.01	0	0	0	0	0	0	0	0	0											950 Per Admit	950 Per Admit	100 / Day Days 21-100			30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 50 UC	200 ASC / 200 OP		25 - 200 copay; 30 Rad Ther		20 coin	40 OP SA / 40 Cardiac Rehab	15 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	30 coin	40 Vision																				950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											none	950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											0	22.4	0.21	1.63	-	1.47	1.59	1.56	1.53	7.16	-	3.3	-	0.02	1.1	3.96	13.1	0.55	0.37	-	0.17	0.79	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.51	22.4	0.21	1.63	-	1.47	1.59	1.56	1.53	7.16	-	3.3	-	0.02	1.1	3.96	13.1	0.55	0.37	-	0.17	0.79	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.51
H0351_802_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	282.89	2.7	820.49	0	175.93	5.64	5.49	366.35	429.69	0	547.51	0	0.12	329.76	3166.22	4170.18	165.8	237.97	0	194.82	2.62	515.01	0	0	0	0	0	0	0	0	0											950 Per Admit	950 Per Admit	100 / Day Days 21-100			30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 50 UC	200 ASC / 200 OP		25 - 200 copay; 30 Rad Ther		20 coin	40 OP SA / 40 Cardiac Rehab	15 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	30 coin	40 Vision																				950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											none	950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											0	22.4	0.21	1.63	-	1.47	1.59	1.56	1.53	7.16	-	3.3	-	0.02	1.1	3.96	13.1	0.55	0.37	-	0.17	0.79	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.51	22.4	0.21	1.63	-	1.47	1.59	1.56	1.53	7.16	-	3.3	-	0.02	1.1	3.96	13.1	0.55	0.37	-	0.17	0.79	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.51
H0351_803_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	282.82	2.7	820.29	0	175.89	5.64	5.49	366.26	429.58	0	547.38	0	0.12	329.68	3165.46	4169.18	165.76	237.91	0	194.77	2.62	514.89	0	0	0	0	0	0	0	0	0											950 Per Admit	950 Per Admit	100 / Day Days 21-100			30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 50 UC	200 ASC / 200 OP		25 - 200 copay; 30 Rad Ther		20 coin	40 OP SA / 40 Cardiac Rehab	15 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	30 coin	40 Vision																				950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											none	950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											0	22.39	0.21	1.63	-	1.47	1.59	1.56	1.53	7.16	-	3.3	-	0.02	1.1	3.96	13.1	0.55	0.37	-	0.17	0.79	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.49	22.39	0.21	1.63	-	1.47	1.59	1.56	1.53	7.16	-	3.3	-	0.02	1.1	3.96	13.1	0.55	0.37	-	0.17	0.79	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.49
H0351_804_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	284.13	2.71	824.09	0	176.7	5.66	5.52	367.95	431.57	0	549.91	0	0.12	331.21	3180.11	4188.47	166.53	239.01	0	195.67	2.64	517.27	0	0	0	0	0	0	0	0	0											950 Per Admit	950 Per Admit	100 / Day Days 21-100			30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 50 UC	200 ASC / 200 OP		25 - 200 copay; 30 Rad Ther		20 coin	40 OP SA / 40 Cardiac Rehab	15 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	30 coin	40 Vision																				950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											none	950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											0	22.49	0.21	1.64	-	1.47	1.6	1.57	1.53	7.19	-	3.32	-	0.02	1.1	3.97	13.16	0.56	0.37	-	0.17	0.79	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.78	22.49	0.21	1.64	-	1.47	1.6	1.57	1.53	7.19	-	3.32	-	0.02	1.1	3.97	13.16	0.56	0.37	-	0.17	0.79	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.78
H0351_805_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	284.13	2.71	824.09	0	176.7	5.66	5.52	367.95	431.57	0	549.91	0	0.12	331.21	3180.11	4188.47	166.53	239.01	0	195.67	2.64	517.27	0	0	0	0	0	0	0	0	0											950 Per Admit	950 Per Admit	100 / Day Days 21-100			30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 50 UC	200 ASC / 200 OP		25 - 200 copay; 30 Rad Ther		20 coin	40 OP SA / 40 Cardiac Rehab	15 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	30 coin	40 Vision																				950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											none	950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											0	22.49	0.21	1.64	-	1.47	1.6	1.57	1.53	7.19	-	3.32	-	0.02	1.1	3.97	13.16	0.56	0.37	-	0.17	0.79	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.78	22.49	0.21	1.64	-	1.47	1.6	1.57	1.53	7.19	-	3.32	-	0.02	1.1	3.97	13.16	0.56	0.37	-	0.17	0.79	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.78
H0351_806_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	P	P	O	Coin	P	V	V	V	V	P	V	Coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	283.36	2.7	821.85	0	176.22	5.65	5.5	366.95	430.4	0	548.42	0	0.12	330.31	3171.47	4177.1	166.07	238.37	0	195.14	2.63	515.87	0	0	0	0	0	0	0	0	0											950 Per Admit	950 Per Admit	100 / Day Days 21-100			30 coin DME / 20 coin Diabetic Supplies	30 coin Prosthetics / 20 coin Diabetic Supplies	50 ER / 50 UC	200 ASC / 200 OP		25 - 200 copay; 30 Rad Ther		20 coin	40 OP SA / 40 Cardiac Rehab	15 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	30 coin	40 Vision																				950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											none	950	950	23.83	0	100	0.28	0.28	50	200	0	72.38	0	0.2	40	14.99	37.69	40	18.45	0	10.69	0.3	37.35	0	0	0	0	0	0	0	0	0											0	22.43	0.21	1.63	-	1.47	1.59	1.56	1.53	7.17	-	3.31	-	0.02	1.1	3.96	13.12	0.55	0.37	-	0.17	0.79	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.61	22.43	0.21	1.63	-	1.47	1.59	1.56	1.53	7.17	-	3.31	-	0.02	1.1	3.96	13.12	0.55	0.37	-	0.17	0.79	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.61
H0354_001_0	2006																						A	A	D		T	P		V	V	V	V		V	V			V	V		V	Coin				V		V				V																																																					-	286.18	4.2	724.38		231.15	24.86		486.14	123.11	412.27	1525		75.4	379.59			57.82	95.35		6637.14	3.51				132.22		33.12				152.11											Contracted - 400/admit; Non-contracted - 876/admit; Gastic Bypass - 20 coin.	MHSA - 876/admit	Contracted - 100/day; days 21-100; Non-contracted - 100/day		100/trip	20 for high cost DME		CMG Urgent Care - 20/visit; Non-CMG Urgent Care - 50/visit; Emergency Room - 50/visit	150/visit	CMG Specialist - 20/visit; Non-CMG Specialist - 30/visit	High Tech - 150/visit; Low Tech  - 30/visit; Mammography - 0/visit		25/visit	30/visit			30/visit	CMG Specialist - 20/visit; Non-CMG Specialist - 30/visit		Primary Care - 10/visit; CMG Specialist - 20/visit; Non-CMG Specialist - 30/visitGastric Bypass - 20 coin.	20 coinsurance				CMG Routine Exam - 20/visit		Hearing Aid Fitting - 0/visit; CMG Routine Exam - 20/visit				CMG Podiatrist - 20/visit; CMG Nail Technician - 10/visit; Non-CMG Nail Technician - 30/visitNon-CMG Podiatrist - 30/visit											434.36	876	100		100	2.52		37.52	150	25.2	50.47		25.2	30			30	19.03		18.85	0.2				22.45		10				15.06												434.36	876	100		100	2.52		37.52	150	25.2	50.47		25.2	30			30	19.03		18.85	0.2				22.45		10				15.06												10.36	0.31	6.04	-	1.93	0.01	-	1.52	1.54	0.87	6.41	-	0.16	0.95	-	-	0.14	0.15	-	10.43	0.7	-	-	-	0.25	-	0.03	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	41.97	10.36	0.31	6.04	-	1.93	0.01	-	1.52	1.54	0.87	6.41	-	0.16	0.95	-	-	0.14	0.15	-	10.43	0.7	-	-	-	0.25	-	0.03	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	41.97
H0354_012_0	2006																						A	A	D		T	P		V	V	V	V		V	V			V	V		V	Coin				V		V																																																									-	370.11	5.43	1503.45		359.64	29.89		738.36	107.75	404.33	1734.99		89.69	266.57			71.89	119.69		8021.52	5				206.22		45.21				190.94											Contracted - 0/admit; Non-contracted - 876/admit; Gastic Bypass - 20 coin.	MHSA - 0/admit	Contracted - 0/day; days 21-100; Non-contracted - 50/day		50/trip	20 for high cost DME		CMG Urgent Care - 10/visit; Non-CMG Urgent Care - 50/visit; Emergency Room - 50/visit	10/visit	CMG Specialist - 0/visit; Non-CMG Specialist - 10/visit	High Tech - 10/visit; Low Tech  - 5/visit; Mammography - 0/visit		5/visit	5/visit			10/visit	CMG Specialist - 0/visit; Non-CMG Specialist - 10/visit		Primary Care - 0/visit; CMG Specialist - 0/visit; Non-CMG Specialist - 10/visitGastric Bypass - 20 coin.	20 coinsurance				CMG Routine Exam - 0/visit		Hearing Aid Fitting - 0/visit; CMG Routine Exam - 0/visit				CMG Podiatrist - 0/visit; CMG Nail Technician - 0/visit; Non-CMG Nail Technician - 10/visitNon-CMG Podiatrist - 10/visit											85.73	0	4.98		50	3.4		35.59	10	5	4.85		5	5			10	4.35		4	0.2				2.43		0				0.04												85.73	0	4.98		50	3.4		35.59	10	5	4.85		5	5			10	4.35		4	0.2				2.43		0				0.04												2.64	-	0.62	-	1.5	0.01	-	2.19	0.09	0.17	0.7	-	0.04	0.11	-	-	0.06	0.04	-	2.67	1	-	-	-	0.04	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	11.89	2.64	-	0.62	-	1.5	0.01	-	2.19	0.09	0.17	0.7	-	0.04	0.11	-	-	0.06	0.04	-	2.67	1	-	-	-	0.04	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	11.89
H0354_801_0	2006																						A	A	D		T	P		V	V	V	V		V	V			V	V		V	Coin																																																															-	260.87	3.83	558.39		185.74	27.7		415.25	133	447.74	1511.9		100.64	874.63			54.29	89.25		6548.83	4.75																					Contracted - 500/admit; Non-contracted - 876/admit; Gastic Bypass - 20 coin.	MHSA - 876/admit	Contracted - 150/day; days 21-100; Non-contracted - 150/day		100/trip	20 for high cost DME		CMG Urgent Care - 50/visit; Non-CMG Urgent Care - 50/visit; Emergency Room - 50/visit	150/visit	CMG Specialist - 30/visit; Non-CMG Specialist - 30/visit	High Tech - 150/visit; Low Tech  - 30/visit; Mammography - 0/visit		30/visit	30/visit			30/visit	CMG Specialist - 30/visit; Non-CMG Specialist - 30/visit		Primary Care - 30/visit; CMG Specialist - 30/visit; Non-CMG Specialist - 30/visitGastric Bypass - 20 coin.	20 coinsurance																					526.77	876	150		100	2.38		49.99	150	30	50.47		30	30			30	30.03		29.99	0.2																						526.77	876	150		100	2.38		49.99	150	30	50.47		30	30			30	30.03		29.99	0.2																						11.45	0.28	6.98	-	1.55	0.01	-	1.73	1.66	1.12	6.36	-	0.25	2.19	-	-	0.14	0.22	-	16.37	0.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.25	11.45	0.28	6.98	-	1.55	0.01	-	1.73	1.66	1.12	6.36	-	0.25	2.19	-	-	0.14	0.22	-	16.37	0.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.25
H0354_804_0	2006																						A	A	D		T	P		V	V	V	V		V	V			V	V		V	Coin																																																															-	260.87	3.83	558.39		185.74	27.7		415.25	133	447.74	1511.9		100.64	874.63			54.29	89.25		6548.83	4.75																					Contracted - 500/admit; Non-contracted - 876/admit; Gastic Bypass - 20 coin.	MHSA - 876/admit	Contracted - 150/day; days 21-100; Non-contracted - 150/day		100/trip	20 for high cost DME		CMG Urgent Care - 50/visit; Non-CMG Urgent Care - 50/visit; Emergency Room - 50/visit	150/visit	CMG Specialist - 30/visit; Non-CMG Specialist - 30/visit	High Tech - 150/visit; Low Tech  - 30/visit; Mammography - 0/visit		30/visit	30/visit			30/visit	CMG Specialist - 30/visit; Non-CMG Specialist - 30/visit		Primary Care - 30/visit; CMG Specialist - 30/visit; Non-CMG Specialist - 30/visitGastric Bypass - 20 coin.	20 coinsurance																					526.77	876	150		100	2.38		49.99	150	30	50.47		30	30			30	30.03		29.99	0.2																						526.77	876	150		100	2.38		49.99	150	30	50.47		30	30			30	30.03		29.99	0.2																						11.45	0.28	6.98	-	1.55	0.01	-	1.73	1.66	1.12	6.36	-	0.25	2.19	-	-	0.14	0.22	-	16.37	0.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.25	11.45	0.28	6.98	-	1.55	0.01	-	1.73	1.66	1.12	6.36	-	0.25	2.19	-	-	0.14	0.22	-	16.37	0.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.25
H0354_805_0	2006																						A	A	D		T	P		V	V	V	V		V	V			V	V		V	Coin																																																															-	260.87	3.83	558.39		185.74	27.7		415.25	133	447.74	1511.9		100.64	874.63			54.29	89.25		6548.83	4.75																					Contracted - 500/admit; Non-contracted - 876/admit; Gastic Bypass - 20 coin.	MHSA - 876/admit	Contracted - 150/day; days 21-100; Non-contracted - 150/day		100/trip	20 for high cost DME		CMG Urgent Care - 50/visit; Non-CMG Urgent Care - 50/visit; Emergency Room - 50/visit	150/visit	CMG Specialist - 30/visit; Non-CMG Specialist - 30/visit	High Tech - 150/visit; Low Tech  - 30/visit; Mammography - 0/visit		30/visit	30/visit			30/visit	CMG Specialist - 30/visit; Non-CMG Specialist - 30/visit		Primary Care - 30/visit; CMG Specialist - 30/visit; Non-CMG Specialist - 30/visitGastric Bypass - 20 coin.	20 coinsurance																					526.77	876	150		100	2.38		49.99	150	30	50.47		30	30			30	30.03		29.99	0.2																						526.77	876	150		100	2.38		49.99	150	30	50.47		30	30			30	30.03		29.99	0.2																						11.45	0.28	6.98	-	1.55	0.01	-	1.73	1.66	1.12	6.36	-	0.25	2.19	-	-	0.14	0.22	-	16.37	0.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.25	11.45	0.28	6.98	-	1.55	0.01	-	1.73	1.66	1.12	6.36	-	0.25	2.19	-	-	0.14	0.22	-	16.37	0.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.25
H0401_002_0	2006											3000											D	D	D	Coin	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V			V		V		Coin	V																																																						-	1506.4	87.83	478.34	0	135.64	15.3	13.23	289.04	33.11	0	12.51	1.34	0.01	16.36	3738.7	4617.58	136.68	2.25	18.57	316.37	25.3	0			117.8		210.9		31.96	0												270	175	125	0	150	20	20	50	20	0	0 / 20	20	30	20 / 40 / 30	15 / 0	30	40 / 30	20	0 / 20	0 / 30	30	0			30		30		See PBP	0												270	175	125	0	150	0.2	0.2	50	0.2	0	0.27	0.2	0.3	0.2	15	27.19	37.5	0.2	0.16	0.33	0.3	0			30		30		0.22	0													160.32	103.91	74.22	0	89.06	0.12	0.12	29.69	0.12	0	0.16	0.12	0.18	0.12	15	27.19	37.5	0.12	0.1	0.33	0.18	0			30		30		0.22	0													20.12	0.76	2.96	-	1.01	1.82	1.57	0.72	3.93	-	2	0.16	0	1.93	4.67	10.46	0.43	0.27	1.77	0.01	4.51	-	-	-	0.29	-	0.53	-	7.01	-	-	-	-	-	-	-	-	-	-	-	-	66.93	20.12	0.76	2.96	-	1.01	1.82	1.57	0.72	3.93	-	2	0.16	0	1.93	4.67	10.46	0.43	0.27	1.77	0.01	4.51	-	-	-	0.29	-	0.53	-	7.01	-	-	-	-	-	-	-	-	-	-	-	-	66.93
H0401_003_0	2006											2400											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V			V		V		Coin	V																																																						-	1506.4	87.8	478.3	0	135.6	15.3	13.23	289	33.11	0	12.51	1.34	0.01	16.4	3738.7	4617.6	136.7	2.25	18.57	316.4	25.3	0			117.8		210.9		31.96	0												250	175	85	0	150	20	20	50	20	0	0 / 20	20	20	20 / 40 / 30	Dec-00	25	40 / 30	20	0 / 20	0 / 25	20	0			25		25		See PBP	0												250	175	85	0	150	0.2	0.2	50	0.2	0	0.18	0.2	0.2	0.2	12	22.39	37.5	0.2	0.11	0.25	0.2	0			25		25		18.7	0													142.22	99.55	48.35	0	85.33	0.11	0.11	28.44	0.11	0	0.1	0.11	0.11	0.11	12	22.39	37.5	0.11	0.06	0.25	0.11	0			25		25		18.7	0													17.85	0.73	1.93	-	0.96	1.74	1.51	0.69	3.77	-	1.28	0.15	0	1.85	3.74	8.62	0.43	0.26	1.13	0.01	2.88	-	-	-	0.25	-	0.44	-	5.96	-	-	-	-	-	-	-	-	-	-	-	-	56.16	17.85	0.73	1.93	-	0.96	1.74	1.51	0.69	3.77	-	1.28	0.15	0	1.85	3.74	8.62	0.43	0.26	1.13	0.01	2.88	-	-	-	0.25	-	0.44	-	5.96	-	-	-	-	-	-	-	-	-	-	-	-	56.16
H0401_004_0	2006											600											D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	V	V	Coin	V																																																						-	1752.29	101.03	501.09		181.6	20.49	17.71	511.09	652.41		762.01	63.02	0.02	1721.68	9431.3	5544.34	193.56	359.3	5042.9	403.21	32.11				117.8		308.96		44.01													25	25	15		100	20	20	40	15		0 / 10	15	20	15 / 10 / 8 / 4	Feb-00	4	04-Aug	10	0 / 10	0 / 4	20				05-Apr		4		See PBP													25	25	15		100	0.2	0.2	40	15		9.59	15	0.2	14.21	1.1	3.76	7	10	5.36	0.25	0.2				4.95		4		0.22														15.14	15.14	9.09		60.58	0.12	0.12	24.23	9.09		5.81	9.09	0.12	8.61	1.1	3.76	7	6.06	3.25	0.25	0.12				4.95		4		0.22														2.21	0.13	0.38	-	0.92	2.48	2.15	1.03	0.49	-	0.37	0.05	0	1.23	0.87	1.74	0.11	0.18	1.36	0.01	3.89	-	-	-	0.05	-	0.1	-	9.71	-	-	-	-	-	-	-	-	-	-	-	-	29.47	2.21	0.13	0.38	-	0.92	2.48	2.15	1.03	0.49	-	0.37	0.05	0	1.23	0.87	1.74	0.11	0.18	1.36	0.01	3.89	-	-	-	0.05	-	0.1	-	9.71	-	-	-	-	-	-	-	-	-	-	-	-	29.47
H0401_801_0	2006											3500											D	D	D	Coin	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V			V		V			V																																																						-	1674.14	93.65	522.96	0	148.33	16.44	14.54	314.87	37.49	910.62	16.15	1.51	0.01	18.32	4210.68	5254.21	141.83	2.58	21.11	359.35	28.93	0			133.3		238.65			0												250	175	125	0	150	30	30	50	30	20	20 / 30	30	30	30 / 40 / 30	35 / 0	35	40 / 30	30	0 / 30	0 / 35	30	0			35		35			0												250	175	125	0	150	0.3	0.3	50	0.3	20	0.25	0.3	0.3	0.3	35	31.34	37.5	0.3	0.29	0.2	0.3	0			35		35			0													146.65	102.65	73.32	0	87.99	0.18	0.18	29.33	0.18	11.73	0.15	0.18	0.18	0.17	35	31.34	37.5	0.18	0.17	0.2	0.18	0			35		35			0													20.46	0.8	3.2	-	1.09	2.89	2.56	0.77	6.6	0.89	2.41	0.27	0	3.21	12.28	13.72	0.44	0.45	3.58	0.01	5.09	-	-	-	0.39	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.8	20.46	0.8	3.2	-	1.09	2.89	2.56	0.77	6.6	0.89	2.41	0.27	0	3.21	12.28	13.72	0.44	0.45	3.58	0.01	5.09	-	-	-	0.39	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.8
H0504_015_0	2006																						D	D	D	V	T	Coin	Coin	V	V	P	P	V	O	P	P	P	V	P	P	P	Coin		T		P	P	P	P																																																								-	825.58	14.89	410.3	0	211	10.95	7.33	447	234	0	0	0	25.02	222	5072.87	4398.13	234	975	0	1431	7.67	733	0	0	440	149	0	0	0	0	0																	11b Pros 20 / 11c Diab Supp 20	50 ER / 25 Urgent (50 WW)					Equivalent of 10 Coinsurance																																																																							200	200	50	0	125	0.2	0.2	38.65	125	0	0	0	17.1	10	5	10	30	10	0	10	0.2	10	0	0	10	20	0	0	0	0	0												13.76	0.25	1.71	-	2.2	2.19	1.47	1.44	2.44	-	-	-	0.04	0.19	2.11	3.67	0.59	0.81	-	1.19	1.53	0.61	-	-	0.37	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.8	13.76	0.25	1.71	-	2.2	2.19	1.47	1.44	2.44	-	-	-	0.04	0.19	2.11	3.67	0.59	0.81	-	1.19	1.53	0.61	-	-	0.37	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.8
H0504_017_0	2006																						D	D	D	V	T	Coin	Coin	V	V	P	P	V	O	P	P	P	V	P	P	P	Coin		T		P	P	P	P																																																								-	828.46	14.89	392.9	0	214	11.71	7.77	467	267	0	0	0	24.34	250	4855.73	4231.27	213	891	0	1340	6.53	700	0	0	418	180	0	0	0	0	0																	11b Pros 20 / 11c Diab Supp 20	50 ER / 25 Urgent (50 WW)					Equivalent of 10 Coinsurance																																																																							150	150	50	0	75	0.2	0.2	39.67	100	0	0	0	14.95	10	5	10	30	10	0	10	0.2	10	0	0	10	20	0	0	0	0	0												10.36	0.19	1.64	-	1.34	2.34	1.55	1.54	2.23	-	-	-	0.03	0.21	2.02	3.53	0.53	0.74	-	1.12	1.31	0.58	-	-	0.35	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.9	10.36	0.19	1.64	-	1.34	2.34	1.55	1.54	2.23	-	-	-	0.03	0.21	2.02	3.53	0.53	0.74	-	1.12	1.31	0.58	-	-	0.35	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.9
H0504_019_0	2006																						D	D	D		T	Coin	Coin	V	V				O	P	P	P	V	P		P	Coin	O			P	P																																																										-	825.58	14.89	410.3	0	211	10.95	7.33	447	234	0	0	0	25.02	222	5072.87	4398.13	234	975	0	1431	7.67	733	0	0	440	149	0	0	0	0	0																	11b Pros 20 / 11c Diab Supp 20	50 ER / 25 Urgent (50 WW)					Equivalent of 10 Coinsurance																																																																							200	200	50	0	125	0.2	0.2	38.65	125	0	0	0	17.1	10	5	10	30	10	0	10	0.2	10	0	0	10	20	0	0	0	0	0												13.76	0.25	1.71	-	2.2	2.19	1.47	1.44	2.44	-	-	-	0.04	0.19	2.11	3.67	0.59	0.81	-	1.19	1.53	0.61	-	-	0.37	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.8	13.76	0.25	1.71	-	2.2	2.19	1.47	1.44	2.44	-	-	-	0.04	0.19	2.11	3.67	0.59	0.81	-	1.19	1.53	0.61	-	-	0.37	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.8
H0504_021_0	2006																										T	Coin		V					O				V				Coin					P																																																										-	0	0	0	0	190	9.73	0	452	0	0	0	0	23.09	0	0	0	225	0	0	0	7.63	0	0	0	0	123	0	0	0	0	0																		50 ER/0 Urgent Care (50 WW)																																																																												0	0	0	0	50	0.2	0	26.67	0	0	0	0	25	0	0	0	30	0	0	0	0.2	0	0	0	0	25	0	0	0	0	0												-	-	-	-	0.79	1.95	-	1	-	-	-	-	0.05	-	-	-	0.56	-	-	-	1.53	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.14	-	-	-	-	0.79	1.95	-	1	-	-	-	-	0.05	-	-	-	0.56	-	-	-	1.53	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.14
H0504_023_0	2006																										T	Coin		V					O				V				Coin					P																																																										-	0	0	0	0	190	9.73	0	452	0	0	0	0	23.09	0	0	0	225	0	0	0	7.63	0	0	0	0	123	0	0	0	0	0																		50 ER/0 Urgent Care (50 WW)																																																																												0	0	0	0	50	0.2	0	26.67	0	0	0	0	25	0	0	0	30	0	0	0	0.2	0	0	0	0	25	0	0	0	0	0												-	-	-	-	0.79	1.95	-	1	-	-	-	-	0.05	-	-	-	0.56	-	-	-	1.53	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.14	-	-	-	-	0.79	1.95	-	1	-	-	-	-	0.05	-	-	-	0.56	-	-	-	1.53	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.14
H0523_002_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	987.35	9.97	15.48		17.6	0.01	0	20.55	2.03					0.3	20657.69	6663.35			123.36	0	285.6	0.52						0														75/day 375 max	75/day 375 max	0/day for 1st 20 days20/day for days 21-100																																							45.5	45.5	8.03	0	100	0.2	0.2	46.75	150	0	34.2	10	10	10	5	10	25	10	10	0	45	10	0	0	0	0	0	0	0	0	0												45.5	45.5	8.03	0	100	0.2	0.2	46.75	150	0	34.2	10	10	10	5	10	25	10	10		45	10			0		0			0													3.74	0.04	0.01	-	0.15	0	0	0.08	0.03	-	-	-	-	0	8.61	5.55	-	-	0.1	-	1.07	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.38	3.74	0.04	0.01	-	0.15	0	0	0.08	0.03	-	-	-	-	0	8.61	5.55	-	-	0.1	-	1.07	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.38
H0523_022_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P																																																						-	2303.12	23.26	85.3		31.5			41.63	0.65		2.4		7.71	2.34	22871.41	6259.38	0.62	4	165.64	0	285.6	0.28						0														50/day 250 max	50/day 250 max	0/day for 1st 20 days20/day for days 21-100																																							30.34	30.34	8.03		100	0.2	0.2	46.75	100	0	34.2	10	10	10	5	10	25	10	10	0	45	10	0	0	0	0	0	0	0	0	0												30.34	30.34	8.03		100	0.2	0.2	46.75	100	0	34.2	10	10	10	5	10	25	10	10		45	10			0		0			0													5.82	0.06	0.06	-	0.26	-	-	0.16	0.01	-	0.01	-	0.01	0	9.53	5.22	0	0	0.14	-	1.07	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.34	5.82	0.06	0.06	-	0.26	-	-	0.16	0.01	-	0.01	-	0.01	0	9.53	5.22	0	0	0.14	-	1.07	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.34
H0523_025_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1731.86	17.49	109.81		37.12	0.04	0	40.46			-0.04				20216.41	5797.4	10.12		98.39	0	285.6							0														75/day 375 max	75/day 375 max	0/day for 1st 20 days20/day for days 21-100																																							45.5	45.5	8.03	0	100	0.2	0.2	46.75	100	0	34.2	10	10	10	5	10	25	10	10	0	45	10	0	0	0	0	0	0	0	0	0												45.5	45.5	8.03	0	100	0.2	0.2	46.75	100	0	17.1	10	10	10	5	10	25	10	10		45	10			0		0			0													6.57	0.07	0.07	-	0.31	0.01	0	0.16	-	-	0	-	-	-	8.42	4.83	0.02	-	0.08	-	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.61	6.57	0.07	0.07	-	0.31	0.01	0	0.16	-	-	0	-	-	-	8.42	4.83	0.02	-	0.08	-	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.61
H0523_026_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P																																																						-	2086.69	21.08	85.73		31.66			41.84	0.66		2.39		7.75		21211.84	5522.98	0.63		166.48	0	285.6							0														50/day 250 max	50/day 250 max	0/day for 1st 20 days20/day for days 21-100																																							30.34	30.34	8.03	0	100	0.2	0.2	46.75	100	0	34.2	10	10	10	5	10	25	10	10	0	45	10	0	0	0	0	0	0	0	0	0												30.34	30.34	8.03	0	100	0.2	0.2	46.75	100	0	34.2	10	10	10	5	10	25	10	10		45	10			0		0			0													5.28	0.05	0.06	-	0.26	-	-	0.16	0.01	-	0.01	-	0.01	-	8.84	4.6	0	-	0.14	-	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.48	5.28	0.05	0.06	-	0.26	-	-	0.16	0.01	-	0.01	-	0.01	-	8.84	4.6	0	-	0.14	-	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.48
H0523_031_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	2296.11	23.19	84.48		31.5	0.01	0	41.63	0.65		2.4	3.3	7.14	2.17	21526.03	6130.32	0.64	3.92	162.23	0	285.6	0.28						0														100/day 500 max	100/day 500 max	0/day for 1st 20 days50/day for days 21-100																		20 copay																					60.67	60.67	20.07	0	75	0.2	0.2	46.75	100	0	34.2	15	15	15	10	15	15	15	15	0	67.5	15	0	0	0	0	0	0	0	0	0												60.67	60.67	20.07	0	75	0.2	0.2	46.75	100	0	34.2	15	15	15	10	15	15	15	15		67.5	15			0		0			0													11.61	0.12	0.14	-	0.2	0	0	0.16	0.01	-	0.01	0	0.01	0	17.94	7.66	0	0	0.2	-	1.61	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.67	11.61	0.12	0.14	-	0.2	0	0	0.16	0.01	-	0.01	0	0.01	0	17.94	7.66	0	0	0.2	-	1.61	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.67
H0523_032_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	2289.11	23.12	85.16		31.5	0.01	0	41.63	0.65		2.4	3.3	7.14	2.17	21526.03	6130.32	0.64	3.92	162.23	0	285.6	0.28						0														150/day 750 max	150/day 750 max	0/day for 1st 20 days25/day for days 21-100																		20 copay																					91.01	91.01	10.04	0	50	0.2	0.2	46.75	100	0	17.1	15	15	15	10	15	15	15	15	0	67.5	15	0	0	0	0	0	0	0	0	0												91.01	91.01	10.04	0	50	0.2	0.2	46.75	100	0	17.1	15	15	15	10	15	15	15	15		67.5	15			0		0			0													17.36	0.18	0.07	-	0.13	0	0	0.16	0.01	-	0	0	0.01	0	17.94	7.66	0	0	0.2	-	1.61	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.34	17.36	0.18	0.07	-	0.13	0	0	0.16	0.01	-	0	0	0.01	0	17.94	7.66	0	0	0.2	-	1.61	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.34
H0523_034_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	2289.11	23.12	85.16		31.5	0.01	0	41.63	0.65		2.4	3.3	7.14	2.17	21526.03	6130.32	0.64	3.92	162.23	0	285.6	0.28						0														150/day 750 max	150/day 750 max	0/day for 1st 20 days25/day for days 21-100																		20 copay																					91.01	91.01	10.04	0	50	0.2	0.2	46.75	100	0	17.1	15	15	15	10	15	15	15	15	0	67.5	15	0	0	0	0	0	0	0	0	0												91.01	91.01	10.04	0	50	0.2	0.2	46.75	100	0	17.1	15	15	15	10	15	15	15	15		67.5	15			0		0			0													17.36	0.18	0.07	-	0.13	0	0	0.16	0.01	-	0	0	0.01	0	17.94	7.66	0	0	0.2	-	1.61	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.34	17.36	0.18	0.07	-	0.13	0	0	0.16	0.01	-	0	0	0.01	0	17.94	7.66	0	0	0.2	-	1.61	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.34
H0523_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O								P																																																						-	2059.54	20.8	73.55		28.56	0.01	0	37.08	0.59		2.17	0	6.7	2.03	17074.74	5323.32	0.55	3.4	140.87		258.9	0.26																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	7.7	98.3	0	35	35	35	35	35	35	35	0	67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	7.7	98.3		35	35	35	35	35	35	35		67.5	35								0													24.66	0.25	0.61	-	0.36	0	0	0.15	0.01	-	0.02	-	0.02	0.01	49.8	15.53	0	0.01	0.41	-	1.46	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.3	24.66	0.25	0.61	-	0.36	0	0	0.15	0.01	-	0.02	-	0.02	0.01	49.8	15.53	0	0.01	0.41	-	1.46	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.3
H0523_805_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O								P																																																						-	2059.54	20.8	73.55		28.56	0.01	0	37.08	0.59		2.17	0	6.7	2.03	17074.74	5323.32	0.55	3.4	140.87		258.9	0.26																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	7.7	98.3	0	35	35	35	35	35	35	35	0	67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	7.7	98.3		35	35	35	35	35	35	35		67.5	35								0													24.66	0.25	0.61	-	0.36	0	0	0.15	0.01	-	0.02	-	0.02	0.01	49.8	15.53	0	0.01	0.41	-	1.46	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.3	24.66	0.25	0.61	-	0.36	0	0	0.15	0.01	-	0.02	-	0.02	0.01	49.8	15.53	0	0.01	0.41	-	1.46	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.3
H0523_806_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O								P																																																						-	2059.54	20.8	73.55		28.56	0.01	0	37.08	0.59		2.17	0	6.7	2.03	17074.74	5323.32	0.55	3.4	140.87		258.9	0.26																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	7.7	98.3	0	35	35	35	35	35	35	35	0	67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	7.7	98.3		35	35	35	35	35	35	35		67.5	35								0													24.66	0.25	0.61	-	0.36	0	0	0.15	0.01	-	0.02	-	0.02	0.01	49.8	15.53	0	0.01	0.41	-	1.46	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.3	24.66	0.25	0.61	-	0.36	0	0	0.15	0.01	-	0.02	-	0.02	0.01	49.8	15.53	0	0.01	0.41	-	1.46	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.3
H0524_001_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	804.31	46.35	495.22		229.31	242.19	44.08	354.58	41.1	5064.26	1867.63			72.59	8305.88	2.54	228.14	772.79			188.15				254.98					211.59												300 /day	300 /day	75 /days 21-100		100 /trip	twenty percent	twenty percent	50	125 /procedure	20 /routine lab	20 /x-ray 50 /MRI PET CAT Scan			25	25	25	25	25			10 /generic 30 /brand				25					25												302.78	302.78	75		100	38.46	21.25	50	125.3	21.46	25.68			17.55	25.34	25.34	25.34	25.34			17.17				25.34					38.5													185.86	185.86	10.07		100	38.46	21.25	50	125.3	21.46	25.68			17.55	24.07	25.34	25.34	25.34			17.17				25.34					38.5													12.46	0.72	0.42	-	1.91	0.78	0.08	1.48	0.43	9.06	4	-	-	0.11	16.66	0.01	0.48	1.63	-	-	0.27	-	-	-	0.54	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	51.69	12.46	0.72	0.42	-	1.91	0.78	0.08	1.48	0.43	9.06	4	-	-	0.11	16.66	0.01	0.48	1.63	-	-	0.27	-	-	-	0.54	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	51.69
H0524_002_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	813.33	46.87	617.7		227.04	242.19	44.08	468.43	46.38	15768.45	5815.17			226.01	7862.07	2.4	215.95	731.5			188.15				240.83					80.72												300 /day	300 /day	75 /days 21-100		100 /trip	twenty percent	twenty percent	50	150 /procedure	20 /routine lab	20 /x-ray 50 /MRI PET CAT Scan			10	10	10	10	10			10 /generic 30 /brand				10					10												302.78	302.78	75		100	38.46	21.25	50	150.29	21.46	25.68			7.22	10.34	10.34	10.34	10.34			17.17				10.34					23.5													197.37	197.37	11.39		100	38.46	21.25	50	150.29	21.46	25.68			7.22	9.82	10.34	10.34	10.34			17.17				10.34					23.5													13.38	0.77	0.59	-	1.89	0.78	0.08	1.95	0.58	28.2	12.44	-	-	0.14	6.43	0	0.19	0.63	-	-	0.27	-	-	-	0.21	-	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	68.68	13.38	0.77	0.59	-	1.89	0.78	0.08	1.95	0.58	28.2	12.44	-	-	0.14	6.43	0	0.19	0.63	-	-	0.27	-	-	-	0.21	-	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	68.68
H0524_003_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	733.09	42.24	473.32		205.3	242.19	44.08	557.7	52.42	5064.26	1867.63			72.59	8241.25	2.52	226.36	766.78			188.15				246.52					119.61												300 /day	300 /day	75 /days 21-100		100 /trip	twenty percent	twenty percent	50	150 /procedure	20 /routine lab	20 /x-ray 50 /MRI PET CAT Scan			10	10	10	10	10			10 /generic 30 /brand				10					10												302.78	302.78	75		100	38.46	21.25	50	150.29	21.46	25.68			7.22	10.34	10.34	10.34	10.34			17.17				10.34					23.5													197.37	197.37	11.39		100	38.46	21.25	50	150.29	21.46	25.68			7.22	9.82	10.34	10.34	10.34			17.17				10.34					23.5													12.06	0.69	0.45	-	1.71	0.78	0.08	2.32	0.66	9.06	4	-	-	0.04	6.74	0	0.2	0.66	-	-	0.27	-	-	-	0.21	-	-	-	-	0.23	-	-	-	-	-	-	-	-	-	-	-	40.16	12.06	0.69	0.45	-	1.71	0.78	0.08	2.32	0.66	9.06	4	-	-	0.04	6.74	0	0.2	0.66	-	-	0.27	-	-	-	0.21	-	-	-	-	0.23	-	-	-	-	-	-	-	-	-	-	-	40.16
H0524_006_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	645.98	37.22	536.1		195.44	242.19	44.08	957.6	47.35	5064.26	1867.63			72.59	6350.59	1.94	174.43	590.87			188.15				65.84					49.68												275 /day	275 /day	75 /days 21-100		100 /trip	twenty percent	twenty percent	50	100 /procedure	20 /routine lab	20 /x-ray 50 /MRI PET CAT Scan			25	25	25	25	25			10 /generic 30 /brand				25					25												277.78	277.78	75		100	38.46	21.25	50	100.31	21.46	25.68			17.55	25.34	25.34	25.34	25.34			17.17				25.34					38.5													174.84	174.84	10.91		100	38.46	21.25	50	100.31	21.46	25.68			17.55	24.07	25.34	25.34	25.34			17.17				25.34					38.5													9.41	0.54	0.49	-	1.63	0.78	0.08	3.99	0.4	9.06	4	-	-	0.11	12.74	0	0.37	1.25	-	-	0.27	-	-	-	0.14	-	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	45.4	9.41	0.54	0.49	-	1.63	0.78	0.08	3.99	0.4	9.06	4	-	-	0.11	12.74	0	0.37	1.25	-	-	0.27	-	-	-	0.14	-	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	45.4
H0524_008_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	891.09	41.07	758.77		207.95	264.9	34.95	508.61	68.15	4646.7	1637.99			60.33	7237.29	1.72	225.73	648.3			165.59				236.94					124.13												300 / day	300 /day	75 / days 21-100		150 / trip	twenty percent	twenty percent	50	200 /procedure	15 /routine lab	15 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												302.78	302.78	75		150	43	21.36	50	200.31	16.46	22.25			13.56	20.34	20.34	20.34	20.34			14.31				20.34					33.5													194.65	194.65	12.02		150	43	21.36	50	200.31	16.46	22.25			13.56	19.32	20.34	20.34	20.34			14.31				20.34					33.5													14.45	0.67	0.76	-	2.6	0.95	0.06	2.12	1.14	6.37	3.04	-	-	0.07	11.65	0	0.38	1.1	-	-	0.2	-	-	-	0.4	-	-	-	-	0.35	-	-	-	-	-	-	-	-	-	-	-	46.31	14.45	0.67	0.76	-	2.6	0.95	0.06	2.12	1.14	6.37	3.04	-	-	0.07	11.65	0	0.38	1.1	-	-	0.2	-	-	-	0.4	-	-	-	-	0.35	-	-	-	-	-	-	-	-	-	-	-	46.31
H0524_009_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	794.19	36.61	613.73		203.34	264.9	34.95	403.23	85.86	4646.7	1637.99			60.33	7983.11	1.9	248.99	715.11			165.59				259.1					308.44												300 / day	300 /day	75 / days 21-100		225 / trip	twenty percent	twenty percent	50	200 /procedure	15 /routine lab	15 /xray 50 MRI PET CAT Scan			25	25	25	25	25			10 /generic 40 /brand				25					25												302.78	302.78	75		225	43	21.36	50	200.31	16.46	22.25			16.86	25.34	25.34	25.34	25.34			14.31				25.34					38.5													184.87	184.87	11.27		225	43	21.36	50	200.31	16.46	22.25			16.86	24.07	25.34	25.34	25.34			14.31				25.34					38.5													12.24	0.56	0.58	-	3.81	0.95	0.06	1.68	1.43	6.37	3.04	-	-	0.08	16.01	0	0.53	1.51	-	-	0.2	-	-	-	0.55	-	-	-	-	0.99	-	-	-	-	-	-	-	-	-	-	-	50.6	12.24	0.56	0.58	-	3.81	0.95	0.06	1.68	1.43	6.37	3.04	-	-	0.08	16.01	0	0.53	1.51	-	-	0.2	-	-	-	0.55	-	-	-	-	0.99	-	-	-	-	-	-	-	-	-	-	-	50.6
H0524_010_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	798.98	36.83	583.65		181.29	264.9	34.95	394.94	85.57	3960.45	1396.08			51.42	6803.17	1.62	212.19	609.41			165.59				210.13					136.65												300 / day	300 /day	75 / days 21-100		150 / trip	twenty percent	twenty percent	50	200 /procedure	15 /routine lab	15 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												302.78	302.78	75		150	43	21.36	50	200.31	16.46	16.58			10.34	20.34	20.34	20.34	20.34			14.31				20.34					33.5													194.65	48.54	75		150	43	21.36	50	200.31	16.46	16.58			10.34	19.32	20.34	20.34	20.34			14.31				20.34					33.5													12.96	0.15	3.65	-	2.27	0.95	0.06	1.65	1.43	5.43	1.93	-	-	0.04	10.95	0	0.36	1.03	-	-	0.2	-	-	-	0.36	-	-	-	-	0.38	-	-	-	-	-	-	-	-	-	-	-	43.8	12.96	0.15	3.65	-	2.27	0.95	0.06	1.65	1.43	5.43	1.93	-	-	0.04	10.95	0	0.36	1.03	-	-	0.2	-	-	-	0.36	-	-	-	-	0.38	-	-	-	-	-	-	-	-	-	-	-	43.8
H0524_013_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	742.35	34.22	592.65		199.2	264.9	34.95	457.91	93.77	4646.7	1637.99			60.33	7044.05	1.67	219.7	630.99			165.59				251.64					343.36												300 / day	300 /day	75 / days 21-100		150 / trip	twenty percent	twenty percent	50	200 /procedure	15 /routine lab	15 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												302.78	302.78	75		150	43	21.36	50	200.31	16.46	22.25			13.56	20.34	20.34	20.34	20.34			14.31				20.34					33.5													194.65	194.65	12.02		150	43	21.36	50	200.31	16.46	22.25			13.56	19.32	20.34	20.34	20.34			14.31				20.34					33.5													12.04	0.56	0.59	-	2.49	0.95	0.06	1.91	1.57	6.37	3.04	-	-	0.07	11.34	0	0.37	1.07	-	-	0.2	-	-	-	0.43	-	-	-	-	0.96	-	-	-	-	-	-	-	-	-	-	-	44.01	12.04	0.56	0.59	-	2.49	0.95	0.06	1.91	1.57	6.37	3.04	-	-	0.07	11.34	0	0.37	1.07	-	-	0.2	-	-	-	0.43	-	-	-	-	0.96	-	-	-	-	-	-	-	-	-	-	-	44.01
H0524_014_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	794.03	36.6	670.48		184.72	264.9	34.95	389.68	59.45	4646.7	1637.99			60.33	6821.43	1.62	212.76	611.05			165.59				247.79					114.2												225 / day	225 /day	75 / days 21-100		125 / trip	twenty percent	twenty percent	50	125 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												227.78	227.78	75		125	43	21.36	50	20.34	11.46	18.05			13.56	20.34	20.34	20.34	20.34			14.31				20.34					33.5													159.59	159.59	15.3		125	43	21.36	50	20.34	11.46	18.05			13.56	19.32	20.34	20.34	20.34			14.31				20.34					33.5													10.56	0.49	0.85	-	1.92	0.95	0.06	1.62	0.1	4.44	2.46	-	-	0.07	10.98	0	0.36	1.04	-	-	0.2	-	-	-	0.42	-	-	-	-	0.32	-	-	-	-	-	-	-	-	-	-	-	36.85	10.56	0.49	0.85	-	1.92	0.95	0.06	1.62	0.1	4.44	2.46	-	-	0.07	10.98	0	0.36	1.04	-	-	0.2	-	-	-	0.42	-	-	-	-	0.32	-	-	-	-	-	-	-	-	-	-	-	36.85
H0524_015_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	693.99	39.99	490.6		201.47	242.19	44.08	309.17	61.91	5064.26	1867.63			72.59	8644.78	2.64	237.45	804.32			188.15				264.38					14.3												300 /day	300 /day	75 /days 21-100		100 /trip	twenty percent	twenty percent	50	150 /procedure	20 /routine lab	20 /x-ray 50 /MRI PET CAT Scan			10	10	10	10	10			10 /generic 30 /brand				10					10												302.78	302.78	75		100	38.46	21.25	50	150.1	21.46	25.64			7.21	10.34	10.34	10.34	10.34			17.17				10.34					23.5													197.37	197.37	11.39		99.88	38.41	21.22	49.94	150.1	21.43	25.64			7.21	9.82	10.32	10.32	10.32			17.15				10.32					23.47													11.41	0.66	0.47	-	1.68	0.78	0.08	1.29	0.77	9.05	3.99	-	-	0.04	7.07	0	0.2	0.69	-	-	0.27	-	-	-	0.23	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	38.71	11.41	0.66	0.47	-	1.68	0.78	0.08	1.29	0.77	9.05	3.99	-	-	0.04	7.07	0	0.2	0.69	-	-	0.27	-	-	-	0.23	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	38.71
H0524_017_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	634.74	36.58	593.95		211.53	242.19	44.08	174.4	20.52	5064.26	1867.63			72.59	8484.42	2.59	233.04	789.4			188.15				250.84					43.89												300 /day	300 /day	75 /days 21-100		100 /trip	twenty percent	twenty percent	50	150 /procedure	20 /routine lab	20 /x-ray 50 /MRI PET CAT Scan			10	10	10	10	10			10 /generic 30 /brand				10					10												302.78	302.78	75		100	38.46	21.25	50	150.1	21.46	25.64			7.21	10.34	10.34	10.34	10.34			17.17				10.34					23.5													197.37	197.37	11.39		99.88	38.41	21.22	49.94	150.1	21.43	25.64			7.21	9.82	10.32	10.32	10.32			17.15				10.32					23.47													10.44	0.6	0.56	-	1.76	0.78	0.08	0.73	0.26	9.05	3.99	-	-	0.04	6.94	0	0.2	0.68	-	-	0.27	-	-	-	0.22	-	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	36.68	10.44	0.6	0.56	-	1.76	0.78	0.08	0.73	0.26	9.05	3.99	-	-	0.04	6.94	0	0.2	0.68	-	-	0.27	-	-	-	0.22	-	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	36.68
H0524_018_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	712.08	41.03	459.67		195.94	242.19	44.08	669.1	63.16	5064.26	1867.63			72.59	7581.26	2.31	208.24	705.37			188.15				253.48					137.34												300 /day	300 /day	75 /days 21-100		100 /trip	twenty percent	twenty percent	50	125 /procedure	20 /routine lab	20 /x-ray 50 /MRI PET CAT Scan			25	25	25	25	25			10 /generic 30 /brand				25					25												302.78	302.78	75		100	38.46	21.25	50	125.3	21.46	25.68			17.55	25.34	25.34	25.34	25.34			17.17				25.34					38.5													185.86	185.86	10.07		100	38.46	21.25	50	125.3	21.46	25.68			17.55	24.07	25.34	25.34	25.34			17.17				25.34					38.5													11.03	0.64	0.39	-	1.63	0.78	0.08	2.79	0.66	9.06	4	-	-	0.11	15.21	0	0.44	1.49	-	-	0.27	-	-	-	0.54	-	-	-	-	0.44	-	-	-	-	-	-	-	-	-	-	-	49.53	11.03	0.64	0.39	-	1.63	0.78	0.08	2.79	0.66	9.06	4	-	-	0.11	15.21	0	0.44	1.49	-	-	0.27	-	-	-	0.54	-	-	-	-	0.44	-	-	-	-	-	-	-	-	-	-	-	49.53
H0524_019_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	705.85	40.67	361		217.96	242.19	44.08	471.23	47.35	5064.26	1867.63			72.59	5493.04	1.68	150.88	511.08			188.15				267.12					95.71												275 /day	275 /day	75 /days 21-100		100 /trip	twenty percent	twenty percent	50	100 /procedure	25 /routine lab	25 /x-ray 50 /MRI PET CAT Scan			25	25	25	25	25			10 /generic 30 /brand				25					25												277.78	277.78	75		100	38.46	21.25	50	100.31	21.46	25.68			17.55	25.34	25.34	25.34	25.34			17.17				25.34					38.5													174.84	174.84	10.91		100	38.46	21.25	50	100.31	21.46	25.68			17.55	24.07	25.34	25.34	25.34			17.17				25.34					38.5													10.28	0.59	0.33	-	1.82	0.78	0.08	1.96	0.4	9.06	4	-	-	0.11	11.02	0	0.32	1.08	-	-	0.27	-	-	-	0.56	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	42.95	10.28	0.59	0.33	-	1.82	0.78	0.08	1.96	0.4	9.06	4	-	-	0.11	11.02	0	0.32	1.08	-	-	0.27	-	-	-	0.56	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	42.95
H0524_020_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	557.45	25.7	275.21		178.06	264.9	34.95	337.92	86.62	3558.26	1254.31			46.2	5353.3	1.27	166.97	479.54			165.59				253.62					251.82												300 / day	300 /day	75 / days 21-100		150 / trip	twenty percent	twenty percent	50	200 /procedure	15 /routine lab	15 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												302.78	302.78	75		150	43	21.36	50	200.31	16.46	16.58			10.34	20.34	20.34	20.34	20.34			14.31				20.34					33.5													194.65	194.65	12.02		150	43	21.36	50	200.31	16.46	16.58			10.34	19.32	20.34	20.34	20.34			14.31				20.34					33.5													9.04	0.42	0.28	-	2.23	0.95	0.06	1.41	1.45	4.88	1.73	-	-	0.04	8.62	0	0.28	0.81	-	-	0.2	-	-	-	0.43	-	-	-	-	0.7	-	-	-	-	-	-	-	-	-	-	-	33.53	9.04	0.42	0.28	-	2.23	0.95	0.06	1.41	1.45	4.88	1.73	-	-	0.04	8.62	0	0.28	0.81	-	-	0.2	-	-	-	0.43	-	-	-	-	0.7	-	-	-	-	-	-	-	-	-	-	-	33.53
H0524_021_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	926.69	42.72	605.06		209.9	264.9	34.95	514.74	51.1	4646.7	1637.99			60.33	7483.46	1.78	233.41	670.35			165.59				244.6					135.28												300 / day	300 /day	75 / days 21-100		150 / trip	twenty percent	twenty percent	50	200 /procedure	15 /routine lab	15 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												302.78	302.78	75		150	43	21.36	50	200.31	16.46	22.25			13.56	20.34	20.34	20.34	20.34			14.31				20.34					33.5													194.65	194.65	12.02		150	43	21.36	50	200.31	16.46	22.25			13.56	19.32	20.34	20.34	20.34			14.31				20.34					33.5													15.03	0.69	0.61	-	2.62	0.95	0.06	2.14	0.85	6.37	3.04	-	-	0.07	12.05	0	0.4	1.14	-	-	0.2	-	-	-	0.41	-	-	-	-	0.38	-	-	-	-	-	-	-	-	-	-	-	47.02	15.03	0.69	0.61	-	2.62	0.95	0.06	2.14	0.85	6.37	3.04	-	-	0.07	12.05	0	0.4	1.14	-	-	0.2	-	-	-	0.41	-	-	-	-	0.38	-	-	-	-	-	-	-	-	-	-	-	47.02
H0524_022_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	997.87	46	616.79		243.19	264.9	34.95	400.96	49.43	241.01	8.88			832.83	7413.59	1.76	231.23	664.09			165.59				251.22					150.34												225 / day	225 /day	75 / days 21-100		125 / trip	twenty percent	twenty percent	50	125 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												227.78	227.78	75		125	43	21.36	50	20.34	11.46	11.58			10.34	20.34	20.34	20.34	20.34			14.31				20.34					33.5													159.59	159.59	15.3		125	43	21.36	50	20.34	11.46	11.58			10.34	19.32	20.34	20.34	20.34			14.31				20.34					33.5													13.27	0.61	0.79	-	2.53	0.95	0.06	1.67	0.08	0.23	0.01	-	-	0.72	11.94	0	0.39	1.13	-	-	0.2	-	-	-	0.43	-	-	-	-	0.42	-	-	-	-	-	-	-	-	-	-	-	35.42	13.27	0.61	0.79	-	2.53	0.95	0.06	1.67	0.08	0.23	0.01	-	-	0.72	11.94	0	0.39	1.13	-	-	0.2	-	-	-	0.43	-	-	-	-	0.42	-	-	-	-	-	-	-	-	-	-	-	35.42
H0524_023_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	742.31	34.22	505.38		191.7	264.9	34.95	665.49	102.99	4646.7	1637.99			60.33	6625.57	1.57	206.65	593.5			165.59				212.5					129.76												225 / day	225 /day	75 / days 21-100		125 / trip	twenty percent	twenty percent	50	125 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												227.78	227.78	75		125	43	21.36	50	20.34	11.46	18.05			13.56	20.34	20.34	20.34	20.34			14.31				20.34					33.5													159.59	159.59	15.3		125	43	21.36	50	20.34	11.46	18.05			13.56	19.32	20.34	20.34	20.34			14.31				20.34					33.5													9.87	0.46	0.64	-	2	0.95	0.06	2.77	0.17	4.44	2.46	-	-	0.07	10.67	0	0.35	1.01	-	-	0.2	-	-	-	0.36	-	-	-	-	0.36	-	-	-	-	-	-	-	-	-	-	-	36.84	9.87	0.46	0.64	-	2	0.95	0.06	2.77	0.17	4.44	2.46	-	-	0.07	10.67	0	0.35	1.01	-	-	0.2	-	-	-	0.36	-	-	-	-	0.36	-	-	-	-	-	-	-	-	-	-	-	36.84
H0524_024_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	1076.88	49.64	875.06		291.39	264.9	34.95	153.56	18.13	278.06	98.02			3.61	7073.1	1.68	220.61	633.59			165.59				20.9					1038												225 / day	225 /day	75 / days 21-100		125 / trip	twenty percent	twenty percent	50	125 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												227.78	227.78	75		125	43	21.36	50	20.34	11.46	11.58			10.34	20.34	20.34	20.34	20.34			14.31				20.34					33.5													159.59	159.59	15.3		125	43	21.36	50	20.34	11.46	11.58			10.34	19.32	20.34	20.34	20.34			14.31				20.34					33.5													14.32	0.66	1.12	-	3.04	0.95	0.06	0.64	0.03	0.27	0.09	-	-	0	11.39	0	0.37	1.07	-	-	0.2	-	-	-	0.04	-	-	-	-	2.9	-	-	-	-	-	-	-	-	-	-	-	37.15	14.32	0.66	1.12	-	3.04	0.95	0.06	0.64	0.03	0.27	0.09	-	-	0	11.39	0	0.37	1.07	-	-	0.2	-	-	-	0.04	-	-	-	-	2.9	-	-	-	-	-	-	-	-	-	-	-	37.15
H0524_025_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	1358.44	62.62	916.99		259.65	264.9	34.95	111.49	71.76	3815.13	1344.86			49.53	7291.72	1.73	227.43	653.18			165.59				198.64					293.41												225 / day	225 /day	75 / day 21-100		125 / trip	twenty percent	twenty percent	50	125 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												227.78	227.78	75		125	43	21.36	50	20.34	11.46	11.58			10.34	20.34	20.34	20.34	20.34			14.31				20.34					33.5													159.59	159.59	15.3		125	43	21.36	50	20.34	11.46	11.58			10.34	19.32	20.34	20.34	20.34			14.31				20.34					33.5													18.07	0.83	1.17	-	2.7	0.95	0.06	0.46	0.12	3.64	1.3	-	-	0.04	11.74	0	0.39	1.11	-	-	0.2	-	-	-	0.34	-	-	-	-	0.82	-	-	-	-	-	-	-	-	-	-	-	43.94	18.07	0.83	1.17	-	2.7	0.95	0.06	0.46	0.12	3.64	1.3	-	-	0.04	11.74	0	0.39	1.11	-	-	0.2	-	-	-	0.34	-	-	-	-	0.82	-	-	-	-	-	-	-	-	-	-	-	43.94
H0524_026_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	775.63	35.75	853.08		153.09	264.9	34.95	421.91	84.43	1472.79	519.17			19.12	6768.42	1.61	211.1	606.3			165.59				228.16					115.01												225 / day	225 /day	75 / days 21-100		125 / trip	twenty percent	twenty percent	50	125 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			20	20	20	20	20			10 /generic 40 /brand				20					20												227.78	227.78	75		125	43	21.36	50	20.34	11.46	11.58			10.34	20.34	20.34	20.34	20.34			14.31				20.34					33.5													159.59	159.59	15.3		125	43	21.36	50	20.34	11.46	11.58			10.34	19.32	20.34	20.34	20.34			14.31				20.34					33.5													10.32	0.48	1.09	-	1.59	0.95	0.06	1.76	0.14	1.41	0.5	-	-	0.02	10.9	0	0.36	1.03	-	-	0.2	-	-	-	0.39	-	-	-	-	0.32	-	-	-	-	-	-	-	-	-	-	-	31.5	10.32	0.48	1.09	-	1.59	0.95	0.06	1.76	0.14	1.41	0.5	-	-	0.02	10.9	0	0.36	1.03	-	-	0.2	-	-	-	0.39	-	-	-	-	0.32	-	-	-	-	-	-	-	-	-	-	-	31.5
H0524_027_0	2006											3000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	948.41	43.72	622.33		168.55	264.9	34.95	456.7	78.7	4646.7	1637.99			60.33	7512.79	1.79	234.32	672.98			165.59				230.03					185.32												300 / day	300 /day	75 / days 21-100		225 / trip	twenty percent	twenty percent	50	200 /procedure	15 /routine lab	15 /xray 50 MRI PET CAT Scan			25	25	25	25	25			10 /generic 40 /brand				25					25												302.78	302.78	75		225	43	21.36	50	200.31	16.46	22.25			16.86	25.34	25.34	25.34	25.34			14.31				25.34					38.5													184.87	184.87	11.27		225	43	21.36	50	200.31	16.46	22.25			16.86	24.07	25.34	25.34	25.34			14.31				25.34					38.5													14.61	0.67	0.58	-	3.16	0.95	0.06	1.9	1.31	6.37	3.04	-	-	0.08	15.07	0	0.49	1.42	-	-	0.2	-	-	-	0.49	-	-	-	-	0.59	-	-	-	-	-	-	-	-	-	-	-	51.02	14.61	0.67	0.58	-	3.16	0.95	0.06	1.9	1.31	6.37	3.04	-	-	0.08	15.07	0	0.49	1.42	-	-	0.2	-	-	-	0.49	-	-	-	-	0.59	-	-	-	-	-	-	-	-	-	-	-	51.02
H0524_801_0	2006											2000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	703.29	40.53	490.21		218.55	242.19	44.08	503.88	44.95	5064.26	1867.63			72.59	8172.16	2.5	224.47	760.35			199.61				281.49					118.36												300 /day	300 /day	75 /days 21-100		twenty percent	twenty percent	twenty percent	50	200 /procedure	10 /routine lab	10 /x-ray 50 /MRI PET CAT Scan			40	40	40	40	40			10 /generic 35 /brand				40					40												402.78	402.78	75		43.71	38.46	21.25	50	40.34	11.46	16.28			26.64	40.34	40.34	40.34	40.34			19.21				40.34					40.34													178.87	178.87	3.86		41.76	36.74	20.3	47.77	38.53	10.95	16.28			26.64	38.53	38.53	38.53	38.53			19.21				38.53					38.53													10.48	0.6	0.16	-	0.76	0.74	0.07	2.01	0.14	4.62	2.53	-	-	0.16	26.24	0.01	0.72	2.44	-	-	0.32	-	-	-	0.9	-	-	-	-	0.38	-	-	-	-	-	-	-	-	-	-	-	53.3	10.48	0.6	0.16	-	0.76	0.74	0.07	2.01	0.14	4.62	2.53	-	-	0.16	26.24	0.01	0.72	2.44	-	-	0.32	-	-	-	0.9	-	-	-	-	0.38	-	-	-	-	-	-	-	-	-	-	-	53.3
H0524_802_0	2006											2000											D	D			T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	834.92	38.49	497.34		200.28	264.9	34.95	498.6	76.72	4646.7	1637.99			60.33	7543.84	1.79	235.29	675.76			162.25				262.34					266.93												300 /day	300 /day	75 /days 21-100		twenty percent	twenty percent	twenty percent	50	200 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			40	40	40	40	40			10 /generic 40 /brand				40					40												402.78	402.78	75		40.06	43	21.36	50	40.34	11.46	17.54			26.02	40.34	40.34	40.34	40.34			14.97				40.34					40.34													189.71	189.71	5.09		38.91	41.77	20.75	48.58	39.19	11.13	17.54			26.02	39.19	39.19	39.19	39.19			14.54				39.19					39.19													13.2	0.61	0.21	-	0.65	0.92	0.06	2.02	0.25	4.31	2.39	-	-	0.13	24.64	0.01	0.77	2.21	-	-	0.2	-	-	-	0.86	-	-	-	-	0.87	-	-	-	-	-	-	-	-	-	-	-	54.3	13.2	0.61	0.21	-	0.65	0.92	0.06	2.02	0.25	4.31	2.39	-	-	0.13	24.64	0.01	0.77	2.21	-	-	0.2	-	-	-	0.86	-	-	-	-	0.87	-	-	-	-	-	-	-	-	-	-	-	54.3
H0524_803_0	2006											2000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	696.36	40.13	594.92		233.23	242.19	44.08	594.21	41.73	14809.28	5461.44			212.27	7808.87	2.38	214.49	726.55			199.61				266.35					142.35												300 /day	300 /day	75 /days 21-100		twenty percent	twenty percent	twenty percent	50	200 /procedure	10 /routine lab	10 /x-ray 50 /MRI PET CAT Scan			40	40	40	40	40			10 /generic 35 /brand				40					40												402.78	402.78	75		46.65	38.46	21.25	50	40.34	11.46	16.28			26.64	40.34	40.34	40.34	40.34			19.21				40.34					40.34													178.87	178.87	3.86		44.56	36.74	20.3	47.77	38.53	10.95	16.28			26.64	38.53	38.53	38.53	38.53			19.21				38.53					38.53													10.38	0.6	0.19	-	0.87	0.74	0.07	2.37	0.13	13.51	7.41	-	-	0.47	25.08	0.01	0.69	2.33	-	-	0.32	-	-	-	0.86	-	-	-	-	0.46	-	-	-	-	-	-	-	-	-	-	-	66.48	10.38	0.6	0.19	-	0.87	0.74	0.07	2.37	0.13	13.51	7.41	-	-	0.47	25.08	0.01	0.69	2.33	-	-	0.32	-	-	-	0.86	-	-	-	-	0.46	-	-	-	-	-	-	-	-	-	-	-	66.48
H0524_804_0	2006											2000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	988.97	45.59	583.61		239.58	264.9	34.95	546.64	82.59	3771.94	1329.63			48.97	7512.89	1.79	234.32	672.99			162.25				261.8					405.15												300 /day	300 /day	75 /days 21-100		twenty percent	twenty percent	twenty percent	50	200 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			40	40	40	40	40			10 /generic 40 /brand				40					40												402.78	402.78	75		47.92	43	21.36	50	40.34	11.46	11.25			19.76	40.34	40.34	40.34	40.34			14.97				40.34					40.34													189.71	189.71	5.09		46.55	41.77	20.75	48.58	39.19	11.13	11.25			19.76	39.19	39.19	39.19	39.19			14.54				39.19					39.19													15.63	0.72	0.25	-	0.93	0.92	0.06	2.21	0.27	3.5	1.25	-	-	0.08	24.53	0.01	0.77	2.2	-	-	0.2	-	-	-	0.85	-	-	-	-	1.32	-	-	-	-	-	-	-	-	-	-	-	55.7	15.63	0.72	0.25	-	0.93	0.92	0.06	2.21	0.27	3.5	1.25	-	-	0.08	24.53	0.01	0.77	2.2	-	-	0.2	-	-	-	0.85	-	-	-	-	1.32	-	-	-	-	-	-	-	-	-	-	-	55.7
H0524_805_0	2006											2000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	703.29	40.53	490.21		218.55	242.19	44.08	503.88	44.95	5064.26	1867.63			72.59	8172.16	2.5	224.47	760.35			199.61				281.49					118.36												300 /day	300 /day	75 /days 21-100		twenty percent	twenty percent	twenty percent	50	200 /procedure	10 /routine lab	10 /x-ray 50 /MRI PET CAT Scan			40	40	40	40	40			10 /generic 35 /brand				40					40												402.78	402.78	75		43.71	38.46	21.25	50	40.34	11.46	16.28			26.64	40.34	40.34	40.34	40.34			19.21				40.34					40.34													178.87	178.87	3.86		41.76	36.74	20.3	47.77	38.53	10.95	16.28			26.64	38.53	38.53	38.53	38.53			19.21				38.53					38.53													10.48	0.6	0.16	-	0.76	0.74	0.07	2.01	0.14	4.62	2.53	-	-	0.16	26.24	0.01	0.72	2.44	-	-	0.32	-	-	-	0.9	-	-	-	-	0.38	-	-	-	-	-	-	-	-	-	-	-	53.3	10.48	0.6	0.16	-	0.76	0.74	0.07	2.01	0.14	4.62	2.53	-	-	0.16	26.24	0.01	0.72	2.44	-	-	0.32	-	-	-	0.9	-	-	-	-	0.38	-	-	-	-	-	-	-	-	-	-	-	53.3
H0524_806_0	2006											2000											D	D			T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	834.92	38.49	497.34		200.28	264.9	34.95	498.6	76.72	4646.7	1637.99			60.33	7543.84	1.79	235.29	675.76			162.25				262.34					266.93												300 /day	300 /day	75 /days 21-100		twenty percent	twenty percent	twenty percent	50	200 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			40	40	40	40	40			10 /generic 40 /brand				40					40												402.78	402.78	75		40.06	43	21.36	50	40.34	11.46	17.54			26.02	40.34	40.34	40.34	40.34			14.97				40.34					40.34													189.71	189.71	5.09		38.91	41.77	20.75	48.58	39.19	11.13	17.54			26.02	39.19	39.19	39.19	39.19			14.54				39.19					39.19													13.2	0.61	0.21	-	0.65	0.92	0.06	2.02	0.25	4.31	2.39	-	-	0.13	24.64	0.01	0.77	2.21	-	-	0.2	-	-	-	0.86	-	-	-	-	0.87	-	-	-	-	-	-	-	-	-	-	-	54.3	13.2	0.61	0.21	-	0.65	0.92	0.06	2.02	0.25	4.31	2.39	-	-	0.13	24.64	0.01	0.77	2.21	-	-	0.2	-	-	-	0.86	-	-	-	-	0.87	-	-	-	-	-	-	-	-	-	-	-	54.3
H0524_807_0	2006											2000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	696.36	40.13	594.92		233.23	242.19	44.08	594.21	41.73	14809.28	5461.44			212.27	7808.87	2.38	214.49	726.55			199.61				266.35					142.35												300 /day	300 /day	75 /days 21-100		twenty percent	twenty percent	twenty percent	50	200 /procedure	10 /routine lab	10 /x-ray 50 /MRI PET CAT Scan			40	40	40	40	40			10 /generic 35 /brand				40					40												402.78	402.78	75		46.65	38.46	21.25	50	40.34	11.46	16.28			26.64	40.34	40.34	40.34	40.34			19.21				40.34					40.34													178.87	178.87	3.86		44.56	36.74	20.3	47.77	38.53	10.95	16.28			26.64	38.53	38.53	38.53	38.53			19.21				38.53					38.53													10.38	0.6	0.19	-	0.87	0.74	0.07	2.37	0.13	13.51	7.41	-	-	0.47	25.08	0.01	0.69	2.33	-	-	0.32	-	-	-	0.86	-	-	-	-	0.46	-	-	-	-	-	-	-	-	-	-	-	66.48	10.38	0.6	0.19	-	0.87	0.74	0.07	2.37	0.13	13.51	7.41	-	-	0.47	25.08	0.01	0.69	2.33	-	-	0.32	-	-	-	0.86	-	-	-	-	0.46	-	-	-	-	-	-	-	-	-	-	-	66.48
H0524_808_0	2006											2000											D	D	D		T	O	O	V	P	V	V			V	V	V	V	V			S				V					V																																																						-	988.97	45.59	583.61		239.58	264.9	34.95	546.64	82.59	3771.94	1329.63			48.97	7512.89	1.79	234.32	672.99			162.25				261.8					405.15												300 /day	300 /day	75 /days 21-100		twenty percent	twenty percent	twenty percent	50	200 /procedure	10 /routine lab	10 /xray 50 MRI PET CAT Scan			40	40	40	40	40			10 /generic 40 /brand				40					40												402.78	402.78	75		47.92	43	21.36	50	40.34	11.46	11.25			19.76	40.34	40.34	40.34	40.34			14.97				40.34					40.34													189.71	189.71	5.09		46.55	41.77	20.75	48.58	39.19	11.13	11.25			19.76	39.19	39.19	39.19	39.19			14.54				39.19					39.19													15.63	0.72	0.25	-	0.93	0.92	0.06	2.21	0.27	3.5	1.25	-	-	0.08	24.53	0.01	0.77	2.2	-	-	0.2	-	-	-	0.85	-	-	-	-	1.32	-	-	-	-	-	-	-	-	-	-	-	55.7	15.63	0.72	0.25	-	0.93	0.92	0.06	2.21	0.27	3.5	1.25	-	-	0.08	24.53	0.01	0.77	2.2	-	-	0.2	-	-	-	0.85	-	-	-	-	1.32	-	-	-	-	-	-	-	-	-	-	-	55.7
H0532_001_0	2006											-											A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	Coin	V	Coin	V	V	O											-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	293.15	4.33	1576.99	1740.59	385.87	13.79	7.42	316.42	283.34	2179.64	1034.15	0	16.54	1994.42	15026.64	15192.58	205.77	771.38	3834.9	9182.85	8.62	647.04	0	0	424.75	0	182.67	0	0	0	0											450	45000	0	0	100	20	20	50 ER 40 UC	100	0	0	100	0	20 Partial Hosp and CORF 0 Other	15	20	20	20	0	0	0.2	20 Vision Exams 0 Blood	0	20	20	0	20	0	0	0	0											450	450	0	0	100	0.2	0.2	49.5	100	0	0	100	0	2.68	4.91	6.1	20	20	0	0	0.2	19	0	20	20	0	20	0	0	0	0											-	450	450	0	0	100	0.2	0.2	49.5	100	0	0	100	0	2.68	4.91	6.1	20	20	0	0	0.2	19	0	20	20	0	20	0	0	0	0											0	10.99	0.16	-	-	3.22	2.76	1.48	1.31	2.36	-	-	-	-	0.45	6.15	7.72	0.34	1.29	-	-	1.72	1.02	-	-	0.71	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.99	10.99	0.16	-	-	3.22	2.76	1.48	1.31	2.36	-	-	-	-	0.45	6.15	7.72	0.34	1.29	-	-	1.72	1.02	-	-	0.71	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.99
H0532_005_0	2006											-											A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	Coin	V	Coin	V	V	O											-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	293.15	4.33	1576.99	1740.59	385.87	13.79	7.42	316.42	283.34	2179.64	1034.15	0	16.54	1994.42	15026.64	15192.58	205.77	771.38	3834.9	9182.85	8.62	647.04	0	0	424.75	0	182.67	0	0	0	0											450	45000	0	0	100	20	20	50 ER 40 UC	100	0	0	100	0	20 Partial Hosp and CORF 0 Other	15	20	20	20	0	0	0.2	20 Vision Exams 0 Blood	0	20	20	0	20	0	0	0	0											450	450	0	0	100	0.2	0.2	49.5	100	0	0	100	0	2.68	4.91	6.1	20	20	0	0	0.2	19	0	20	20	0	20	0	0	0	0											-	450	450	0	0	100	0.2	0.2	49.5	100	0	0	100	0	2.68	4.91	6.1	20	20	0	0	0.2	19	0	20	20	0	20	0	0	0	0											0	10.99	0.16	-	-	3.22	2.76	1.48	1.31	2.36	-	-	-	-	0.45	6.15	7.72	0.34	1.29	-	-	1.72	1.02	-	-	0.71	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.99	10.99	0.16	-	-	3.22	2.76	1.48	1.31	2.36	-	-	-	-	0.45	6.15	7.72	0.34	1.29	-	-	1.72	1.02	-	-	0.71	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.99
H0532_801_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	Coin	V	Coin	V	V	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	210.03	2.25	55.15	36.63	7.87	13.79	8.9	316.42	14.62	11.15	23.8	0	0.24	33.54	82.6	78.36	1.49	1.56	21.03	10.99	8.99	4.6	0	0	0	0	0	0	0	0	0																																																				0.06	0.06	0.13	0	0.23	0.23	0.23	50	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	0.06	0.06	0.13	0	0.23	0.23	0.23	50	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	12.82	0.14	7.05	-	1.83	3.21	2.07	1.32	3.41	-	-	-	0.06	7.81	19.25	18.26	0.35	0.36	4.9	2.56	2.09	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.57	12.82	0.14	7.05	-	1.83	3.21	2.07	1.32	3.41	-	-	-	0.06	7.81	19.25	18.26	0.35	0.36	4.9	2.56	2.09	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.57
H0532_802_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	Coin	V	Coin	V	V	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	210.03	2.25	55.15	36.63	7.87	13.79	8.9	316.42	14.62	11.15	23.8	0	0.24	33.54	82.6	78.36	1.49	1.56	21.03	10.99	8.99	4.6	0	0	0	0	0	0	0	0	0																																																				0.06	0.06	0.13	0	0.23	0.23	0.23	50	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	0.06	0.06	0.13	0	0.23	0.23	0.23	50	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	12.82	0.14	7.05	-	1.83	3.21	2.07	1.32	3.41	-	-	-	0.06	7.81	19.25	18.26	0.35	0.36	4.9	2.56	2.09	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.57	12.82	0.14	7.05	-	1.83	3.21	2.07	1.32	3.41	-	-	-	0.06	7.81	19.25	18.26	0.35	0.36	4.9	2.56	2.09	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.57
H0538_001_0	2006																						A	A			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	0	0	0	0	259.48	9.2	6.12	222.21	177.2	0	0	0	0	145.23	4131.89	6549.43	212.82	816.96	0	1340.68	5.04	26.45	0	0	366.18	247.9	0	0	0	0	0																	20 prosth/supp (11b) 0 diab supp (11c)								10 urgent care (4b 4b1)  20 ther inj	5 specialist visit (7d) 20 ther inj	5 MH (7e) 5 psych (7h) 5 SA (9c)	5 PT/OT (7c 7i) CORF (3)		5 chiro (7b) pod (7f) hearing (18a)						Copays vary																																																										0	0	0	0	50	0.2	0.18	50	100	0	0	0	0	5	2.18	4.5	5	5	0	5	0.2	100	0	0	35	52.79	0	0	0	0	0												-	-	-	-	1.08	1.84	1.12	0.93	1.48	-	-	-	-	0.06	0.75	2.46	0.09	0.34	-	0.56	1.01	0.22	-	-	1.07	1.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.09	-	-	-	-	1.08	1.84	1.12	0.93	1.48	-	-	-	-	0.06	0.75	2.46	0.09	0.34	-	0.56	1.01	0.22	-	-	1.07	1.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.09
H0538_002_0	2006																						D	D			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	982.26	19.74	0	0	269.97	9.71	6.47	291.13	251.18	0	0	0	0	162.14	9114.83	7336.35	240.23	924.33	0	1512.55	4.45	38.47	0	0	362.1	247.84	0	0	0	0	0											copay applies to days 1-20	copay applies to days 1-20					20 prosth/supp (11b) 0 diab supp (11c)								10 PCP (7a) 15 specialist (7d) urgent care (4b 4b1)  20 ther inj	10 PCP (7a) 15 specialist (7d) 20 ther inj	15 MH (7e) 15 psych (7h) 15 SA (9c)	15 PT/OT (7c 7i) CORF (3)		15 chiro (7b) pod (7f) hearing (18a)						Copays vary																																																										175	175	0	0	50	0.2	0.18	50	100	0	0	0	0	15	5.96	9.53	15	15	0	15	0.2	100	0	0	35	52.79	0	0	0	0	0												14.32	0.29	-	-	1.12	1.94	1.19	1.21	2.09	-	-	-	-	0.2	4.53	5.82	0.3	1.16	-	1.89	0.89	0.32	-	-	1.06	1.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.43	14.32	0.29	-	-	1.12	1.94	1.19	1.21	2.09	-	-	-	-	0.2	4.53	5.82	0.3	1.16	-	1.89	0.89	0.32	-	-	1.06	1.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.43
H0538_003_0	2006																						A	A			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	343.25	6.25	0	0	475.52	15.62	10.36	488.39	301.29	0	0	0	0	181	9103.82	7222.41	231.07	889.56	0	1433.89	5.44	69.85	0	0	448.1	329.6	0	0	0	0	0											copay is per admit	copay is per admit					20 prosth/supp (11b) 0 diab supp (11c)								10 PCP (7a) 15 specialist (7d) urgent care (4b 4b1)  20 ther inj	10 PCP (7a) 15 specialist (7d) 20 ther inj	15 MH (7e) 15 psych (7h) 15 SA (9c)	15 PT/OT (7c 7i) CORF (3)		15 chiro (7b) pod (7f) hearing (18a)						Copays vary																																																										250	250	0	0	50	0.2	0.18	50	100	0	0	0	0	15	5.92	9.41	15	15	0	15	0.2	100	0	0	35	52.79	0	0	0	0	0												7.15	0.13	-	-	1.98	3.12	1.9	2.03	2.51	-	-	-	-	0.23	4.49	5.66	0.29	1.11	-	1.79	1.09	0.58	-	-	1.31	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.83	7.15	0.13	-	-	1.98	3.12	1.9	2.03	2.51	-	-	-	-	0.23	4.49	5.66	0.29	1.11	-	1.79	1.09	0.58	-	-	1.31	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.83
H0538_009_0	2006																						Coin	Coin			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	314.31	2.82	0	0	0	11.4	7.58	0	0	0	0	0	0	0	0	0	0	0	0	0	5.89	0	0	0	0	0	0	0	0	0	0											Medicare deductibles	Medicare deductibles																																																																																		0.06	0.06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												17.61	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.77	17.61	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.77
H0538_013_0	2006																						D	D			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	794.4	16.56	0	0	174	8.99	6	231	208	0	0	0	0	148	8173	6462	197	759	0	1228	5.18	20	0	0	382	262	0	0	0	0	0											copay applies to days 1-20	copay applies to days 1-20					20 prosth/supp (11b) 0 diab supp (11c)								10 PCP (7a) 15 specialist (7d) urgent care (4b 4b1)  20 ther inj	10 PCP (7a) 15 specialist (7d) 20 ther inj	15 MH (7e) 15 psych (7h) 15 SA (9c)	15 PT/OT (7c 7i) CORF (3)		15 chiro (7b) pod (7f) hearing (18a)						Copays vary																																																										175	175	0	0	50	0.2	0.18	50	100	0	0	0	0	15	6.3	10.09	15	15	0	15	0.2	100	0	0	35	52.79	0	0	0	0	0												11.59	0.24	-	-	0.73	1.8	1.1	0.96	1.73	-	-	-	-	0.19	4.29	5.43	0.25	0.95	-	1.54	1.04	0.17	-	-	1.11	1.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.26	11.59	0.24	-	-	0.73	1.8	1.1	0.96	1.73	-	-	-	-	0.19	4.29	5.43	0.25	0.95	-	1.54	1.04	0.17	-	-	1.11	1.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.26
H0538_018_0	2006																						D	D			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	799.2	16.56	0	0	175	9.39	6.24	244	219	0	0	0	0	156	7682	6073	186	719	0	1151	5.04	20	0	0	356	262	0	0	0	0	0											copay applies to days 1-20	copay applies to days 1-20					20 prosth/supp (11b) 0 diab supp (11c)								10 PCP (7a) 15 specialist (7d) urgent care (4b 4b1)  20 ther inj	10 PCP (7a) 15 specialist (7d) 20 ther inj	15 MH (7e) 15 psych (7h) 15 SA (9c)	15 PT/OT (7c 7i) CORF (3)		15 chiro (7b) pod (7f) hearing (18a)						Copays vary																																																										175	175	0	0	50	0.2	0.18	50	100	0	0	0	0	15	6.28	10.09	15	15	0	15	0.2	100	0	0	35	52.79	0	0	0	0	0												11.66	0.24	-	-	0.73	1.88	1.15	1.02	1.83	-	-	-	-	0.2	4.02	5.11	0.23	0.9	-	1.44	1.01	0.17	-	-	1.04	1.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.76	11.66	0.24	-	-	0.73	1.88	1.15	1.02	1.83	-	-	-	-	0.2	4.02	5.11	0.23	0.9	-	1.44	1.01	0.17	-	-	1.04	1.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.76
H0538_020_0	2006																						Coin	Coin			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	262.64	2.3	0	0	0	12.2	8.11	0	0	0	0	0	0	0	0	0	0	0	0	0	5.79	0	0	0	0	0	0	0	0	0	0											Medicare deductibles	Medicare deductibles																																																																																		0.06	0.06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												15.83	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.97	15.83	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.97
H0538_802_0	2006																						D	D			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	906.87	18.63	0	0	254.83	10.38	6.91	286.79	229.28	0	0	0	0	165.2	8361	6905.04	218.44	839.26	0	1357.62	5.03	32.46	0	0	378.4	268.56	0	0	0	0	0											copay applies to days 1-20	copay applies to days 1-20					20 prosth/supp (11b) 0 diab supp (11c)								20 office visit (7a 7d) 20 urgent care (4b 4b1)  20 ther inj	20 office visit (7a 7d) 20 ther inj	20 MH (7e) 20 psych (7h) 20 SA (9c)	20 PT/OT (7c 7i) CORF (3)		20 chiro (7b) pod (7f) hearing (18a)						Copays vary																																																										150	150	0	0	50	0.2	0.18	50	100	0	0	0	0	20	11.53	12.58	20	20	0	20	0.2	100	0	0	35	52.79	0	0	0	0	0												11.34	0.23	-	-	1.06	2.08	1.27	1.19	1.91	-	-	-	-	0.28	8.03	7.24	0.36	1.4	-	2.26	1.01	0.27	-	-	1.1	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.22	11.34	0.23	-	-	1.06	2.08	1.27	1.19	1.91	-	-	-	-	0.28	8.03	7.24	0.36	1.4	-	2.26	1.01	0.27	-	-	1.1	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.22
H0538_803_0	2006																						D	D			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	906.87	18.63	0	0	254.83	10.38	6.91	286.79	229.28	0	0	0	0	165.2	8361	6905.04	218.44	839.26	0	1357.62	5.03	32.46	0	0	378.4	268.56	0	0	0	0	0											copay applies to days 1-20	copay applies to days 1-20					20 prosth/supp (11b) 0 diab supp (11c)								20 office visit (7a 7d) 20 urgent care (4b 4b1)  20 ther inj	20 office visit (7a 7d) 20 ther inj	20 MH (7e) 20 psych (7h) 20 SA (9c)	20 PT/OT (7c 7i) CORF (3)		20 chiro (7b) pod (7f) hearing (18a)						Copays vary																																																										150	150	0	0	50	0.2	0.18	50	100	0	0	0	0	20	11.53	12.58	20	20	0	20	0.2	100	0	0	35	52.79	0	0	0	0	0												11.34	0.23	-	-	1.06	2.08	1.27	1.19	1.91	-	-	-	-	0.28	8.03	7.24	0.36	1.4	-	2.26	1.01	0.27	-	-	1.1	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.22	11.34	0.23	-	-	1.06	2.08	1.27	1.19	1.91	-	-	-	-	0.28	8.03	7.24	0.36	1.4	-	2.26	1.01	0.27	-	-	1.1	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.22
H0538_804_0	2006																						D	D			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	906.87	18.63	0	0	254.83	10.38	6.91	286.79	229.28	0	0	0	0	165.2	8361	6905.04	218.44	839.26	0	1357.62	5.03	32.46	0	0	378.4	268.56	0	0	0	0	0											copay applies to days 1-20	copay applies to days 1-20					20 prosth/supp (11b) 0 diab supp (11c)								20 office visit (7a 7d) 20 urgent care (4b 4b1)  20 ther inj	20 office visit (7a 7d) 20 ther inj	20 MH (7e) 20 psych (7h) 20 SA (9c)	20 PT/OT (7c 7i) CORF (3)		20 chiro (7b) pod (7f) hearing (18a)						Copays vary																																																										150	150	0	0	50	0.2	0.18	50	100	0	0	0	0	20	11.53	12.58	20	20	0	20	0.2	100	0	0	35	52.79	0	0	0	0	0												11.34	0.23	-	-	1.06	2.08	1.27	1.19	1.91	-	-	-	-	0.28	8.03	7.24	0.36	1.4	-	2.26	1.01	0.27	-	-	1.1	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.22	11.34	0.23	-	-	1.06	2.08	1.27	1.19	1.91	-	-	-	-	0.28	8.03	7.24	0.36	1.4	-	2.26	1.01	0.27	-	-	1.1	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.22
H0538_805_0	2006																						D	D			T	Coin	Coin	V	V					V	P	P	V			V	Coin	V			V		V				V																																																					-	906.87	18.63	0	0	254.83	10.38	6.91	286.79	229.28	0	0	0	0	165.2	8361	6905.04	218.44	839.26	0	1357.62	5.03	32.46	0	0	378.4	268.56	0	0	0	0	0											copay applies to days 1-20	copay applies to days 1-20					20 prosth/supp (11b) 0 diab supp (11c)								20 office visit (7a 7d) 20 urgent care (4b 4b1)  20 ther inj	20 office visit (7a 7d) 20 ther inj	20 MH (7e) 20 psych (7h) 20 SA (9c)	20 PT/OT (7c 7i) CORF (3)		20 chiro (7b) pod (7f) hearing (18a)						Copays vary																																																										150	150	0	0	50	0.2	0.18	50	100	0	0	0	0	20	11.53	12.58	20	20	0	20	0.2	100	0	0	35	52.79	0	0	0	0	0												11.34	0.23	-	-	1.06	2.08	1.27	1.19	1.91	-	-	-	-	0.28	8.03	7.24	0.36	1.4	-	2.26	1.01	0.27	-	-	1.1	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.22	11.34	0.23	-	-	1.06	2.08	1.27	1.19	1.91	-	-	-	-	0.28	8.03	7.24	0.36	1.4	-	2.26	1.01	0.27	-	-	1.1	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.22
H0540_001_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1270.72	26.95	926.56	11.51	151.57	13.11	0.91	417.87	413.53	9.42	25.59			24.8	10656.01	5342.72	1.04	734.23	4251.55	19764.88		659.13			335.89		143.95			35.99												150 per day 750 annual max	300 per admit	75 each day for days 21-100		100 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	10 per visit	10 per visit		10 per visit	25 per visit	10 per visit		10 per visit			10 per visit		10 per visit			10 per visit												63	36.31	38.27	0.15	100	0.3	0.3	50	104.53	0.02	0.02			0.02	7.28	4.85	0.5	10	1.13	3.23		10			47.54		10			10												none	63	36.31	38.27	0.15	100	0.3	0.3	50	104.53	0.02	0.02			0.02	7.28	4.85	0.5	10	1.13	3.23		10			47.54		10			10													6.67	0.08	2.96	1.73	1.26	3.93	0.27	1.74	3.6	0.2	0.55	-	-	0.53	6.47	2.16	0.52	0.61	0.4	5.32	-	0.55	-	-	1.33	-	0.12	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	41.04	6.67	0.08	2.96	1.73	1.26	3.93	0.27	1.74	3.6	0.2	0.55	-	-	0.53	6.47	2.16	0.52	0.61	0.4	5.32	-	0.55	-	-	1.33	-	0.12	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	41.04
H0540_010_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1155.43	24.39	698.57	19.5	168.14	17.87	1.25	588.89	544.55	11.06	30.05			29.12	10650.76	5990.35	1.32	796.18	4588.23	19802.05		667.43			340.12		145.76			36.44												50 per admit	50 per admit	0 each day for days 21-100		25 per trip			25 per admit	25 per admit	See comment 1	See comment 1			See comment 1 2	10 per visit	10 per visit		10 per visit	10 per visit	10 per visit		10 per visit			10 per visit		10 per visit			10 per visit												8.82	6.05	0	0	25	0.2	0.2	25	36.25	0.02	0.02			0.02	7.47	4.91	0	10	0.99	3.49		10			52.6		10			10												none	8.82	6.05	0	0	25	0.2	0.2	25	36.25	0.02	0.02			0.02	7.47	4.91	0	10	0.99	3.49		10			52.6		10			10													0.85	0.01	-	-	0.35	3.57	0.25	1.23	1.65	0.24	0.64	-	-	0.62	6.63	2.45	-	0.66	0.38	5.75	-	0.56	-	-	1.49	-	0.12	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	27.49	0.85	0.01	-	-	0.35	3.57	0.25	1.23	1.65	0.24	0.64	-	-	0.62	6.63	2.45	-	0.66	0.38	5.75	-	0.56	-	-	1.49	-	0.12	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	27.49
H0540_012_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1492.72	31.66	726.95	17.4	179.98	15.65	1.09	369.51	365.67	8.86	24.09			23.34	12115.46	5845.51	1.17	783.55	4663.11	22851.13		764.18			389.42		166.89			41.72												150 per day 750 annual max	300 per admit	75 each day for days 21-100		100 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	10 per visit	10 per visit		10 per visit	25 per visit	10 per visit		10 per visit			10 per visit		10 per visit			10 per visit												63	36.31	38.27	0.15	100	0.3	0.3	50	105.47	0.02	0.02			0.02	7.48	4.99	0.5	10	1.25	3.01		10			50.58		10			10												none	63	36.31	38.27	0.15	100	0.3	0.3	50	105.47	0.02	0.02			0.02	7.48	4.99	0.5	10	1.25	3.01		10			50.58		10			10													7.84	0.1	2.32	2.61	1.5	4.69	0.33	1.54	3.21	0.19	0.52	-	-	0.5	7.55	2.43	0.59	0.65	0.49	5.72	-	0.64	-	-	1.64	-	0.14	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	45.23	7.84	0.1	2.32	2.61	1.5	4.69	0.33	1.54	3.21	0.19	0.52	-	-	0.5	7.55	2.43	0.59	0.65	0.49	5.72	-	0.64	-	-	1.64	-	0.14	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	45.23
H0540_013_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1475.07	31.28	817.96	20.23	170.77	15.81	1.1	378.22	374.28	9.61	26.13			25.32	12175.07	5820.4	1.2	770.29	4533.4	20938.3		773.31			394.07		168.89			42.22												150 per day 750 annual max	300 per admit	75 each day for days 21-100		100 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	10 per visit	10 per visit		10 per visit	25 per visit	10 per visit		10 per visit			10 per visit		10 per visit			10 per visit												63	36.31	38.27	0.15	100	0.3	0.3	50	106.39	0.02	0.02			0.02	7.59	4.89	0.5	10	1.18	3.22		10			53.54		10			10												none	63	36.31	38.27	0.15	100	0.3	0.3	50	106.39	0.02	0.02			0.02	7.59	4.89	0.5	10	1.18	3.22		10			53.54		10			10													7.74	0.09	2.61	3.03	1.42	4.74	0.33	1.58	3.32	0.21	0.56	-	-	0.54	7.7	2.37	0.6	0.64	0.45	5.61	-	0.64	-	-	1.76	-	0.14	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	46.13	7.74	0.09	2.61	3.03	1.42	4.74	0.33	1.58	3.32	0.21	0.56	-	-	0.54	7.7	2.37	0.6	0.64	0.45	5.61	-	0.64	-	-	1.76	-	0.14	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	46.13
H0540_015_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	P	T	V	Coin	P	V	P	O	V	V																																																					-	1060.07	20.54	780.9	22.17	284.41	22.31	1.56	397.91	375.01	0	1242.67	0	0.29	1535.88	0	0	172.72	235.61	0	9725.26	7.17	643.68	0	0	2.73	0	165.26	0	0	0	0											150 / day up to 5 days.	300 / admit	75 / day days 21 - 100	15 coinsurance	100 copay	30 coinsurance	30 coinsurance	50 ER copay / 10 Urgent Care copay	100 copay		25 Radiation Therapy copay		20 coinsurance	10 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	10 copay		10 PCP copay / 10 SCP copay		10 Vision Exams copay			50 coinsurance		10 copay															150	73.87	17.88	0.15	99.12	0.3	0.3	36.12	99.12	0	1.39	0	0	3.51	0	0	38.3	9.91	0	9.92	0	9.91	0	0	0.5	0	9.91	0	0	0	0												150	73.87	17.88	0.15	99.12	0.3	0.3	36.12	99.12	0	1.39	0	0	3.51	0	0	38.3	9.91	0	9.92	0	9.91	0	0	0.5	0	9.91	0	0	0	0												13.25	0.13	1.16	3.33	2.35	6.63	0.46	1.2	3.1	-	0.14	-	0	0.45	-	-	0.55	0.19	-	8.04	-	0.53	-	-	1.35	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.01	13.25	0.13	1.16	3.33	2.35	6.63	0.46	1.2	3.1	-	0.14	-	0	0.45	-	-	0.55	0.19	-	8.04	-	0.53	-	-	1.35	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.01
H0540_016_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	P	T	V	Coin	P	V	P	O	V	V																																																					-	1111.74	21.78	862.5	27.48	274.14	20.7	1.44	417.47	393.53	0	1304.04	0	0.31	1611.8	0	0	177.07	241.58	0	9843.71	7.69	650.2	0	0	2.7	0	167.07	0	0	0	0											150 / day up to 5 days.	300 / admit	75 / day days 21 - 100	15 coinsurance	100 copay	30 coinsurance	30 coinsurance	50 ER copay / 10 Urgent Care copay	100 copay		25 Radiation Therapy copay		20 coinsurance	10 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	10 copay		10 PCP copay / 10 SCP copay		10 Vision Exams copay			50 coinsurance		10 copay															150	73.53	17.88	0.15	99	0.3	0.3	36.08	99	0	1.4	0	0	3.51	0	0	38.26	9.9	0	9.91	0	9.9	0	0	0.5	0	9.9	0	0	0	0												150	73.53	17.88	0.15	99	0.3	0.3	36.08	99	0	1.4	0	0	3.51	0	0	38.26	9.9	0	9.91	0	9.9	0	0	0.5	0	9.9	0	0	0	0												13.9	0.13	1.28	4.12	2.26	6.15	0.43	1.26	3.25	-	0.15	-	0	0.47	-	-	0.56	0.2	-	8.13	-	0.54	-	-	1.34	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.3	13.9	0.13	1.28	4.12	2.26	6.15	0.43	1.26	3.25	-	0.15	-	0	0.47	-	-	0.56	0.2	-	8.13	-	0.54	-	-	1.34	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.3
H0540_017_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1214.22	25.75	1086.79	8.48	163.35	11.38	0.79	380.26	376.3	9.62	26.14			25.33	10512.09	5194.34	1.03	766.89	4371.06	20404.26		639.32			325.79		139.63			34.91												150 per day 750 annual max	300 per admit	75 each day for days 21-100		100 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	10 per visit	10 per visit		10 per visit	25 per visit	10 per visit		10 per visit			10 per visit		10 per visit			10 per visit												63	36.31	38.27	0.15	100	0.3	0.3	50	106.31	0.02	0.02			0.02	7.14	5	0.5	10	1.11	3.26		10			44.79		10			10												none	63	36.31	38.27	0.15	100	0.3	0.3	50	106.31	0.02	0.02			0.02	7.14	5	0.5	10	1.11	3.26		10			44.79		10			10													6.38	0.08	3.47	1.27	1.36	3.41	0.24	1.58	3.33	0.21	0.56	-	-	0.54	6.26	2.16	0.51	0.64	0.4	5.54	-	0.53	-	-	1.22	-	0.12	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	39.84	6.38	0.08	3.47	1.27	1.36	3.41	0.24	1.58	3.33	0.21	0.56	-	-	0.54	6.26	2.16	0.51	0.64	0.4	5.54	-	0.53	-	-	1.22	-	0.12	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	39.84
H0540_018_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1079.58	23	662.17	17.04	159.38	16.5	1.15	491.22	486.11	10.43	28.35			27.47	10007.39	5489.23	1.15	731.11	4259.48	18539.36		612.89			312.32		133.85			34.54												200 per day 1000 annual max	300 per admit	75 each day for days 21-100		100 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	15 per visit	15 per visit		15 per visit	25 per visit	15 per visit		15 per visit			11 per visit		15 per visit			10 per visit												84	36.31	38.27	0.15	100	0.3	0.3	50	103.69	0.02	0.02			0.02	8.41	6.64	0.5	15	1.04	4.1		15			52.35		15			10												none	84	36.31	38.27	0.15	100	0.3	0.3	50	103.69	0.02	0.02			0.02	8.41	6.64	0.5	15	1.04	4.1		15			52.35		15			10													7.56	0.07	2.11	2.56	1.33	4.95	0.35	2.05	4.2	0.22	0.61	-	-	0.59	7.02	3.04	0.57	0.91	0.37	6.34	-	0.77	-	-	1.36	-	0.17	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	47.16	7.56	0.07	2.11	2.56	1.33	4.95	0.35	2.05	4.2	0.22	0.61	-	-	0.59	7.02	3.04	0.57	0.91	0.37	6.34	-	0.77	-	-	1.36	-	0.17	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	47.16
H0540_019_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1075.58	22.75	648.7	17.07	159.53	16.54	1.15	491.7	486.58	10.45	28.4			27.52	9908.78	5491.22	1.15	731.82	4263.58	18493.24		613.48			312.62		133.98			34.58												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			13.75 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	103.7	0.02	0.02			0.02	10.87	10.07	0.5	25	1.04	5.51		25			52.4		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	103.7	0.02	0.02			0.02	10.87	10.07	0.5	25	1.04	5.51		25			52.4		25			10													9.41	0.21	2.76	2.56	1.99	4.96	0.35	2.05	4.2	0.22	0.61	-	-	0.59	8.98	4.61	0.58	1.52	0.37	8.49	-	1.28	-	-	1.37	-	0.28	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	57.41	9.41	0.21	2.76	2.56	1.99	4.96	0.35	2.05	4.2	0.22	0.61	-	-	0.59	8.98	4.61	0.58	1.52	0.37	8.49	-	1.28	-	-	1.37	-	0.28	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	57.41
H0540_020_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1345.18	28.32	835.9	14.39	165.01	14.46	1.01	427.13	422.69	9.66	26.25			25.43	11128.64	5592.49	1.13	758.23	4320.15	20188.82		683			348.05		149.16			38.49												200 per day 1000 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			13.75 per visit		25 per visit			10 per visit												84	108.94	51.03	0.15	150	0.3	0.3	50	104.58	0.02	0.02			0.02	10.76	10.14	0.5	25	1.13	5.24		25			49.04		25			10												none	84	108.94	51.03	0.15	150	0.3	0.3	50	104.58	0.02	0.02			0.02	10.76	10.14	0.5	25	1.13	5.24		25			49.04		25			10													9.42	0.26	3.55	2.16	2.06	4.34	0.3	1.78	3.68	0.21	0.56	-	-	0.54	9.98	4.72	0.57	1.58	0.41	8.81	-	1.42	-	-	1.42	-	0.31	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	58.13	9.42	0.26	3.55	2.16	2.06	4.34	0.3	1.78	3.68	0.21	0.56	-	-	0.54	9.98	4.72	0.57	1.58	0.41	8.81	-	1.42	-	-	1.42	-	0.31	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	58.13
H0540_021_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1491.21	31.39	714.06	17.53	180.63	15.76	1.1	370.85	366.99	8.93	24.26			23.51	11969.42	5821.45	1.18	761.81	4583.48	22557.05		742.98			378.61		162.26			41.87												200 per day 1000 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			13.75 per visit		25 per visit			10 per visit												84	108.94	51.03	0.15	150	0.3	0.3	50	105.52	0.02	0.02			0.02	10.89	10.01	0.5	25	1.25	4.74		25			50.76		25			10												none	84	108.94	51.03	0.15	150	0.3	0.3	50	105.52	0.02	0.02			0.02	10.89	10.01	0.5	25	1.25	4.74		25			50.76		25			10													10.44	0.28	3.04	2.63	2.26	4.73	0.33	1.55	3.23	0.19	0.52	-	-	0.5	10.86	4.86	0.59	1.59	0.48	8.9	-	1.55	-	-	1.6	-	0.34	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	60.49	10.44	0.28	3.04	2.63	2.26	4.73	0.33	1.55	3.23	0.19	0.52	-	-	0.5	10.86	4.86	0.59	1.59	0.48	8.9	-	1.55	-	-	1.6	-	0.34	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	60.49
H0540_022_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1473.61	31.02	803.47	20.38	171.39	15.92	1.11	379.59	375.64	9.68	26.32			25.5	12027.69	5797.35	1.21	748.93	4456.1	20675.8		751.88			383.15		164.21			42.38												200 per day 1000 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			13.75 per visit		25 per visit			10 per visit												84	108.94	51.03	0.15	150	0.3	0.3	50	106.45	0.02	0.02			0.02	10.98	9.84	0.5	25	1.18	5.07		25			53.74		25			10												none	84	108.94	51.03	0.15	150	0.3	0.3	50	106.45	0.02	0.02			0.02	10.98	9.84	0.5	25	1.18	5.07		25			53.74		25			10													10.32	0.28	3.42	3.06	2.14	4.78	0.33	1.58	3.33	0.21	0.56	-	-	0.55	11.01	4.75	0.6	1.56	0.44	8.74	-	1.57	-	-	1.72	-	0.34	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	61.31	10.32	0.28	3.42	3.06	2.14	4.78	0.33	1.58	3.33	0.21	0.56	-	-	0.55	11.01	4.75	0.6	1.56	0.44	8.74	-	1.57	-	-	1.72	-	0.34	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	61.31
H0540_023_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1210.55	25.48	1065.36	8.5	163.61	11.41	0.8	380.86	376.9	9.65	26.22			25.41	10454.77	5158.65	1.03	744.11	4287.76	20163.5		620.33			316.11		135.48			34.96												200 per day 1000 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	15 per visit	15 per visit		15 per visit	25 per visit	15 per visit		15 per visit			11.25 per visit		15 per visit			10 per visit												84	108.94	51.03	0.15	150	0.3	0.3	50	106.33	0.02	0.02			0.02	8.26	6.82	0.5	15	1.11	3.9		15			44.86		15			10												none	84	108.94	51.03	0.15	150	0.3	0.3	50	106.33	0.02	0.02			0.02	8.26	6.82	0.5	15	1.11	3.9		15			44.86		15			10													8.47	0.23	4.53	1.28	2.05	3.42	0.24	1.59	3.34	0.21	0.56	-	-	0.54	7.19	2.93	0.52	0.93	0.4	6.55	-	0.78	-	-	1.18	-	0.17	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	47.13	8.47	0.23	4.53	1.28	2.05	3.42	0.24	1.59	3.34	0.21	0.56	-	-	0.54	7.19	2.93	0.52	0.93	0.4	6.55	-	0.78	-	-	1.18	-	0.17	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	47.13
H0540_024_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	P	T	V	Coin	P	V	P	O	V	V																																																					-	1060.1	20.41	773	22.17	281.59	22.09	1.54	381.48	371.29	0	1230.35	0	0.29	1520.66	0	0	171.01	216.3	0	9185.22	7.1	584.16	0	0	2.48	0	150.04	0	0	0	0											200 / day up to 5 days.	900 / admit	100 / day days 21 - 100	15 coinsurance	150 copay	30 coinsurance	30 coinsurance	50 ER copay / 25 Urgent Care copay	100 copay		25 Radiation Therapy copay		20 coinsurance	25 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	25 copay		10 PCP copay / 25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	25 Vision Exams copay			50 coinsurance		25 copay															200	140.73	23.83	0.15	150.16	0.3	0.3	41.56	100.11	0	1.41	0	0	7.01	0	0	40.11	23.14	0	18.2	0.2	25.03	0	0	0.5	0	25.03	0	0	0	0												200	140.73	23.83	0.15	150.16	0.3	0.3	41.56	100.11	0	1.41	0	0	7.01	0	0	40.11	23.14	0	18.2	0.2	25.03	0	0	0.5	0	25.03	0	0	0	0												17.67	0.24	1.54	3.33	3.52	6.63	0.46	1.32	3.1	-	0.14	-	0	0.89	-	-	0.57	0.42	-	13.93	1.42	1.22	-	-	1.24	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.95	17.67	0.24	1.54	3.33	3.52	6.63	0.46	1.32	3.1	-	0.14	-	0	0.89	-	-	0.57	0.42	-	13.93	1.42	1.22	-	-	1.24	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.95
H0540_025_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	P	T	V	Coin	P	V	P	O	V	V																																																					-	1111.77	21.39	853.8	27.48	271.29	20.49	1.43	400.14	389.45	0	1290.49	0	0.31	1595.06	0	0	175.23	221.65	0	9291.9	7.61	589.87	0	0	2.45	0	151.54	0	0	0	0											200 / day up to 5 days.	900 / admit	100 / day days 21 - 100	15 coinsurance	150 copay	30 coinsurance	30 coinsurance	50 ER copay / 25 Urgent Care copay	100 copay		25 Radiation Therapy copay		20 coinsurance	25 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	25 copay		10 PCP copay / 25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	25 Vision Exams copay			50 coinsurance		25 copay															200	140.8	23.83	0.15	150.06	0.3	0.3	41.53	100.04	0	1.42	0	0	7.01	0	0	40.08	23.36	0	18.2	0.2	25.01	0	0	0.5	0	25.01	0	0	0	0												200	140.8	23.83	0.15	150.06	0.3	0.3	41.53	100.04	0	1.42	0	0	7.01	0	0	40.08	23.36	0	18.2	0.2	25.01	0	0	0.5	0	25.01	0	0	0	0												18.53	0.25	1.7	4.12	3.39	6.15	0.43	1.38	3.25	-	0.15	-	0	0.93	-	-	0.59	0.43	-	14.09	1.52	1.23	-	-	1.22	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.68	18.53	0.25	1.7	4.12	3.39	6.15	0.43	1.38	3.25	-	0.15	-	0	0.93	-	-	0.59	0.43	-	14.09	1.52	1.23	-	-	1.22	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.68
H0540_026_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1093.52	23.02	917.04	6.17	129.88	11.16	0.78	408.16	403.92	9.34	25.38			24.59	9592.9	4859.75	0.9	638.25	3947.76	18462.94		568.82			289.87		124.23			32.06												200 per day 1000 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	15 per visit	15 per visit		15 per visit	25 per visit	15 per visit		15 per visit			11.25 per visit		15 per visit			10 per visit												84	108.94	51.03	0.15	150	0.3	0.3	50	104.75	0.02	0.02			0.02	8.25	6.36	0.5	15	1.16	3.67		15			45.46		15			10												none	84	108.94	51.03	0.15	150	0.3	0.3	50	104.75	0.02	0.02			0.02	8.25	6.36	0.5	15	1.16	3.67		15			45.46		15			10													7.66	0.21	3.9	0.93	1.62	3.35	0.23	1.7	3.53	0.2	0.54	-	-	0.53	6.6	2.57	0.45	0.8	0.38	5.64	-	0.71	-	-	1.1	-	0.16	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	42.82	7.66	0.21	3.9	0.93	1.62	3.35	0.23	1.7	3.53	0.2	0.54	-	-	0.53	6.6	2.57	0.45	0.8	0.38	5.64	-	0.71	-	-	1.1	-	0.16	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	42.82
H0540_801_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1354.21	28.64	807.58	14.54	160.95	14.26	0.99	407.56	403.31	9.45	25.69			24.89	11152.02	5536.02	1.11	740	4317.8	20444.3		685.89			349.52		149.8			38.66												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			13.75 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	104.95	0.02	0.02			0.02	10.79	9.99	0.5	25	1.13	5.06		25			49.31		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	104.95	0.02	0.02			0.02	10.79	9.99	0.5	25	1.13	5.06		25			49.31		25			10													11.85	0.26	3.43	2.18	2.01	4.28	0.3	1.7	3.53	0.2	0.55	-	-	0.53	10.02	4.61	0.56	1.54	0.41	8.62	-	1.43	-	-	1.44	-	0.31	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	59.78	11.85	0.26	3.43	2.18	2.01	4.28	0.3	1.7	3.53	0.2	0.55	-	-	0.53	10.02	4.61	0.56	1.54	0.41	8.62	-	1.43	-	-	1.44	-	0.31	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	59.78
H0540_802_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1354.21	28.64	807.58	14.54	160.95	14.26	0.99	407.56	403.31	9.45	25.69			24.89	11152.02	5536.02	1.11	740	4317.8	20444.3		685.89			349.52		149.8			38.66												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			13.75 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	104.95	0.02	0.02			0.02	10.79	9.99	0.5	25	1.13	5.06		25			49.31		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	104.95	0.02	0.02			0.02	10.79	9.99	0.5	25	1.13	5.06		25			49.31		25			10													11.85	0.26	3.43	2.18	2.01	4.28	0.3	1.7	3.53	0.2	0.55	-	-	0.53	10.02	4.61	0.56	1.54	0.41	8.62	-	1.43	-	-	1.44	-	0.31	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	59.78	11.85	0.26	3.43	2.18	2.01	4.28	0.3	1.7	3.53	0.2	0.55	-	-	0.53	10.02	4.61	0.56	1.54	0.41	8.62	-	1.43	-	-	1.44	-	0.31	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	59.78
H0540_803_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1605.04	33.94	578.8	20.19	224.84	21.05	1.47	386.84	382.81	9.91	26.94			26.11	12555.27	5954.86	1.23	745.75	4976.39	21894		769.67			392.21		168.09			43.38												200 per day 1000 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	15 per visit	15 per visit		15 per visit	25 per visit	15 per visit		15 per visit			11.25 per visit		15 per visit			10 per visit												84	108.94	51.03	0.15	150	0.3	0.3	50	106.52	0.02	0.02			0.02	8.52	6.35	0.5	15	1.25	3.62		15			55.52		15			10												none	84	108.94	51.03	0.15	150	0.3	0.3	50	106.52	0.02	0.02			0.02	8.52	6.35	0.5	15	1.25	3.62		15			55.52		15			10													11.24	0.31	2.46	3.03	2.81	6.31	0.44	1.61	3.4	0.21	0.58	-	-	0.56	8.91	3.15	0.62	0.93	0.52	6.61	-	0.96	-	-	1.81	-	0.21	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	56.72	11.24	0.31	2.46	3.03	2.81	6.31	0.44	1.61	3.4	0.21	0.58	-	-	0.56	8.91	3.15	0.62	0.93	0.52	6.61	-	0.96	-	-	1.81	-	0.21	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	56.72
H0540_804_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1605.04	33.94	578.8	20.19	224.84	21.05	1.47	386.84	382.81	9.91	26.94			26.11	12555.27	5954.86	1.23	745.75	4976.39	21894		769.67			392.21		168.09			43.38												200 per day 1000 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	15 per visit	15 per visit		15 per visit	25 per visit	15 per visit		15 per visit			11.25 per visit		15 per visit			10 per visit												84	108.94	51.03	0.15	150	0.3	0.3	50	106.52	0.02	0.02			0.02	8.52	6.35	0.5	15	1.25	3.62		15			55.52		15			10												none	84	108.94	51.03	0.15	150	0.3	0.3	50	106.52	0.02	0.02			0.02	8.52	6.35	0.5	15	1.25	3.62		15			55.52		15			10													11.24	0.31	2.46	3.03	2.81	6.31	0.44	1.61	3.4	0.21	0.58	-	-	0.56	8.91	3.15	0.62	0.93	0.52	6.61	-	0.96	-	-	1.81	-	0.21	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	56.72	11.24	0.31	2.46	3.03	2.81	6.31	0.44	1.61	3.4	0.21	0.58	-	-	0.56	8.91	3.15	0.62	0.93	0.52	6.61	-	0.96	-	-	1.81	-	0.21	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	56.72
H0540_805_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1172.32	24.79	1004.03	8.16	163.1	11.41	0.8	380.47	376.51	9.69	26.33			25.51	10322.18	5139.03	1.03	741.82	4274.54	20047.33		618.42			315.14		135.06			34.85												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			25 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	106.42	0.02	0.02			0.02	17.54	10.54	0.5	25	1.11	7.92		25			44.96		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	106.42	0.02	0.02			0.02	17.54	10.54	0.5	25	1.11	7.92		25			44.96		25			10													10.26	0.23	4.27	1.22	2.04	3.42	0.24	1.59	3.34	0.21	0.56	-	-	0.55	15.09	4.51	0.52	1.55	0.4	13.23	-	1.29	-	-	1.18	-	0.28	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	65.98	10.26	0.23	4.27	1.22	2.04	3.42	0.24	1.59	3.34	0.21	0.56	-	-	0.55	15.09	4.51	0.52	1.55	0.4	13.23	-	1.29	-	-	1.18	-	0.28	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	65.98
H0540_806_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1172.32	24.79	1004.03	8.16	163.1	11.41	0.8	380.47	376.51	9.69	26.33			25.51	10322.18	5139.03	1.03	741.82	4274.54	20047.33		618.42			315.14		135.06			34.85												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			25 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	106.42	0.02	0.02			0.02	17.54	10.54	0.5	25	1.11	7.92		25			44.96		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	106.42	0.02	0.02			0.02	17.54	10.54	0.5	25	1.11	7.92		25			44.96		25			10													10.26	0.23	4.27	1.22	2.04	3.42	0.24	1.59	3.34	0.21	0.56	-	-	0.55	15.09	4.51	0.52	1.55	0.4	13.23	-	1.29	-	-	1.18	-	0.28	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	65.98	10.26	0.23	4.27	1.22	2.04	3.42	0.24	1.59	3.34	0.21	0.56	-	-	0.55	15.09	4.51	0.52	1.55	0.4	13.23	-	1.29	-	-	1.18	-	0.28	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	65.98
H0540_807_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H0540_808_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H0540_809_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H0540_810_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H0540_811_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H0540_812_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H0543_001_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1287.27	32.97	1160.73	2228.27	269.86	19.77	113.01	340.92	264.57	0	16.72	0	93.38	635.82	6218.45	4488.75	194.89	301.12	3867.81	7914.82	23.55	0	0	0	92.56	258.17	0	0	0	0	275.33											250 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	109.69	49	0	75	0.2	29.82	49.12	100	0	0.2	0	0	89.38	5	10	30	30	4	0	0.2	0	0	0	25	20	0	0	0	0	0											0	43.55	109.69	49	0	75	0.2	29.82	49.12	100	0	0.2	0	0	89.38	5	10	30	30	4	0	0.2	0	0	0	25	20	0	0	0	0	0												4.67	0.3	4.74	-	1.69	3.95	0.28	1.4	2.2	-	3.34	-	-	4.74	2.59	3.74	0.49	0.75	1.29	-	4.71	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.51	4.67	0.3	4.74	-	1.69	3.95	0.28	1.4	2.2	-	3.34	-	-	4.74	2.59	3.74	0.49	0.75	1.29	-	4.71	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.51
H0543_004_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1214.61	31.11	1139.36	2228.52	269.89	17.7	111.69	336.92	268.26	0	14.97	0	91.03	640.45	6219.17	4489.27	194.91	301.16	3884.03	7915.73	24.32	0	0	0	92.57	258.2	0	0	0	0	275.36											200 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											34.84	109.69	49	0	75	0.2	27.02	49.12	100	0	0.2	0	0	89.58	5	10	30	30	3.57	0	0.2	0	0	0	25	20	0	0	0	0	0											0	34.84	109.69	49	0	75	0.2	27.02	49.12	100	0	0.2	0	0	89.58	5	10	30	30	3.57	0	0.2	0	0	0	25	20	0	0	0	0	0												3.53	0.28	4.65	-	1.69	3.54	0.25	1.38	2.24	-	2.99	-	-	4.78	2.59	3.74	0.49	0.75	1.15	-	4.86	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.54	3.53	0.28	4.65	-	1.69	3.54	0.25	1.38	2.24	-	2.99	-	-	4.78	2.59	3.74	0.49	0.75	1.15	-	4.86	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.54
H0543_007_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1312.87	33.63	1061.35	2212.66	267.97	17.27	112.22	338.53	262.3	0	14.61	0	83.04	631.36	6174.91	4457.32	193.53	299.01	3856.62	7859.39	23.93	0	0	0	91.91	256.36	0	0	0	0	273.4											250 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	109.69	49	0	75	0.2	26.24	49.12	100	0	0.2	0	0	89.38	5	10	30	30	3.5	0	0.2	0	0	0	25	20	0	0	0	0	0											0	43.55	109.69	49	0	75	0.2	26.24	49.12	100	0	0.2	0	0	89.38	5	10	30	30	3.5	0	0.2	0	0	0	25	20	0	0	0	0	0												4.77	0.31	4.33	-	1.67	3.45	0.25	1.39	2.19	-	2.92	-	-	4.7	2.57	3.71	0.48	0.75	1.13	-	4.79	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.02	4.77	0.31	4.33	-	1.67	3.45	0.25	1.39	2.19	-	2.92	-	-	4.7	2.57	3.71	0.48	0.75	1.13	-	4.79	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.02
H0543_013_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1312.87	33.63	742.83	2199.67	266.4	15.87	111.56	336.55	262.3	0	13.42	0	92.18	627.66	5371.31	3748.01	192.39	297.26	3247.49	6635.47	23.92	0	0	0	91.37	254.85	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	24.25	49.12	100	0	0.2	0	0	89.38	15	30	30	30	3.82	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	24.25	49.12	100	0	0.2	0	0	89.38	15	30	30	30	3.82	0	0.2	0	0	0	25	20	0	0	0	0	0												7.62	0.31	3.03	-	1.66	3.17	0.23	1.38	2.19	-	2.68	-	-	4.67	6.71	9.37	0.48	0.74	1.04	-	4.78	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.69	7.62	0.31	3.03	-	1.66	3.17	0.23	1.38	2.19	-	2.68	-	-	4.67	6.71	9.37	0.48	0.74	1.04	-	4.78	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.69
H0543_019_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1514.33	38.79	742.83	2218.6	268.69	17.64	113.84	353.39	268.26	0	14.92	0	71.46	652.77	5715.22	4003.74	194.05	299.82	3524.04	7195.42	23.8	0	0	0	92.16	257.05	0	0	0	0	274.13											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	26.42	49.12	175	0	0.2	0	0	153.41	10	20	30	30	3.92	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	26.42	49.12	175	0	0.2	0	0	153.41	10	20	30	30	3.92	0	0.2	0	0	0	25	20	0	0	0	0	0												8.79	0.35	3.03	-	1.68	3.53	0.25	1.45	3.91	-	2.98	-	-	8.35	4.76	6.67	0.49	0.75	1.15	-	4.76	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.53	8.79	0.35	3.03	-	1.68	3.53	0.25	1.45	3.91	-	2.98	-	-	8.35	4.76	6.67	0.49	0.75	1.15	-	4.76	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.53
H0543_022_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1514.33	38.79	1251.78	2243.25	271.68	19.21	112.42	339.15	270.59	0	16.25	0	70.57	644.68	5778.69	4048.21	196.2	303.15	3550.27	7275.34	23.44	0	0	0	93.18	259.9	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	29.14	49.12	175	0	0.2	0	0	153.41	10	20	30	30	4.24	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	29.14	49.12	175	0	0.2	0	0	153.41	10	20	30	30	4.24	0	0.2	0	0	0	25	20	0	0	0	0	0												8.79	0.35	5.11	-	1.7	3.84	0.27	1.39	3.95	-	3.25	-	-	8.24	4.82	6.75	0.49	0.76	1.25	-	4.69	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.28	8.79	0.35	5.11	-	1.7	3.84	0.27	1.39	3.95	-	3.25	-	-	8.24	4.82	6.75	0.49	0.76	1.25	-	4.69	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.28
H0543_026_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1338.82	34.29	1017.3	2223.1	269.24	17.9	112.05	340.65	270.23	0	15.14	0	87.28	631.69	5054.59	3787.93	194.44	300.43	3217.84	6581.83	23.82	0	0	0	0	0	0	0	0	0	0											912 per admit	912 per admit	0 days 1-20; 114 days 21-100	Covered in Full	80	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :20 PCP; 30 in-area in-network 50 other	Ambulatory Surgical Center: 275; Outpatient Hospital: 275	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 275; Non-Surgical Cases - ASC: 275	20	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	0	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not Covered		Acupuncture: Not covered; Chiropractic : Not covered											158.89	109.69	56	0	80	0.2	27.23	49.12	275	0	0.2	0	0	237.89	20	30	30	30	4.35	0	0.2	0	0	0	0	0	0	0	0	0	0											0	158.89	109.69	56	0	80	0.2	27.23	49.12	275	0	0.2	0	0	237.89	20	30	30	30	4.35	0	0.2	0	0	0	0	0	0	0	0	0	0												17.73	0.31	4.75	-	1.79	3.58	0.25	1.39	6.19	-	3.03	-	-	12.52	8.42	9.47	0.49	0.75	1.17	-	4.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.62	17.73	0.31	4.75	-	1.79	3.58	0.25	1.39	6.19	-	3.03	-	-	12.52	8.42	9.47	0.49	0.75	1.17	-	4.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.62
H0543_028_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2199.19	266.34	20.53	110.22	365.56	283.33	0	17.37	0	84.56	632.02	5665.22	4430.19	227.41	409.34	3647.49	7469.91	23.96	0	0	0	91.35	254.8	0	0	0	0	0											200 per admit	200 per admit	0 [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	25 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 40; Urgent Care :10 PCP Copay;20 In Area/In Network;40 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	10	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											34.84	24.06	0	0	25	0.2	31.76	39.11	0	0	0.2	0	0	0	10	10	10	0	4.41	0	0.2	0	0	0	25	20	0	0	0	0	0											0	34.84	24.06	0	0	25	0.2	31.76	39.11	0	0	0.2	0	0	0	10	10	10	0	4.41	0	0.2	0	0	0	25	20	0	0	0	0	0												4.22	0.07	-	-	0.55	4.11	0.29	1.19	-	-	3.47	-	-	-	4.72	3.69	0.19	-	1.34	-	4.79	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.26	4.22	0.07	-	-	0.55	4.11	0.29	1.19	-	-	3.47	-	-	-	4.72	3.69	0.19	-	1.34	-	4.79	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.26
H0543_029_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1381.46	35.39	1210.8	2261.42	273.88	21.35	111.71	346.79	296.22	0	18.06	0	70.12	606.86	5825.51	4081	197.79	305.6	3578.17	7334.27	23.72	0	0	0	93.94	262.01	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	32.59	49.12	175	0	0.2	0	0	152.21	10	20	30	30	4.67	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	32.59	49.12	175	0	0.2	0	0	152.21	10	20	30	30	4.67	0	0.2	0	0	0	25	20	0	0	0	0	0												8.02	0.32	4.94	-	1.71	4.27	0.3	1.42	4.32	-	3.61	-	-	7.7	4.85	6.8	0.49	0.76	1.39	-	4.74	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.31	8.02	0.32	4.94	-	1.71	4.27	0.3	1.42	4.32	-	3.61	-	-	7.7	4.85	6.8	0.49	0.76	1.39	-	4.74	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.31
H0543_032_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1171.52	30.01	917.97	2230.82	270.17	17.22	111.8	337.27	268.26	0	14.56	0	85.21	641.11	5746.67	4025.77	195.11	301.47	3544.75	7235.02	23.93	0	0	0	92.67	258.46	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	26.25	49.12	175	0	0.2	0	0	153.41	10	20	30	30	3.8	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	26.25	49.12	175	0	0.2	0	0	153.41	10	20	30	30	3.8	0	0.2	0	0	0	25	20	0	0	0	0	0												6.8	0.27	3.75	-	1.69	3.44	0.24	1.38	3.91	-	2.91	-	-	8.2	4.79	6.71	0.49	0.75	1.12	-	4.79	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.88	6.8	0.27	3.75	-	1.69	3.44	0.24	1.38	3.91	-	2.91	-	-	8.2	4.79	6.71	0.49	0.75	1.12	-	4.79	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.88
H0543_035_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1657.92	42.47	1315.15	2173.47	263.23	18.42	111.52	372.73	415.81	0	15.58	0	85	639.49	5692.27	4451.35	224.75	404.55	3666.15	7503.43	24.2	0	0	0	90.28	251.82	0	0	0	0	0											200 Select/800 Standard per admit	20000	0 [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	25 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 40; Urgent Care :9 PCP Copay;20 In Area/In Network;40 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	9	9	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											55.44	24.06	0	0	25	0.2	28.17	39.11	0	0	0.2	0	0	0	9	9	10	0	3.93	0	0.2	0	0	0	25	20	0	0	0	0	0											0	55.44	24.06	0	0	25	0.2	28.17	39.11	0	0	0.2	0	0	0	9	9	10	0	3.93	0	0.2	0	0	0	25	20	0	0	0	0	0												7.66	0.09	-	-	0.55	3.68	0.26	1.21	-	-	3.12	-	-	-	4.27	3.34	0.19	-	1.2	-	4.84	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.02	7.66	0.09	-	-	0.55	3.68	0.26	1.21	-	-	3.12	-	-	-	4.27	3.34	0.19	-	1.2	-	4.84	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.02
H0543_036_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2195.26	265.86	19.38	112.64	373.59	283.33	0	16.39	0	85.85	645.9	5655.08	4422.26	227	408.61	3641.05	7456.55	23.78	0	0	0	91.19	254.34	0	0	0	0	0											200 Select/800 Standard per admit	200 per admit	0 [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	25 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 40; Urgent Care :10 PCP Copay;20 In Area/In Network;40 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	10	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											44.25	24.06	0	0	25	0.2	29.34	39.11	0	0	0.2	0	0	0	10	10	10	0	4.17	0	0.2	0	0	0	25	20	0	0	0	0	0											0	44.25	24.06	0	0	25	0.2	29.34	39.11	0	0	0.2	0	0	0	10	10	10	0	4.17	0	0.2	0	0	0	25	20	0	0	0	0	0												5.36	0.07	-	-	0.55	3.88	0.28	1.22	-	-	3.28	-	-	-	4.71	3.69	0.19	-	1.26	-	4.76	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.86	5.36	0.07	-	-	0.55	3.88	0.28	1.22	-	-	3.28	-	-	-	4.71	3.69	0.19	-	1.26	-	4.76	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.86
H0543_046_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1216.48	31.16	1483.7	2215.27	268.29	21.45	111.02	334.92	363.81	0	18.14	0	85.18	636.64	5409.4	3775.58	193.75	299.37	3255.58	6682.53	24.46	0	0	0	92.02	256.66	0	0	0	0	0											600 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											104.53	109.69	49	0	75	0.2	32.94	49.12	200	0	0.2	0	0	174.69	15	29.95	30	30	5.16	0	0.2	0	0	0	25	20	0	0	0	0	0											0	104.53	109.69	49	0	75	0.2	32.94	49.12	200	0	0.2	0	0	174.69	15	29.95	30	30	5.16	0	0.2	0	0	0	25	20	0	0	0	0	0												10.6	0.28	6.06	-	1.68	4.29	0.3	1.37	6.06	-	3.63	-	-	9.27	6.76	9.42	0.48	0.75	1.4	-	4.89	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.87	10.6	0.28	6.06	-	1.68	4.29	0.3	1.37	6.06	-	3.63	-	-	9.27	6.76	9.42	0.48	0.75	1.4	-	4.89	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.87
H0543_049_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1204.51	30.85	742.83	2236.94	270.91	15.3	112.11	355.27	344.94	0	12.95	0	85.45	658.07	5762.46	4036.83	195.65	302.3	3556.32	7254.89	23.9	0	0	0	92.92	259.17	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	23.28	49.12	175	0	0.2	0	0	153.91	10	20	30	30	3.37	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	23.28	49.12	175	0	0.2	0	0	153.91	10	20	30	30	3.37	0	0.2	0	0	0	25	20	0	0	0	0	0												6.99	0.28	3.03	-	1.69	3.06	0.22	1.45	5.03	-	2.59	-	-	8.44	4.8	6.73	0.49	0.76	1	-	4.78	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.97	6.99	0.28	3.03	-	1.69	3.06	0.22	1.45	5.03	-	2.59	-	-	8.44	4.8	6.73	0.49	0.76	1	-	4.78	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.97
H0543_050_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1290.5	33.06	777.5	2224.45	269.4	17.65	112.82	340.34	262.3	0	14.93	0	70.82	634.73	6207.8	4481.06	194.56	300.61	3876.25	7901.26	23.52	0	0	0	92.4	257.72	0	0	0	0	274.86											250 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	109.69	49	0	75	0.2	26.68	49.12	100	0	0.2	0	0	89.38	5	10	30	30	3.56	0	0.2	0	0	0	25	20	0	0	0	0	0											0	43.55	109.69	49	0	75	0.2	26.68	49.12	100	0	0.2	0	0	89.38	5	10	30	30	3.56	0	0.2	0	0	0	25	20	0	0	0	0	0												4.68	0.3	3.17	-	1.68	3.53	0.25	1.39	2.19	-	2.99	-	-	4.73	2.59	3.73	0.49	0.75	1.15	-	4.7	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.96	4.68	0.3	3.17	-	1.68	3.53	0.25	1.39	2.19	-	2.99	-	-	4.73	2.59	3.73	0.49	0.75	1.15	-	4.7	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.96
H0543_060_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1204.51	30.85	1162.18	2175.93	263.52	18.45	110.36	332.91	283.33	0	15.61	0	84.43	620.88	5605.29	3926.73	190.31	294.05	3444.35	7057.02	24.56	0	0	0	90.39	252.1	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	28.51	49.12	200	0	0.2	0	0	174.2	10	20	30	30	4.19	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	28.51	49.12	200	0	0.2	0	0	174.2	10	20	30	30	4.19	0	0.2	0	0	0	25	20	0	0	0	0	0												6.99	0.28	4.75	-	1.65	3.69	0.26	1.36	4.72	-	3.12	-	-	9.01	4.67	6.54	0.48	0.74	1.2	-	4.91	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.99	6.99	0.28	4.75	-	1.65	3.69	0.26	1.36	4.72	-	3.12	-	-	9.01	4.67	6.54	0.48	0.74	1.2	-	4.91	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.99
H0543_065_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1627.99	41.7	1303.82	2227.13	269.72	23.17	112.95	340.75	298.73	0	19.6	0	86.41	635.49	5737.17	4019.12	194.79	300.97	3516.01	7223.06	23.35	0	0	0	92.51	258.03	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	34.97	49.12	175	0	0.2	0	0	152.99	10	20	30	30	5.16	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	34.97	49.12	175	0	0.2	0	0	152.99	10	20	30	30	5.16	0	0.2	0	0	0	25	20	0	0	0	0	0												9.45	0.38	5.32	-	1.69	4.63	0.33	1.39	4.36	-	3.92	-	-	8.1	4.78	6.7	0.49	0.75	1.51	-	4.67	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.1	9.45	0.38	5.32	-	1.69	4.63	0.33	1.39	4.36	-	3.92	-	-	8.1	4.78	6.7	0.49	0.75	1.51	-	4.67	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.1
H0543_070_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1925.35	49.32	1407.32	2227.58	269.78	21.83	111.64	351.08	281.48	0	18.46	0	92.25	640.18	5738.34	4253.65	194.83	301.03	3609.46	7395.43	23.41	0	0	0	92.53	258.09	0	0	0	0	0											400 Select/800 Standard per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	10	15	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											78.05	109.69	49	0	75	0.2	33.33	49.12	200	0	0.2	0	0	174.69	10	15	30	30	4.73	0	0.2	0	0	0	25	20	0	0	0	0	0											0	78.05	109.69	49	0	75	0.2	33.33	49.12	200	0	0.2	0	0	174.69	10	15	30	30	4.73	0	0.2	0	0	0	25	20	0	0	0	0	0												12.52	0.45	5.75	-	1.69	4.37	0.31	1.44	4.69	-	3.69	-	-	9.32	4.78	5.32	0.49	0.75	1.42	-	4.68	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.29	12.52	0.45	5.75	-	1.69	4.37	0.31	1.44	4.69	-	3.69	-	-	9.32	4.78	5.32	0.49	0.75	1.42	-	4.68	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.29
H0543_071_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	2112.65	54.11	2003.12	2261.75	273.92	26.67	113.35	356.47	320.34	0	22.56	0	86.72	650	5826.37	4318.91	197.82	305.65	3657.33	7508.88	24.4	0	0	0	93.95	262.05	0	0	0	0	0											400 Select/800 Standard per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	10	15	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											78.05	109.69	49	0	75	0.2	40.12	49.12	200	0	0.2	0	0	174.69	10	15	30	30	5.71	0	0.2	0	0	0	25	20	0	0	0	0	0											0	78.05	109.69	49	0	75	0.2	40.12	49.12	200	0	0.2	0	0	174.69	10	15	30	30	5.71	0	0.2	0	0	0	25	20	0	0	0	0	0												13.74	0.49	8.18	-	1.71	5.33	0.38	1.46	5.34	-	4.51	-	-	9.46	4.86	5.4	0.49	0.76	1.74	-	4.88	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.38	13.74	0.49	8.18	-	1.71	5.33	0.38	1.46	5.34	-	4.51	-	-	9.46	4.86	5.4	0.49	0.76	1.74	-	4.88	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.38
H0543_072_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1504.36	38.53	974.09	2256.24	273.25	23.97	113.08	355.6	324.6	0	20.27	0	86.51	648.42	5812.18	4308.39	197.34	304.9	3647.76	7490.59	22.84	0	0	0	93.72	261.41	0	0	0	0	0											400 Select/800 Standard per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	10	15	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											78.75	109.69	49	0	75	0.2	36.14	49.12	200	0	0.2	0	0	174.69	10	15	30	30	5.14	0	0.2	0	0	0	25	20	0	0	0	0	0											0	78.75	109.69	49	0	75	0.2	36.14	49.12	200	0	0.2	0	0	174.69	10	15	30	30	5.14	0	0.2	0	0	0	25	20	0	0	0	0	0												9.87	0.35	3.98	-	1.71	4.79	0.34	1.46	5.41	-	4.05	-	-	9.44	4.84	5.39	0.49	0.76	1.56	-	4.57	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.65	9.87	0.35	3.98	-	1.71	4.79	0.34	1.46	5.41	-	4.05	-	-	9.44	4.84	5.39	0.49	0.76	1.56	-	4.57	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.65
H0543_077_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1190.4	30.49	1073.39	2077.16	251.56	18.52	105.35	317.8	244.66	0	15.67	0	87.05	592.7	5796.75	4184.35	181.68	280.7	3606.81	7378.08	23.36	0	0	0	86.28	240.66	157.82	34.14	0	0	256.66											150 Select/250 Standard per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											28.57	109.69	49	0	75	0.2	29.98	49.12	100	0	0.2	0	0	89.38	5	10	30	30	4.02	0	0.2	0	0	0	25	20	25	0	0	0	0											0	28.57	109.69	49	0	75	0.2	29.98	49.12	100	0	0.2	0	0	89.38	5	10	30	30	4.02	0	0.2	0	0	0	25	20	25	0	0	0	0												2.83	0.28	4.38	-	1.57	3.7	0.26	1.3	2.04	-	3.13	-	-	4.41	2.42	3.49	0.45	0.7	1.21	-	4.67	-	-	-	0.18	0.4	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.77	2.83	0.28	4.38	-	1.57	3.7	0.26	1.3	2.04	-	3.13	-	-	4.41	2.42	3.49	0.45	0.7	1.21	-	4.67	-	-	-	0.18	0.4	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.77
H0543_078_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	P	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1706.92	43.72	1539.13	2850.56	345.23	23.02	144.57	436.13	350.82	0	790.61	0	119.46	813.38	8554.8	6689.83	294.76	530.58	5506.86	11252.02	30.28	0	0	503.47	148.16	330.26	271	46.86	0	0	352.22											0 per admit	812 Copay;0 [Day(s) 1-60]; 203 [Day(s) 61-90]; 406 [Day(s) 91-190]	No copay [Day(s) 1-20]; 50 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	50 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	5 Oral Exam (4/yr)15 Cleaning (1/6 mths)	Exam 5/12 months	materials copay 5/12 months	5 Exam/12 months	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	98	24	0	50	0.2	27.15	49.12	0	0	35.62	0	0	0	0	0	10	0	3.08	0	0.2	0	0	57.54	5	5	5	0	0	0	0											0	0	98	24	0	50	0.2	27.15	49.12	0	0	35.62	0	0	0	0	0	10	0	3.08	0	0.2	0	0	57.54	5	5	5	0	0	0	0												-	0.36	3.08	-	1.44	4.6	0.33	1.79	-	-	2.35	-	-	-	-	-	0.25	-	1.41	-	6.06	-	-	2.41	0.06	0.14	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.38	-	0.36	3.08	-	1.44	4.6	0.33	1.79	-	-	2.35	-	-	-	-	-	0.25	-	1.41	-	6.06	-	-	2.41	0.06	0.14	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.38
H0543_079_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	P	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1626.36	41.66	1525.61	2913.03	352.79	21.41	145.99	440.41	359.19	0	816.48	0	118.99	837.17	8742.25	6836.42	301.22	542.2	5639.65	11498.57	30.07	0	0	503.47	151.4	337.5	276.94	47.88	0	0	359.94											0 per admit	812 Copay;0 [Day(s) 1-60]; 203 [Day(s) 61-90]; 406 [Day(s) 91-190]	No copay [Day(s) 1-20]; 50 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	50 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	5 Oral Exam (4/yr)15 Cleaning (1/6 mths)	Exam 5/12 months	materials copay 5/12 months	5 Exam/12 months	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	98	24	0	50	0.2	25	49.12	0	0	32.67	0	0	0	0	0	10	0	2.92	0	0.2	0	0	57.54	5	5	5	0	0	0	0											0	0	98	24	0	50	0.2	25	49.12	0	0	32.67	0	0	0	0	0	10	0	2.92	0	0.2	0	0	57.54	5	5	5	0	0	0	0												-	0.34	3.05	-	1.47	4.28	0.3	1.8	-	-	2.22	-	-	-	-	-	0.25	-	1.37	-	6.01	-	-	2.41	0.06	0.14	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.84	-	0.34	3.05	-	1.47	4.28	0.3	1.8	-	-	2.22	-	-	-	-	-	0.25	-	1.37	-	6.01	-	-	2.41	0.06	0.14	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.84
H0543_081_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	P	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1841.95	47.18	1489.07	3016.1	365.27	22.07	152.97	461.46	368.01	0	836.52	0	113.19	860.62	9051.57	7078.31	311.88	561.39	5840.36	11905.41	23.95	0	0	503.47	156.76	349.44	286.73	49.58	0	0	372.67											0 per admit	812 Copay;0 [Day(s) 1-60]; 203 [Day(s) 61-90]; 406 [Day(s) 91-190]	No copay [Day(s) 1-20]; 50 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	50 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	5 Oral Exam (4/yr)15 Cleaning (1/6 mths)	Exam 5/12 months	materials copay 5/12 months	5 Exam/12 months	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	98	24	0	50	0.2	24.6	49.12	0	0	32.84	0	0	0	0	0	10	0	2.95	0	0.2	0	0	57.54	5	5	5	0	0	0	0											0	0	98	24	0	50	0.2	24.6	49.12	0	0	32.84	0	0	0	0	0	10	0	2.95	0	0.2	0	0	57.54	5	5	5	0	0	0	0												-	0.39	2.98	-	1.52	4.41	0.31	1.89	-	-	2.29	-	-	-	-	-	0.26	-	1.44	-	4.79	-	-	2.41	0.07	0.15	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.02	-	0.39	2.98	-	1.52	4.41	0.31	1.89	-	-	2.29	-	-	-	-	-	0.26	-	1.44	-	4.79	-	-	2.41	0.07	0.15	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.02
H0543_082_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2169.84	262.79	18.74	110.05	353.11	283.33	0	15.85	0	81.41	645.99	5589.6	3915.74	189.78	293.23	3434.38	7037.27	25.48	0	0	0	90.13	251.4	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	29.03	49.12	175	0	0.2	0	0	153.91	10	20	30	30	4.27	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	29.03	49.12	175	0	0.2	0	0	153.91	10	20	30	30	4.27	0	0.2	0	0	0	25	20	0	0	0	0	0												8.44	0.34	4.75	-	1.64	3.75	0.27	1.45	4.13	-	3.17	-	-	8.29	4.66	6.53	0.47	0.73	1.22	-	5.1	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.53	8.44	0.34	4.75	-	1.64	3.75	0.27	1.45	4.13	-	3.17	-	-	8.29	4.66	6.53	0.47	0.73	1.22	-	5.1	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.53
H0543_083_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1375.42	35.59	786.08	2319.27	280.88	16.48	117.63	354.85	277.58	0	13.94	0	95.37	661.78	5974.55	4185.41	239.82	370.55	3466.12	7521.91	22.84	0	0	0	96.34	268.71	176.22	38.12	0	0	286.57											100/day [Day(s) 1-8]	800 per admit	No copay [Day(s) 1-20]; 50 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	50 per trip	15 Coinsurance	Prosthetics: 15 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 15 Coinsurance; MRI/CT/MRA/PET/SPEC: 15 Coinsurance		0	Cardiac Rehabilitation: 10; Pulmonary Rehabilitation: 10; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	20	10	Occupational Therapy: 10; PT/ Speech Therapy: 10	Routine Xray: 10; Therapy - Radiation: 15 Coinsurance; MRI/CT/MRA/PET/SPEC: 15 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 15 Coinsurance; Oral Chemo: 15 Coinsurance; Anti-Emetics / Antigens: 15 Coinsurance; Self Injectibles: 15 Coinsurance; Office Based Injectibles: 15 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											73.78	96.22	24	0	50	0.15	17.92	49.12	100	0	0.15	0	0	86.34	10	20	10	10	10.08	0	0.15	0	0	0	25	20	25	0	0	0	0											0	73.78	96.22	24	0	50	0.15	17.92	49.12	100	0	0.15	0	0	86.34	10	20	10	10	10.08	0	0.15	0	0	0	25	20	25	0	0	0	0												8.46	0.29	1.57	-	1.17	2.47	0.18	1.45	2.31	-	2.09	-	-	4.76	4.98	6.98	0.2	0.31	2.91	-	3.45	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.59	8.46	0.29	1.57	-	1.17	2.47	0.18	1.45	2.31	-	2.09	-	-	4.76	4.98	6.98	0.2	0.31	2.91	-	3.45	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.59
H0543_084_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1211.2	31.02	1136.17	2208.5	267.47	18.05	110.68	333.89	267.5	0	15.27	0	84.67	634.69	6163.28	4448.92	193.16	298.45	3848.23	7844.59	24.23	0	0	0	91.74	255.87	0	0	0	0	272.89											200 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											34.84	109.69	49	0	75	0.2	27.81	49.12	100	0	0.2	0	0	89.58	5	10	30	30	3.67	0	0.2	0	0	0	25	20	0	0	0	0	0											0	34.84	109.69	49	0	75	0.2	27.81	49.12	100	0	0.2	0	0	89.58	5	10	30	30	3.67	0	0.2	0	0	0	25	20	0	0	0	0	0												3.52	0.28	4.64	-	1.67	3.61	0.26	1.37	2.23	-	3.05	-	-	4.74	2.57	3.71	0.48	0.75	1.18	-	4.85	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.51	3.52	0.28	4.64	-	1.67	3.61	0.26	1.37	2.23	-	3.05	-	-	4.74	2.57	3.71	0.48	0.75	1.18	-	4.85	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.51
H0543_085_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1962.42	50.27	1568.95	2938.14	355.83	21.28	147.25	463.07	382.49	0	18	0	121.67	844.38	7568.78	5610.5	256.98	397.05	4760.91	9754.45	25.66	0	0	0	122.05	340.41	0	0	0	0	0											400 Select/800 Standard per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	10	15	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											78.75	109.69	49	0	75	0.2	24.64	49.12	200	0	0.2	0	0	174.69	10	15	30	30	3.5	0	0.2	0	0	0	25	20	0	0	0	0	0											0	78.75	109.69	49	0	75	0.2	24.64	49.12	200	0	0.2	0	0	174.69	10	15	30	30	3.5	0	0.2	0	0	0	25	20	0	0	0	0	0												12.88	0.46	6.41	-	2.22	4.26	0.3	1.9	6.37	-	3.6	-	-	12.29	6.31	7.01	0.64	0.99	1.39	-	5.13	-	-	-	0.25	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.99	12.88	0.46	6.41	-	2.22	4.26	0.3	1.9	6.37	-	3.6	-	-	12.29	6.31	7.01	0.64	0.99	1.39	-	5.13	-	-	-	0.25	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.99
H0543_086_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2238.38	271.09	20.55	112.18	338.41	283.33	0	17.38	0	70.42	643.28	5766.17	4039.43	195.78	302.49	3541.79	7259.57	25.4	0	0	0	92.98	259.34	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	31.24	49.12	175	0	0.2	0	0	153.41	10	20	30	30	4.54	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	31.24	49.12	175	0	0.2	0	0	153.41	10	20	30	30	4.54	0	0.2	0	0	0	25	20	0	0	0	0	0												8.44	0.34	4.75	-	1.69	4.11	0.29	1.39	4.13	-	3.48	-	-	8.22	4.81	6.73	0.49	0.76	1.34	-	5.08	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.67	8.44	0.34	4.75	-	1.69	4.11	0.29	1.39	4.13	-	3.48	-	-	8.22	4.81	6.73	0.49	0.76	1.34	-	5.08	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.67
H0543_089_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2215	268.25	19	112.34	357.42	283.33	0	16.07	0	70.52	632.03	5705.93	4462.03	229.04	412.28	3674.5	7523.6	24.07	0	0	0	92.01	256.63	0	0	0	0	0											200 per admit	200 per admit	0 [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	25 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 40; Urgent Care :10 PCP Copay;20 In Area/In Network;40 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	10	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											34.84	24.06	0	0	25	0.2	28.83	39.11	0	0	0.2	0	0	0	10	10	10	0	4.05	0	0.2	0	0	0	25	20	0	0	0	0	0											0	34.84	24.06	0	0	25	0.2	28.83	39.11	0	0	0.2	0	0	0	10	10	10	0	4.05	0	0.2	0	0	0	25	20	0	0	0	0	0												4.22	0.07	-	-	0.56	3.8	0.27	1.17	-	-	3.21	-	-	-	4.75	3.72	0.19	-	1.24	-	4.81	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.64	4.22	0.07	-	-	0.56	3.8	0.27	1.17	-	-	3.21	-	-	-	4.75	3.72	0.19	-	1.24	-	4.81	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.64
H0543_091_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2211.86	267.87	18.86	112.18	356.91	283.33	0	15.95	0	70.42	631.14	5697.85	4455.71	228.72	411.7	3669.47	7512.95	23.99	0	0	0	91.88	256.27	0	0	0	0	0											200 per admit	200 per admit	0 [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	25 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 40; Urgent Care :10 PCP Copay;20 In Area/In Network;40 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	10	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											34.84	24.06	0	0	25	0.2	28.66	39.11	0	0	0.2	0	0	0	10	10	10	0	4.02	0	0.2	0	0	0	25	20	0	0	0	0	0											0	34.84	24.06	0	0	25	0.2	28.66	39.11	0	0	0.2	0	0	0	10	10	10	0	4.02	0	0.2	0	0	0	25	20	0	0	0	0	0												4.22	0.07	-	-	0.56	3.77	0.27	1.16	-	-	3.19	-	-	-	4.75	3.71	0.19	-	1.23	-	4.8	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.54	4.22	0.07	-	-	0.56	3.77	0.27	1.16	-	-	3.19	-	-	-	4.75	3.71	0.19	-	1.23	-	4.8	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.54
H0543_093_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2270.94	275.03	18.86	112.18	356.91	283.33	0	15.95	0	70.42	658.5	5850.04	4574.72	234.83	422.69	3768.1	7713.62	25.05	0	0	0	94.33	263.11	0	0	0	0	0											200 per admit	200 per admit	0 [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	25 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 40; Urgent Care :10 PCP Copay;20 In Area/In Network;40 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	10	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											34.84	24.06	0	0	25	0.2	28.67	39.11	0	0	0.2	0	0	0	10	10	10	0	3.92	0	0.2	0	0	0	25	20	0	0	0	0	0											0	34.84	24.06	0	0	25	0.2	28.67	39.11	0	0	0.2	0	0	0	10	10	10	0	3.92	0	0.2	0	0	0	25	20	0	0	0	0	0												4.22	0.07	-	-	0.57	3.77	0.27	1.16	-	-	3.19	-	-	-	4.88	3.81	0.2	-	1.23	-	5.01	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.02	4.22	0.07	-	-	0.57	3.77	0.27	1.16	-	-	3.19	-	-	-	4.88	3.81	0.2	-	1.23	-	5.01	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.02
H0543_095_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1214.61	31.11	1139.36	2214.29	268.17	17.96	110.97	334.77	268.26	0	15.19	0	90.45	636.36	6645.27	4832.31	193.67	299.23	4162.23	8474.07	22.72	0	0	0	91.98	256.55	0	0	0	0	267.21											200 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	0	5	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: 5/6 visits; Chiropractic : Not Covered											34.84	109.69	49	0	75	0.2	27.6	49.12	100	0	0.2	0	0	89.58	0	5	30	30	3.38	0	0.2	0	0	0	25	20	0	0	0	0	1.59											0	34.84	109.69	49	0	75	0.2	27.6	49.12	100	0	0.2	0	0	89.58	0	5	30	30	3.38	0	0.2	0	0	0	25	20	0	0	0	0	1.59												3.53	0.28	4.65	-	1.68	3.59	0.26	1.37	2.24	-	3.04	-	-	4.75	-	2.01	0.48	0.75	1.17	-	4.54	-	-	-	0.19	0.43	-	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	35	3.53	0.28	4.65	-	1.68	3.59	0.26	1.37	2.24	-	3.04	-	-	4.75	-	2.01	0.48	0.75	1.17	-	4.54	-	-	-	0.19	0.43	-	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	35
H0543_096_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1351.63	34.62	1218.77	2339.68	283.35	20.98	118.66	357.97	277.8	0	17.75	0	98.05	667.61	6529.38	4713.19	204.64	316.18	4061.03	8310.56	23.55	0	0	0	97.19	271.07	177.77	38.46	0	0	289.09											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	30.15	49.12	50	0	0.2	0	0	46.96	5	10	30	30	4.04	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	30.15	49.12	50	0	0.2	0	0	46.96	5	10	30	30	4.04	0	0.2	0	0	0	25	20	25	0	0	0	0												0.98	0.32	4.98	-	1.77	4.2	0.3	1.47	1.16	-	3.55	-	-	2.61	2.72	3.93	0.51	0.79	1.37	-	4.71	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.38	0.98	0.32	4.98	-	1.77	4.2	0.3	1.47	1.16	-	3.55	-	-	2.61	2.72	3.93	0.51	0.79	1.37	-	4.71	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.38
H0543_097_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1287.27	32.97	1160.73	2228.27	269.86	19.95	113.01	340.92	264.57	0	16.87	0	93.38	635.82	6218.45	4488.75	194.89	301.12	3867.79	7914.82	23.55	0	0	0	92.56	258.17	0	0	0	0	275.33											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	30.1	49.12	50	0	0.2	0	0	46.96	5	10	30	30	4.04	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	30.1	49.12	50	0	0.2	0	0	46.96	5	10	30	30	4.04	0	0.2	0	0	0	25	20	0	0	0	0	0												0.93	0.3	4.74	-	1.69	3.99	0.28	1.4	1.1	-	3.37	-	-	2.49	2.59	3.74	0.49	0.75	1.3	-	4.71	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.5	0.93	0.3	4.74	-	1.69	3.99	0.28	1.4	1.1	-	3.37	-	-	2.49	2.59	3.74	0.49	0.75	1.3	-	4.71	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.5
H0543_098_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1925.35	49.32	1407.32	2227.58	269.78	22.02	111.64	351.08	281.48	0	18.63	0	92.25	640.18	5738.34	4253.65	194.83	301.03	3609.44	7395.43	23.45	0	0	0	92.53	258.09	0	0	0	0	0											400 Select/800 Standard per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	10	15	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											78.05	109.69	49	0	75	0.2	33.63	49.12	200	0	0.2	0	0	174.69	10	15	30	30	4.78	0	0.2	0	0	0	25	20	0	0	0	0	0											0	78.05	109.69	49	0	75	0.2	33.63	49.12	200	0	0.2	0	0	174.69	10	15	30	30	4.78	0	0.2	0	0	0	25	20	0	0	0	0	0												12.52	0.45	5.75	-	1.69	4.4	0.31	1.44	4.69	-	3.73	-	-	9.32	4.78	5.32	0.49	0.75	1.44	-	4.69	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.38	12.52	0.45	5.75	-	1.69	4.4	0.31	1.44	4.69	-	3.73	-	-	9.32	4.78	5.32	0.49	0.75	1.44	-	4.69	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.38
H0543_099_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1504.36	38.53	974.09	2256.24	273.25	24.24	113.08	355.6	324.6	0	20.5	0	86.51	648.42	5812.18	4308.39	197.34	304.9	3647.83	7490.59	22.87	0	0	0	93.72	261.41	0	0	0	0	0											400 Select/800 Standard per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	10	15	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											78.75	109.69	49	0	75	0.2	36.55	49.12	200	0	0.2	0	0	174.69	10	15	30	30	5.2	0	0.2	0	0	0	25	20	0	0	0	0	0											0	78.75	109.69	49	0	75	0.2	36.55	49.12	200	0	0.2	0	0	174.69	10	15	30	30	5.2	0	0.2	0	0	0	25	20	0	0	0	0	0												9.87	0.35	3.98	-	1.71	4.85	0.34	1.46	5.41	-	4.1	-	-	9.44	4.84	5.39	0.49	0.76	1.58	-	4.57	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.78	9.87	0.35	3.98	-	1.71	4.85	0.34	1.46	5.41	-	4.1	-	-	9.44	4.84	5.39	0.49	0.76	1.58	-	4.57	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.78
H0543_104_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1275.34	32.67	1196.33	2339.95	283.39	18.89	117.27	353.77	281.67	0	15.98	0	95.58	672.47	6530.13	4713.74	204.66	316.22	4062.94	8311.52	24.32	0	0	0	97.2	271.11	177.79	38.46	0	0	289.13											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	27.46	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.64	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	27.46	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.64	0	0.2	0	0	0	25	20	25	0	0	0	0												0.93	0.3	4.89	-	1.77	3.78	0.27	1.45	1.17	-	3.2	-	-	2.64	2.72	3.93	0.51	0.79	1.23	-	4.86	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.45	0.93	0.3	4.89	-	1.77	3.78	0.27	1.45	1.17	-	3.2	-	-	2.64	2.72	3.93	0.51	0.79	1.23	-	4.86	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.45
H0543_105_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1214.61	31.11	1139.36	2228.52	269.89	17.95	111.69	336.92	268.26	0	15.18	0	91.03	640.45	6219.17	4489.27	194.91	301.16	3883.25	7915.73	24.32	0	0	0	92.57	258.2	0	0	0	0	275.36											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	27.41	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.62	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	27.41	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.62	0	0.2	0	0	0	25	20	0	0	0	0	0												0.88	0.28	4.65	-	1.69	3.59	0.26	1.38	1.12	-	3.04	-	-	2.51	2.59	3.74	0.49	0.75	1.17	-	4.86	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.62	0.88	0.28	4.65	-	1.69	3.59	0.26	1.38	1.12	-	3.04	-	-	2.51	2.59	3.74	0.49	0.75	1.17	-	4.86	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.62
H0543_106_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1514.33	38.79	742.83	2218.6	268.69	19.06	113.84	353.39	268.26	0	16.12	0	71.46	652.77	6191.49	4469.29	194.05	299.82	3851.45	7880.49	23.82	0	0	0	92.16	257.05	0	0	0	0	274.13											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	28.54	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.87	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	28.54	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.87	0	0.2	0	0	0	25	20	0	0	0	0	0												1.1	0.35	3.03	-	1.68	3.81	0.27	1.45	1.12	-	3.22	-	-	2.56	2.58	3.72	0.49	0.75	1.24	-	4.76	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.76	1.1	0.35	3.03	-	1.68	3.81	0.27	1.45	1.12	-	3.22	-	-	2.56	2.58	3.72	0.49	0.75	1.24	-	4.76	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.76
H0543_108_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1204.51	30.85	742.83	2236.94	270.91	15.94	112.11	355.27	344.94	0	13.49	0	85.45	658.07	5762.46	4036.83	195.65	302.3	3555.75	7254.89	23.9	0	0	0	92.92	259.17	0	0	0	0	276.4											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	24.25	49.12	175	0	0.2	0	0	153.91	10	20	30	30	3.51	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	24.25	49.12	175	0	0.2	0	0	153.91	10	20	30	30	3.51	0	0.2	0	0	0	25	20	0	0	0	0	0												6.99	0.28	3.03	-	1.69	3.19	0.23	1.45	5.03	-	2.7	-	-	8.44	4.8	6.73	0.49	0.76	1.04	-	4.78	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.26	6.99	0.28	3.03	-	1.69	3.19	0.23	1.45	5.03	-	2.7	-	-	8.44	4.8	6.73	0.49	0.76	1.04	-	4.78	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.26
H0543_110_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2199.19	266.34	20.85	110.22	365.56	283.33	0	17.63	0	84.56	632.02	5759.64	4504.02	227.41	409.34	3708.24	7592.23	23.97	0	0	0	91.35	254.8	0	0	0	0	0											200 per admit	20000	0 [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	25 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 40; Urgent Care :9 PCP Copay;20 In Area/In Network;40 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	9	9	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											34.84	24.06	0	0	25	0.2	32.25	39.11	0	0	0.2	0	0	0	9	9	10	0	4.4	0	0.2	0	0	0	25	20	0	0	0	0	0											0	34.84	24.06	0	0	25	0.2	32.25	39.11	0	0	0.2	0	0	0	9	9	10	0	4.4	0	0.2	0	0	0	25	20	0	0	0	0	0												4.22	0.07	-	-	0.55	4.17	0.3	1.19	-	-	3.53	-	-	-	4.32	3.38	0.19	-	1.36	-	4.79	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.69	4.22	0.07	-	-	0.55	4.17	0.3	1.19	-	-	3.53	-	-	-	4.32	3.38	0.19	-	1.36	-	4.79	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.69
H0543_114_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2195.26	265.86	19.59	112.64	373.59	283.33	0	16.57	0	85.85	645.9	5749.33	4495.96	227	408.61	3701.71	7578.65	23.8	0	0	0	91.19	254.34	0	0	0	0	0											200 Select/800 Standard per admit	20000	0 [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	25 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 40; Urgent Care :9 PCP Copay;20 In Area/In Network;40 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	9	9	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											44.25	24.06	0	0	25	0.2	29.65	39.11	0	0	0.2	0	0	0	9	9	10	0	4.14	0	0.2	0	0	0	25	20	0	0	0	0	0											0	44.25	24.06	0	0	25	0.2	29.65	39.11	0	0	0.2	0	0	0	9	9	10	0	4.14	0	0.2	0	0	0	25	20	0	0	0	0	0												5.36	0.07	-	-	0.55	3.92	0.28	1.22	-	-	3.31	-	-	-	4.31	3.37	0.19	-	1.28	-	4.76	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.24	5.36	0.07	-	-	0.55	3.92	0.28	1.22	-	-	3.31	-	-	-	4.31	3.37	0.19	-	1.28	-	4.76	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.24
H0543_115_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1514.33	38.79	1251.78	2243.25	271.68	19.61	112.42	339.15	270.59	0	16.59	0	70.57	644.68	5778.69	4048.21	196.2	303.15	3549.8	7275.34	23.45	0	0	0	93.18	259.9	0	0	0	0	277.18											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	29.74	49.12	175	0	0.2	0	0	153.41	10	20	30	30	4.32	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	29.74	49.12	175	0	0.2	0	0	153.41	10	20	30	30	4.32	0	0.2	0	0	0	25	20	0	0	0	0	0												8.79	0.35	5.11	-	1.7	3.92	0.28	1.39	3.95	-	3.32	-	-	8.24	4.82	6.75	0.49	0.76	1.28	-	4.69	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.46	8.79	0.35	5.11	-	1.7	3.92	0.28	1.39	3.95	-	3.32	-	-	8.24	4.82	6.75	0.49	0.76	1.28	-	4.69	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.46
H0543_116_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1378.51	35.31	1114.41	2323.3	281.37	18.48	117.83	355.46	275.42	0	15.63	0	87.19	662.93	6483.65	4680.19	203.2	313.97	4034.27	8252.36	23.93	0	0	0	96.51	269.18	176.53	38.19	0	0	287.07											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	26.74	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.59	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	26.74	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.59	0	0.2	0	0	0	25	20	25	0	0	0	0												1	0.32	4.55	-	1.76	3.7	0.26	1.45	1.15	-	3.13	-	-	2.59	2.7	3.9	0.51	0.78	1.21	-	4.79	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.82	1	0.32	4.55	-	1.76	3.7	0.26	1.45	1.15	-	3.13	-	-	2.59	2.7	3.9	0.51	0.78	1.21	-	4.79	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.82
H0543_117_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1312.87	33.63	1061.35	2212.66	267.97	17.57	112.22	338.53	262.3	0	14.86	0	83.04	631.36	6174.91	4457.32	193.53	299.01	3855.81	7859.39	23.93	0	0	0	91.91	256.36	0	0	0	0	273.4											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	26.7	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.57	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	26.7	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.57	0	0.2	0	0	0	25	20	0	0	0	0	0												0.95	0.31	4.33	-	1.67	3.51	0.25	1.39	1.09	-	2.97	-	-	2.47	2.57	3.71	0.48	0.75	1.15	-	4.79	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.02	0.95	0.31	4.33	-	1.67	3.51	0.25	1.39	1.09	-	2.97	-	-	2.47	2.57	3.71	0.48	0.75	1.15	-	4.79	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.02
H0543_118_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1355.03	34.71	816.38	2335.67	282.87	18.92	118.46	357.35	275.42	0	16	0	74.36	666.46	6518.19	4705.12	204.29	315.64	4055.16	8296.32	23.52	0	0	0	97.02	270.61	177.47	38.39	0	0	288.6											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	27.23	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.65	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	27.23	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.65	0	0.2	0	0	0	25	20	25	0	0	0	0												0.98	0.32	3.33	-	1.77	3.78	0.27	1.46	1.15	-	3.2	-	-	2.61	2.72	3.92	0.51	0.79	1.23	-	4.7	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.77	0.98	0.32	3.33	-	1.77	3.78	0.27	1.46	1.15	-	3.2	-	-	2.61	2.72	3.92	0.51	0.79	1.23	-	4.7	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.77
H0543_119_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1290.5	33.06	777.5	2224.45	269.4	17.98	112.82	340.34	262.3	0	15.21	0	70.82	634.73	6207.8	4481.06	194.56	300.61	3863.27	7901.26	23.52	0	0	0	92.4	257.72	0	0	0	0	274.86											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	27.17	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.64	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	27.17	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.64	0	0.2	0	0	0	25	20	0	0	0	0	0												0.94	0.3	3.17	-	1.68	3.6	0.26	1.39	1.09	-	3.04	-	-	2.48	2.59	3.73	0.49	0.75	1.17	-	4.7	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.02	0.94	0.3	3.17	-	1.68	3.6	0.26	1.39	1.09	-	3.04	-	-	2.48	2.59	3.73	0.49	0.75	1.17	-	4.7	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.02
H0543_120_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1444.16	36.99	817.11	2419.63	293.04	18.52	122.72	370.2	288.53	0	15.67	0	101.4	690.42	6752.5	4874.25	211.63	326.98	4201.5	8594.55	23.92	0	0	0	100.51	280.34	183.85	39.77	0	0	298.97											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	25.73	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.45	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	25.73	49.12	50	0	0.2	0	0	46.96	5	10	30	30	3.45	0	0.2	0	0	0	25	20	25	0	0	0	0												1.05	0.34	3.34	-	1.83	3.7	0.26	1.52	1.2	-	3.13	-	-	2.7	2.81	4.06	0.53	0.82	1.21	-	4.78	-	-	-	0.21	0.47	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.35	1.05	0.34	3.34	-	1.83	3.7	0.26	1.52	1.2	-	3.13	-	-	2.7	2.81	4.06	0.53	0.82	1.21	-	4.78	-	-	-	0.21	0.47	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.35
H0543_121_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1312.87	33.63	742.83	2199.67	266.4	18.3	111.56	336.55	262.3	0	15.48	0	90.46	627.66	6601.4	5162.28	192.39	297.26	4252.16	8682.73	22.85	0	0	0	91.37	254.85	0	0	0	0	271.79											0 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	109.69	49	0	75	0.2	27.97	49.12	0	0	0.2	0	0	4.55	0	0	30	30	3.37	0	0.2	0	0	0	25	20	0	0	0	0	0											0	0	109.69	49	0	75	0.2	27.97	49.12	0	0	0.2	0	0	4.55	0	0	30	30	3.37	0	0.2	0	0	0	25	20	0	0	0	0	0												-	0.31	3.03	-	1.66	3.66	0.26	1.38	-	-	3.1	-	-	0.24	-	-	0.48	0.74	1.19	-	4.57	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.24	-	0.31	3.03	-	1.66	3.66	0.26	1.38	-	-	3.1	-	-	0.24	-	-	0.48	0.74	1.19	-	4.57	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.24
H0543_122_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1244.56	32.45	716.72	2132.42	258.25	15.9	108.15	326.26	253.08	0	13.45	0	87.69	608.47	5207.1	3633.42	186.51	288.17	2948.03	6432.62	21.88	0	0	0	86.53	247.06	0	0	0	0	0											150/day [Day(s) 1-8]	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	No	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											110.67	109.69	49	0	75	0.2	25.07	49.12	200	0	0.2	0	0	174.2	15	30	30	30	11.54	0	0.2	0	0	0	30	20	0	0	0	0	0											0	110.67	109.69	49	0	75	0.2	25.07	49.12	200	0	0.2	0	0	174.2	15	30	30	30	11.54	0	0.2	0	0	0	30	20	0	0	0	0	0												11.48	0.3	2.93	-	1.61	3.18	0.23	1.34	4.22	-	2.69	-	-	8.83	6.51	9.08	0.47	0.72	2.83	-	4.38	-	-	-	0.22	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.42	11.48	0.3	2.93	-	1.61	3.18	0.23	1.34	4.22	-	2.69	-	-	8.83	6.51	9.08	0.47	0.72	2.83	-	4.38	-	-	-	0.22	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.42
H0543_123_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1453.64	37.23	1162.18	2169.84	262.79	19.11	110.05	353.11	283.33	0	16.16	0	81.41	645.99	5589.6	3915.74	189.78	293.23	3433.95	7037.27	25.47	0	0	0	90.13	251.4	0	0	0	0	268.11											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	29.6	49.12	175	0	0.2	0	0	153.91	10	20	30	30	4.36	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	29.6	49.12	175	0	0.2	0	0	153.91	10	20	30	30	4.36	0	0.2	0	0	0	25	20	0	0	0	0	0												8.44	0.34	4.75	-	1.64	3.82	0.27	1.45	4.13	-	3.23	-	-	8.29	4.66	6.53	0.47	0.73	1.25	-	5.09	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.7	8.44	0.34	4.75	-	1.64	3.82	0.27	1.45	4.13	-	3.23	-	-	8.29	4.66	6.53	0.47	0.73	1.25	-	5.09	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.7
H0543_802_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.35	0.03	0.2	0.58		0.54		0.04	0.44	1.25	2.41	0.15	0.04	0.5	0.26	0.89	0.29																				8.27	1380.42	35.36	1138.51	2095.62	12.53	15.03	1.34	12.28	34.97	0	23.29	0	1.74	18.96	53.66	103.22	2.54	1.67	21.57	11.07	38.17	12.41	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.34	0.32	5.31	-	2.51	3.01	0.27	2.46	6.99	-	4.66	-	0.35	3.79	10.73	20.64	1.27	0.33	4.31	2.21	7.63	2.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.63	12.34	0.32	5.31	-	2.8	3.36	0.3	2.66	7.57	-	5.2	-	0.39	4.23	11.98	23.05	1.42	0.37	4.82	2.47	8.52	2.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.9
H0543_804_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.35	0.03	0.2	0.58		0.54		0.04	0.44	1.25	2.41	0.15	0.04	0.5	0.26	0.89	0.29																				8.27	1380.42	35.36	1138.51	2095.62	12.53	15.03	1.34	12.28	34.97	0	23.29	0	1.74	18.96	53.66	103.22	2.54	1.67	21.57	11.07	38.17	12.41	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.34	0.32	5.31	-	2.51	3.01	0.27	2.46	6.99	-	4.66	-	0.35	3.79	10.73	20.64	1.27	0.33	4.31	2.21	7.63	2.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.63	12.34	0.32	5.31	-	2.8	3.36	0.3	2.66	7.57	-	5.2	-	0.39	4.23	11.98	23.05	1.42	0.37	4.82	2.47	8.52	2.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.9
H0543_805_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.35	0.03	0.2	0.58		0.54		0.04	0.44	1.25	2.41	0.15	0.04	0.5	0.26	0.89	0.29																				8.27	1380.42	35.36	1138.51	2095.62	12.53	15.03	1.34	12.28	34.97	0	23.29	0	1.74	18.96	53.66	103.22	2.54	1.67	21.57	11.07	38.17	12.41	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.34	0.32	5.31	-	2.51	3.01	0.27	2.46	6.99	-	4.66	-	0.35	3.79	10.73	20.64	1.27	0.33	4.31	2.21	7.63	2.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.63	12.34	0.32	5.31	-	2.8	3.36	0.3	2.66	7.57	-	5.2	-	0.39	4.23	11.98	23.05	1.42	0.37	4.82	2.47	8.52	2.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.9
H0543_806_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.35	0.03	0.2	0.58		0.54		0.04	0.44	1.25	2.41	0.15	0.04	0.5	0.26	0.89	0.29																				8.27	1380.42	35.36	1138.51	2095.62	12.53	15.03	1.34	12.28	34.97	0	23.29	0	1.74	18.96	53.66	103.22	2.54	1.67	21.57	11.07	38.17	12.41	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.34	0.32	5.31	-	2.51	3.01	0.27	2.46	6.99	-	4.66	-	0.35	3.79	10.73	20.64	1.27	0.33	4.31	2.21	7.63	2.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.63	12.34	0.32	5.31	-	2.8	3.36	0.3	2.66	7.57	-	5.2	-	0.39	4.23	11.98	23.05	1.42	0.37	4.82	2.47	8.52	2.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.9
H0543_807_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.35	0.03	0.2	0.58		0.54		0.04	0.44	1.35	2.6	0.16	0.04	0.54	0.28	0.89	0.29																				8.64	1311.4	33.59	910.81	2095.62	12.53	15.03	1.34	12.28	34.97	0	23.29	0	1.74	18.96	58.01	111.58	2.75	1.81	23.31	11.96	38.17	12.41	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	11.72	0.31	4.25	-	2.51	3.01	0.27	2.46	6.99	-	4.66	-	0.35	3.79	11.6	22.32	1.37	0.36	4.66	2.39	7.63	2.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.14	11.72	0.31	4.25	-	2.8	3.36	0.3	2.66	7.57	-	5.2	-	0.39	4.23	12.95	24.92	1.54	0.4	5.21	2.67	8.52	2.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.78
H0543_808_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.35	0.03	0.2	0.58		0.54		0.04	0.44	1.35	2.6	0.16	0.04	0.54	0.28	0.89	0.29																				8.64	1311.4	33.59	910.81	2095.62	12.53	15.03	1.34	12.28	34.97	0	23.29	0	1.74	18.96	58.01	111.58	2.75	1.81	23.31	11.96	38.17	12.41	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	11.72	0.31	4.25	-	2.51	3.01	0.27	2.46	6.99	-	4.66	-	0.35	3.79	11.6	22.32	1.37	0.36	4.66	2.39	7.63	2.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.14	11.72	0.31	4.25	-	2.8	3.36	0.3	2.66	7.57	-	5.2	-	0.39	4.23	12.95	24.92	1.54	0.4	5.21	2.67	8.52	2.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.78
H0544_001_0	2006																							D			T	Coin		V					V																																																																							-		2.11			358.21	6.94		368.11					18.22																																																																																																																	150			50	0.1		28.58					25																														-	0.03	-	-	1.49	0.69	-	0.88	-	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.12	-	0.03	-	-	1.49	0.69	-	0.88	-	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.12
H0544_002_0	2006																							D			T	Coin		V					V																																																																							-		2.11			358.21	6.94		368.11					18.22																																																																																																																	150			50	0.1		28.58					25																														-	0.03	-	-	1.49	0.69	-	0.88	-	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.12	-	0.03	-	-	1.49	0.69	-	0.88	-	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.12
H0545_001_0	2006																						D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	P	P	P	V	V	P	P	P	P	P																																																					-	1209.13	88	949.09	0	193.24	9.58	10.14	250.95	302.85	0	573.7	26.74	2.91	735.74	3742.05	5485.95	372.23	1215.1	0	893.55	21.68	0	0	0	109	256.6	0	0	0	0	0											75 days 1-6	75 days 1-6	25 days 21-100		50	20	20/10	50/30	100	15	50/15	100	100	100/10	5	10	10	10		10	10				10	25																54.84	54.84	6.5	0	85	0.2	0.18	49.97	100	0	46.18	100	100	83.94	5	10	10	10	0	10	0.1	0	0	0	15	25	0	0	0	0	0												54.84	54.84	6.5	0	85	0.2	0.18	49.97	100	0	46.18	100	100	83.94	5	10	10	10	0	10	0.1	0	0	0	15	25	0	0	0	0	0												5.53	0.4	0.51	-	1.37	1.92	1.87	1.05	2.52	-	2.21	0.22	0.02	5.15	1.56	4.57	0.31	1.01	-	0.74	2.17	-	-	-	0.14	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.81	5.53	0.4	0.51	-	1.37	1.92	1.87	1.05	2.52	-	2.21	0.22	0.02	5.15	1.56	4.57	0.31	1.01	-	0.74	2.17	-	-	-	0.14	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.81
H0562_002_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	308.47	4.38	70.51	0	311.82	10.2	0	273.69	311.77	0	8.27	0	11.45	0	5544.78	4382.9	112.71	0	0	284.3	33.76	0	0	0	497.62	0	16.06	0	0	0	0											100 per day days 1-4		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															296.67	900	227.02	0	125	0.2	0.2	50	100	0	275	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0											0	296.67	900	227.02	0	125	0.2	0.2	50	100	0	275	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0											0	7.63	0.33	1.33	-	3.25	2.04	-	1.14	2.6	-	0.19	-	0.02	-	4.62	3.65	0.23	-	-	0.24	6.75	-	-	-	0.41	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.45	7.63	0.33	1.33	-	3.25	2.04	-	1.14	2.6	-	0.19	-	0.02	-	4.62	3.65	0.23	-	-	0.24	6.75	-	-	-	0.41	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.45
H0562_009_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	301.5	3.86	78.74	0	280.51	14.27	0	268.13	366.66	0	30.07	0	6.46	0	5875.17	5173.35	116.43	0	0	316.4	37.58	0	0	0	1102.51	0	120.21	0	0	0	0											200 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0											0	665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0											0	16.73	0.29	1.49	-	2.92	2.85	-	1.12	6.11	-	0.69	-	0.01	-	4.9	4.31	0.24	-	-	0.26	7.52	-	-	-	0.92	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.46	16.73	0.29	1.49	-	2.92	2.85	-	1.12	6.11	-	0.69	-	0.01	-	4.9	4.31	0.24	-	-	0.26	7.52	-	-	-	0.92	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.46
H0562_010_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	298.4	4.5	76.69	0	325.02	14.07	0	335.05	322.33	0	18.82	0	24.89	0	5847.97	4720.24	88.56	0	0	302.65	69.66	0	0	0	663.76	0	36.36	0	0	0	0											100 per day days 1-4		0								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															296.67	900	0	0	125	0.2	0.2	50	100	0	275	0	25	0	10	15	25	0	0	15	0.2	0	0	0	15	0	15	0	0	0	0											0	296.67	900	0	0	125	0.2	0.2	50	100	0	275	0	25	0	10	15	25	0	0	15	0.2	0	0	0	15	0	15	0	0	0	0											0	7.38	0.34	-	-	3.39	2.81	-	1.4	2.69	-	0.43	-	0.05	-	4.87	5.9	0.18	-	-	0.38	13.93	-	-	-	0.83	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.62	7.38	0.34	-	-	3.39	2.81	-	1.4	2.69	-	0.43	-	0.05	-	4.87	5.9	0.18	-	-	0.38	13.93	-	-	-	0.83	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.62
H0562_011_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	355.18	9.28	76.16	0	348.63	14.72	0	330.77	337.39	0	36.97	0	11.91	0	7438.16	5891.5	114.83	0	0	381.73	52.46	0	0	0	469	0	26.51	0	0	0	0											175 per day days 1-5		High 90 Low 50 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															582.53	900	256.73	0	125	0.2	0.2	50	175	0	275	0	25	0	10	20	25	0	0	20	0.2	0	0	0	20	0	20	0	0	0	0											0	582.53	900	256.73	0	125	0.2	0.2	50	175	0	275	0	25	0	10	20	25	0	0	20	0.2	0	0	0	20	0	20	0	0	0	0											0	17.24	0.7	1.63	-	3.63	2.94	-	1.38	4.92	-	0.85	-	0.02	-	6.2	9.82	0.24	-	-	0.64	10.49	-	-	-	0.78	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.52	17.24	0.7	1.63	-	3.63	2.94	-	1.38	4.92	-	0.85	-	0.02	-	6.2	9.82	0.24	-	-	0.64	10.49	-	-	-	0.78	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.52
H0562_012_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	276.64	4.46	63.26	0	268.45	11.55	0	256.99	296.61	0	5.96	0	8.18	0	4848.43	3842.67	161.24	0	0	248.89	41.65	0	0	0	530.76	0	32.85	0	0	0	0											200 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	10	25	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0	0											0	665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	10	25	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0	0											0	15.35	0.33	1.2	-	2.8	2.31	-	1.07	4.94	-	0.14	-	0.02	-	4.04	8.01	0.34	-	-	0.52	8.33	-	-	-	1.11	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.56	15.35	0.33	1.2	-	2.8	2.31	-	1.07	4.94	-	0.14	-	0.02	-	4.04	8.01	0.34	-	-	0.52	8.33	-	-	-	1.11	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.56
H0562_017_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	273.97	7.58	81.75	0	256.27	15.98	0	306.92	265.85	0	5.49	0	26.05	0	4396.53	3494.48	102.44	0	0	225.98	35.56	0	0	0	746.61	0	68.93	0	0	0	0											175 per day days 1-8		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															698.12	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	10	15	25	0	0	15	0.2	0	0	0	15	0	15	0	0	0	0											0	698.12	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	10	15	25	0	0	15	0.2	0	0	0	15	0	15	0	0	0	0											0	15.94	0.57	1.55	-	2.67	3.2	-	1.28	3.88	-	0.13	-	0.05	-	3.66	4.37	0.21	-	-	0.28	7.11	-	-	-	0.93	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.92	15.94	0.57	1.55	-	2.67	3.2	-	1.28	3.88	-	0.13	-	0.05	-	3.66	4.37	0.21	-	-	0.28	7.11	-	-	-	0.93	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.92
H0562_036_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	301.5	3.86	78.74	0	280.51	10.06	0	268.13	366.66	0	30.07	0	6.46	0	5875.17	5173.35	116.43	0	0	316.4	43.37	0	0	0	1102.51	0	120.21	0	0	0	0											175 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															582.53	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	10	20	25	0	0	20	0.2	0	0	0	20	0	20	0	0	0	0											0	582.53	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	10	20	25	0	0	20	0.2	0	0	0	20	0	20	0	0	0	0											0	14.64	0.29	1.49	-	2.92	2.01	-	1.12	5.35	-	0.69	-	0.01	-	4.9	8.62	0.24	-	-	0.53	8.67	-	-	-	1.84	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.52	14.64	0.29	1.49	-	2.92	2.01	-	1.12	5.35	-	0.69	-	0.01	-	4.9	8.62	0.24	-	-	0.53	8.67	-	-	-	1.84	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.52
H0562_037_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	301.5	3.86	78.74	0	280.51	11.53	0	268.13	366.66	0	30.07	0	6.46	0	5875.17	5173.35	116.43	0	0	316.4	43.06	0	0	0	1102.51	0	120.21	0	0	0	0											175 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															582.53	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	15	20	25	0	0	20	0.2	0	0	0	20	0	20	0	0	0	0											0	582.53	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	15	20	25	0	0	20	0.2	0	0	0	20	0	20	0	0	0	0											0	14.64	0.29	1.49	-	2.92	2.31	-	1.12	5.35	-	0.69	-	0.01	-	7.34	8.62	0.24	-	-	0.53	8.61	-	-	-	1.84	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.2	14.64	0.29	1.49	-	2.92	2.31	-	1.12	5.35	-	0.69	-	0.01	-	7.34	8.62	0.24	-	-	0.53	8.61	-	-	-	1.84	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.2
H0562_039_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	298.4	4.5	76.69	0	325.02	14.25	0	335.05	322.33	0	18.82	0	24.89	0	5847.97	4720.24	88.56	0	0	302.65	60.89	0	0	0	663.76	0	36.36	0	0	0	0											150 per day days 1-4		0								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															445.01	900	0	0	125	0.2	0.2	50	150	0	275	0	25	0	15	20	25	0	0	20	0.2	0	0	0	20	0	20	0	0	0	0											0	445.01	900	0	0	125	0.2	0.2	50	150	0	275	0	25	0	15	20	25	0	0	20	0.2	0	0	0	20	0	20	0	0	0	0											0	11.07	0.34	-	-	3.39	2.85	-	1.4	4.03	-	0.43	-	0.05	-	7.31	7.87	0.18	-	-	0.5	12.18	-	-	-	1.11	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.76	11.07	0.34	-	-	3.39	2.85	-	1.4	4.03	-	0.43	-	0.05	-	7.31	7.87	0.18	-	-	0.5	12.18	-	-	-	1.11	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.76
H0562_040_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	432.41	8.96	66.68	0	302.99	12.41	0	442.07	392.7	0	75.5	0	4.05	0	6529.46	5320.06	318.22	0	0	339.34	68.98	0	0	0	486.07	0	83.21	0	0	0	0											200 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	15	25	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0	0											0	665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	15	25	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0	0											0	23.99	0.67	1.26	-	3.16	2.48	-	1.84	6.54	-	1.73	-	0.01	-	8.16	11.08	0.66	-	-	0.71	13.8	-	-	-	1.01	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.29	23.99	0.67	1.26	-	3.16	2.48	-	1.84	6.54	-	1.73	-	0.01	-	8.16	11.08	0.66	-	-	0.71	13.8	-	-	-	1.01	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.29
H0562_044_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	308.47	4.38	70.51	0	311.82	10.2	0	273.69	311.77	0	8.27	0	11.45	0	5544.78	4382.9	112.71	0	0	284.3	33.76	0	0	2051.7	497.62	0	16.06	0	0	0	1261.42											100 per day days 1-4		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															296.67	900	227.02	0	125	0.2	0.2	50	100	0	275	0	25	0	10	10	25	0	0	10	0.2	0	0	28.54	10	0	10	0	0	0	10											0	296.67	900	227.02	0	125	0.2	0.2	50	100	0	275	0	25	0	10	10	25	0	0	10	0.2	0	0	28.54	10	0	10	0	0	0	10											0	7.63	0.33	1.33	-	3.25	2.04	-	1.14	2.6	-	0.19	-	0.02	-	4.62	3.65	0.23	-	-	0.24	6.75	-	-	4.88	0.41	-	0.01	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	40.38	7.63	0.33	1.33	-	3.25	2.04	-	1.14	2.6	-	0.19	-	0.02	-	4.62	3.65	0.23	-	-	0.24	6.75	-	-	4.88	0.41	-	0.01	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	40.38
H0562_045_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	298.4	4.5	76.69	0	325.02	14.07	0	335.05	322.33	0	18.82	0	24.89	0	5847.97	4720.24	88.56	0	0	302.65	69.66	0	0	2051.7	663.76	0	36.36	0	0	0	1261.42											100 per day days 1-4		0								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															296.67	900	0	0	125	0.2	0.2	50	100	0	275	0	25	0	10	15	25	0	0	15	0.2	0	0	28.54	15	0	15	0	0	0	10											0	296.67	900	0	0	125	0.2	0.2	50	100	0	275	0	25	0	10	15	25	0	0	15	0.2	0	0	28.54	15	0	15	0	0	0	10											0	7.38	0.34	-	-	3.39	2.81	-	1.4	2.69	-	0.43	-	0.05	-	4.87	5.9	0.18	-	-	0.38	13.93	-	-	4.88	0.83	-	0.05	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	50.55	7.38	0.34	-	-	3.39	2.81	-	1.4	2.69	-	0.43	-	0.05	-	4.87	5.9	0.18	-	-	0.38	13.93	-	-	4.88	0.83	-	0.05	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	50.55
H0562_046_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	355.18	9.28	76.16	0	348.63	14.72	0	330.77	337.39	0	36.97	0	11.91	0	7438.16	5891.5	114.83	0	0	381.73	52.46	0	0	2051.7	469	0	26.51	0	0	0	1261.42											175 per day days 1-5		High 90 Low 50 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															582.53	900	256.73	0	125	0.2	0.2	50	175	0	275	0	25	0	10	20	25	0	0	20	0.2	0	0	28.54	20	0	20	0	0	0	10											0	582.53	900	256.73	0	125	0.2	0.2	50	175	0	275	0	25	0	10	20	25	0	0	20	0.2	0	0	28.54	20	0	20	0	0	0	10											0	17.24	0.7	1.63	-	3.63	2.94	-	1.38	4.92	-	0.85	-	0.02	-	6.2	9.82	0.24	-	-	0.64	10.49	-	-	4.88	0.78	-	0.04	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	67.45	17.24	0.7	1.63	-	3.63	2.94	-	1.38	4.92	-	0.85	-	0.02	-	6.2	9.82	0.24	-	-	0.64	10.49	-	-	4.88	0.78	-	0.04	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	67.45
H0562_047_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	432.41	8.96	66.68	0	302.99	12.41	0	442.07	392.7	0	75.5	0	4.05	0	6529.46	5320.06	318.22	0	0	339.34	68.98	0	0	0	486.07	0	83.21	0	0	0	0											200 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	15	25	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0	0											0	665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	15	25	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0	0											0	23.99	0.67	1.26	-	3.16	2.48	-	1.84	6.54	-	1.73	-	0.01	-	8.16	11.08	0.66	-	-	0.71	13.8	-	-	-	1.01	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.29	23.99	0.67	1.26	-	3.16	2.48	-	1.84	6.54	-	1.73	-	0.01	-	8.16	11.08	0.66	-	-	0.71	13.8	-	-	-	1.01	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.29
H0562_048_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	276.64	4.46	63.26	0	268.45	11.55	0	256.99	296.61	0	5.96	0	8.18	0	4848.43	3842.67	161.24	0	0	248.89	41.65	0	0	0	530.76	0	32.85	0	0	0	0											200 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	10	25	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0	0											0	665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	10	25	25	0	0	25	0.2	0	0	0	25	0	25	0	0	0	0											0	15.35	0.33	1.2	-	2.8	2.31	-	1.07	4.94	-	0.14	-	0.02	-	4.04	8.01	0.34	-	-	0.52	8.33	-	-	-	1.11	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.56	15.35	0.33	1.2	-	2.8	2.31	-	1.07	4.94	-	0.14	-	0.02	-	4.04	8.01	0.34	-	-	0.52	8.33	-	-	-	1.11	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.56
H0562_049_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	301.5	3.86	78.74	0	280.51	14.27	0	268.13	366.66	0	30.07	0	6.46	0	5875.17	5173.35	116.43	0	0	316.4	37.58	0	0	0	1102.51	0	120.21	0	0	0	0											200 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0											0	665.75	900	227.02	0	125	0.2	0.2	50	200	0	275	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0											0	16.73	0.29	1.49	-	2.92	2.85	-	1.12	6.11	-	0.69	-	0.01	-	4.9	4.31	0.24	-	-	0.26	7.52	-	-	-	0.92	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.46	16.73	0.29	1.49	-	2.92	2.85	-	1.12	6.11	-	0.69	-	0.01	-	4.9	4.31	0.24	-	-	0.26	7.52	-	-	-	0.92	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.46
H0562_050_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	301.5	3.86	78.74	0	280.51	10.06	0	268.13	366.66	0	30.07	0	6.46	0	5875.17	5173.35	116.43	0	0	316.4	43.37	0	0	2051.7	1102.51	0	120.21	0	0	0	1261.42											175 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															582.53	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	10	20	25	0	0	20	0.2	0	0	28.54	20	0	20	0	0	0	10											0	582.53	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	10	20	25	0	0	20	0.2	0	0	28.54	20	0	20	0	0	0	10											0	14.64	0.29	1.49	-	2.92	2.01	-	1.12	5.35	-	0.69	-	0.01	-	4.9	8.62	0.24	-	-	0.53	8.67	-	-	4.88	1.84	-	0.2	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	59.45	14.64	0.29	1.49	-	2.92	2.01	-	1.12	5.35	-	0.69	-	0.01	-	4.9	8.62	0.24	-	-	0.53	8.67	-	-	4.88	1.84	-	0.2	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	59.45
H0562_051_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	301.5	3.86	78.74	0	280.51	11.53	0	268.13	366.66	0	30.07	0	6.46	0	5875.17	5173.35	116.43	0	0	316.4	43.06	0	0	2051.7	1102.51	0	120.21	0	0	0	1261.42											175 per day days 1-5		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															582.53	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	15	20	25	0	0	20	0.2	0	0	28.54	20	0	20	0	0	0	10											0	582.53	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	15	20	25	0	0	20	0.2	0	0	28.54	20	0	20	0	0	0	10											0	14.64	0.29	1.49	-	2.92	2.31	-	1.12	5.35	-	0.69	-	0.01	-	7.34	8.62	0.24	-	-	0.53	8.61	-	-	4.88	1.84	-	0.2	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	62.13	14.64	0.29	1.49	-	2.92	2.31	-	1.12	5.35	-	0.69	-	0.01	-	7.34	8.62	0.24	-	-	0.53	8.61	-	-	4.88	1.84	-	0.2	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	62.13
H0562_052_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	298.4	4.5	76.69	0	325.02	14.25	0	335.05	322.33	0	18.82	0	24.89	0	5847.97	4720.24	88.56	0	0	302.65	60.89	0	0	2051.7	663.76	0	36.36	0	0	0	1261.42											150 per day days 1-4		0								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															445.01	900	0	0	125	0.2	0.2	50	150	0	275	0	25	0	15	20	25	0	0	20	0.2	0	0	28.54	20	0	20	0	0	0	10											0	445.01	900	0	0	125	0.2	0.2	50	150	0	275	0	25	0	15	20	25	0	0	20	0.2	0	0	28.54	20	0	20	0	0	0	10											0	11.07	0.34	-	-	3.39	2.85	-	1.4	4.03	-	0.43	-	0.05	-	7.31	7.87	0.18	-	-	0.5	12.18	-	-	4.88	1.11	-	0.06	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	58.69	11.07	0.34	-	-	3.39	2.85	-	1.4	4.03	-	0.43	-	0.05	-	7.31	7.87	0.18	-	-	0.5	12.18	-	-	4.88	1.11	-	0.06	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	58.69
H0562_053_0	2006											none											D	D	D	V	T	P	P	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	744.07	9.22	0	0	235.77	25313.3	21403.16	366.18	353.48	0	1171.35	0	0.21	20.31	4317.81	5885.43	193.46	0	0	260.38	6.76	706.38	0	0	404.73	0	173.46	0	0	0	0											150 per day days 1-4										Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate																					150	271.08	0	0	125	0.91	1.07	39.83	150	0	29.52	0	0.14	25	10	19.97	25	0	0	7.01	0.18	20.28	0	0	20	0	20	0	0	0	0											none	150	271.08	0	0	125	0.91	1.07	39.83	150	0	29.52	0	0.14	25	10	19.97	25	0	0	7.01	0.18	20.28	0	0	20	0	20	0	0	0	0											0	9.3	0.21	-	-	2.46	1.92	1.9	1.22	4.42	-	2.88	-	0.03	0.04	3.6	9.8	0.4	-	-	0.15	1.22	1.19	-	-	0.67	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.7	9.3	0.21	-	-	2.46	1.92	1.9	1.22	4.42	-	2.88	-	0.03	0.04	3.6	9.8	0.4	-	-	0.15	1.22	1.19	-	-	0.67	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.7
H0562_054_0	2006											none											D	D	D	V	T	P	P	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	770.14	9.32	0	0	234.79	25207.95	21314.05	370.34	357.53	0	1184.72	0	0.22	21.4	4647.38	6294.06	203.83	0	0	279.98	6.29	755.68	0	2052	435.61	0	186.72	0	0	0	704											150 per day days 1-4										Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate																					150	271.08	0	0	125	0.89	1.04	39.83	150	0	29.52	0	0.14	25	10	19.97	25	0	0	7.02	0.18	20.09	0	28.54	20	0	20	0	0	0	10											none	150	271.08	0	0	125	0.89	1.04	39.83	150	0	29.52	0	0.14	25	10	19.97	25	0	0	7.02	0.18	20.09	0	28.54	20	0	20	0	0	0	10											0	9.63	0.21	-	-	2.45	1.87	1.85	1.23	4.47	-	2.91	-	0.03	0.04	3.87	10.48	0.42	-	-	0.16	1.13	1.26	-	4.88	0.73	-	0.31	-	-	-	0.59	-	-	-	-	-	-	-	-	-	-	48.53	9.63	0.21	-	-	2.45	1.87	1.85	1.23	4.47	-	2.91	-	0.03	0.04	3.87	10.48	0.42	-	-	0.16	1.13	1.26	-	4.88	0.73	-	0.31	-	-	-	0.59	-	-	-	-	-	-	-	-	-	-	48.53
H0562_055_0	2006											none											D	D	D	V	T	coin	coin	V	coin	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	19.69	1164.65	0	207.05	9.67	9.62	296.41	27.74	0	28.59	0	0.26	28.69	0	0	273.34	0	30.22	18.63	8.21	948.27	0	0	608.85	0	0	0	0	0	0												1-8: 0/Day 9-90: 203 (not to exceed 956)	1-20: 0/Day 21-100: 50/Day		25 copay	25 DME/Prosthetics; 15 Diabetic Supplies	25 DME/Prosthetics; 15 Diabetic Supplies	50 ER / 30 UC	0 ASC / 0 OP		20 Rad; 0-20 X-Rays		25 Copay valued as 15 coinsurance	10 OP SA			10 MH			0 Hearing / 0 Preventive	20 coinsurance	2 Vision			5 copay						0											0	31.37	11.92	0	25	0.23	0.23	43.22	0	0	0.04	0	0.15	10	0	0	10	0	0.02	0	0.2	1.87	0	0	5	0	0	0	0	0	0											none	0	31.37	11.92	0	25	0.23	0.23	43.22	0	0	0.04	0	0.15	10	0	0	10	0	0.02	0	0.2	1.87	0	0	5	0	0	0	0	0	0											0	-	0.05	1.16	-	0.43	2.24	2.26	1.07	-	-	1.18	-	0.04	0.02	-	-	0.23	-	0.46	-	1.64	0.15	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.18	-	0.05	1.16	-	0.43	2.24	2.26	1.07	-	-	1.18	-	0.04	0.02	-	-	0.23	-	0.46	-	1.64	0.15	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.18
H0562_056_0	2006											none											D	D	D	V	T	coin	coin	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1502.14	15.19	0	0	342.02	16.09	16.02	571.46	43.36	0	1804.84	0	0.38	38.91	8676.78	9180.43	370.7	0	0	344.23	12.76	116.45	0	2051.7	0	0	0	0	0	0	1261.42											50 copay / day days 1 - 4	900 / Admit	1-20: 0/Day 21-100: 20/Day		75 copay	10 DME/Prosthetics; 0 Diabetic Supplies	10 DME/Prosthetics; 0 Diabetic Supplies	50 ER / 25 UC	0 ASC / 0 OP		10 CT Scan; 10 MRI; 10 Nuclear Med; 20 Therapeutic		25 Copay valued as 16 coinsurance	25 OP SA	5 PCP	5 SCP / 10 Chiro / 0 Podiatrist	25 MH			0 Hearing / 0 Preventive	20 coinsurance	0 Vision		Copays vary by service. Average =							0											50	271.08	0	0	75	0.08	0.08	41.37	0	0	15.15	0	0.16	25	5	5.55	25	0	0	0	0.1	0	0	28.54	0	0	0	0	0	0	10											none	50	271.08	0	0	75	0.08	0.08	41.37	0	0	15.15	0	0.16	25	5	5.55	25	0	0	0	0.1	0	0	28.54	0	0	0	0	0	0	10											0	6.26	0.34	-	-	2.14	1.31	1.35	1.97	-	-	2.28	-	0.06	0.08	3.62	4.24	0.77	-	-	-	1.28	-	-	4.88	-	-	-	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	31.63	6.26	0.34	-	-	2.14	1.31	1.35	1.97	-	-	2.28	-	0.06	0.08	3.62	4.24	0.77	-	-	-	1.28	-	-	4.88	-	-	-	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	31.63
H0562_057_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	273.97	7.58	81.75	0	256.27	15.98	0	306.92	265.85	0	5.49	0	26.05	0	4396.53	3494.48	102.44	0	0	225.98	35.56	0	0	0	746.61	0	68.93	0	0	0	0											175 per day days 1-8		75 per day days 21-100								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate				0		0															698.12	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	10	15	25	0	0	15	0.2	0	0	0	15	0	15	0	0	0	0											0	698.12	900	227.02	0	125	0.2	0.2	50	175	0	275	0	25	0	10	15	25	0	0	15	0.2	0	0	0	15	0	15	0	0	0	0											0	15.94	0.57	1.55	-	2.67	3.2	-	1.28	3.88	-	0.13	-	0.05	-	3.66	4.37	0.21	-	-	0.28	7.11	-	-	-	0.93	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.92	15.94	0.57	1.55	-	2.67	3.2	-	1.28	3.88	-	0.13	-	0.05	-	3.66	4.37	0.21	-	-	0.28	7.11	-	-	-	0.93	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.92
H0562_801_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	254.92	3.27	52.26	0	244.27	10.64	0	250.42	332	0	14.83	0	11.47	0	5631.01	4594.03	112.14	0	0	292.82	42.66	0	0	2051.7	685.96	0	56.66	0	0	0	1261.42											per Admit		per Admit								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay																		700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91
H0562_802_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	254.92	3.27	52.26	0	244.27	10.64	0	250.42	332	0	14.83	0	11.47	0	5631.01	4594.03	112.14	0	0	292.82	42.66	0	0	2051.7	685.96	0	56.66	0	0	0	1261.42											per Admit		per Admit								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91
H0562_803_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	254.92	3.27	52.26	0	244.27	10.64	0	250.42	332	0	14.83	0	11.47	0	5631.01	4594.03	112.14	0	0	292.82	42.66	0	0	2051.7	685.96	0	56.66	0	0	0	1261.42											per Admit		per Admit								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91
H0562_804_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	254.92	3.27	52.26	0	244.27	10.64	0	250.42	332	0	14.83	0	11.47	0	5631.01	4594.03	112.14	0	0	292.82	42.66	0	0	2051.7	685.96	0	56.66	0	0	0	1261.42											per Admit		per Admit								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91
H0562_805_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	254.92	3.27	52.26	0	244.27	10.64	0	250.42	332	0	14.83	0	11.47	0	5631.01	4594.03	112.14	0	0	292.82	42.66	0	0	2051.7	685.96	0	56.66	0	0	0	1261.42											per Admit		per Admit								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91
H0562_806_0	2006											0											A	BP	A	V	T	Coin	Coin	V	V	P	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	254.92	3.27	52.26	0	244.27	10.64	0	250.42	332	0	14.83	0	11.47	0	5631.01	4594.03	112.14	0	0	292.82	42.66	0	0	2051.7	685.96	0	56.66	0	0	0	1261.42											per Admit		per Admit								Adv Rad and Rad Thrpy above 1000										20 of Contracted Rate			Average Copay	0		0															700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	700	900	700	0	125	0.2	0.2	50	300	0	275	0	25	0	40	40	40	0	0	40	0.2	0	0	28.54	40	0	40	0	0	0	10											0	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91	14.87	0.25	3.05	-	2.54	2.13	-	1.04	8.3	-	0.34	-	0.02	-	18.77	15.31	0.37	-	-	0.98	8.53	-	-	4.88	2.29	-	0.19	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	84.91
H0564_003_0	2006																						Ded		Ded	V	Ded	Ded		V	Ded	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O												45.05		6.88		2.43	2.82			7.58																																	64.75				1304.37				239.86		146.22					7983.1	1478.61	141.94	823.37	1813.43	5490.19	16.08	0	0	84.12	420.21	323.32	180.09		66.77	0	794.08														0				50		20 coin on complex pcdr					30	30	30	30	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20/30	75 glasses/95 contacts	30		30	0	30											0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	30	30	30	30	0	0	0.2	0	0	15	20	0	30	0	30	0	30											0	0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	30	30	30	30	0	0	0.2	0	0	15	20	0	30	0	30	0	30											1900	-	-	-	-	-	-	-	1	-	13.16	-	-	-	-	19.96	3.7	0.35	2.06	-	-	3.22	-	-	0.11	0.7	-	0.45	-	0.17	-	1.99	-	-	-	-	-	-	-	-	-	-	46.85	45.05	-	6.88	-	2.43	2.82	-	1	7.58	13.16	-	-	-	-	19.96	3.7	0.35	2.06	-	-	3.22	-	-	0.11	0.7	-	0.45	-	0.17	-	1.99	-	-	-	-	-	-	-	-	-	-	111.6
H0564_004_0	2006											2100											D		D	V	T	Coin		V	V	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O											0	0		0	0	0	0		0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0											-	1428.44		936.77	1676.02	199.79	16.11		240.76	216.36	90					10853.87	2010.32	192.98	1119.45	2145.03	6494.12	11.9	0	0	80.76	420.21	323.32	172.89		35.13	0	762.32											100/day		95/day for days 21-100	0	100	20 coinsurance		50	100	20 coin - complex					5	10	20	20	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20	75 glasses/95 contacts	20		30	0	20											100		63.69	0	100	0.2		50	100	0.09					5	10	20	20	0	0	0.2	0	0	15	20	0	20		30	0	20											2100	93.17		63.69	0	98.69	0.2		49.05	100	0.09					5	10	20	20	0	0	0.2	0	0	15	20	0	20		30	0	20											0	11.09	-	4.97	-	1.64	3.22	-	0.98	1.8	8.1	-	-	-	-	4.52	1.68	0.32	1.87	-	-	2.38	-	-	0.1	0.7	-	0.29	-	0.09	-	1.27	-	-	-	-	-	-	-	-	-	-	45.03	11.09	-	4.97	-	1.64	3.22	-	0.98	1.8	8.1	-	-	-	-	4.52	1.68	0.32	1.87	-	-	2.38	-	-	0.1	0.7	-	0.29	-	0.09	-	1.27	-	-	-	-	-	-	-	-	-	-	45.03
H0564_005_0	2006											1500											D		D	V	T	Coin		V	V	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O											0	0		0	0	0	0		0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0											-	996.43		791.01	1384.14	185.57	10.99		202.79	182.26	91.55					8569.09	1587.14	152.35	883.81	1693.49	5127.08	12.07	0	0	65.19	420.21	323.32	139.57		61.71	0	615.41											75/day		100/day for days 21-100	0	100	20 coinsurance		50	100	20 coin - complex					5	10	10	10	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20-Oct	75 glasses/95 contacts	10		30	0	20											75		67.04	0	100	0.2		50	100	0.09					5	10	10	10	0	0	0.2	0	0	15	20	0	10		30	0	20											1500	71.53		67.04	0	99.41	0.2		49.51	100	0.09					5	10	10	10	0	0	0.2	0	0	15	20	0	10		30	0	20											0	5.94	-	4.42	-	1.54	2.2	-	0.84	1.52	8.24	-	-	-	-	3.57	1.32	0.13	0.74	-	-	2.41	-	-	0.08	0.7	-	0.12	-	0.15	-	1.03	-	-	-	-	-	-	-	-	-	-	34.94	5.94	-	4.42	-	1.54	2.2	-	0.84	1.52	8.24	-	-	-	-	3.57	1.32	0.13	0.74	-	-	2.41	-	-	0.08	0.7	-	0.12	-	0.15	-	1.03	-	-	-	-	-	-	-	-	-	-	34.94
H0564_006_0	2006											750											D		D	V	T	Coin		V	V	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O											0	0		0	0	0	0		0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0											-	1271.26		852.42	1846.19	205.88	15.04		305.28	274.37	73.39					9012.12	1669.2	160.23	929.5	1781.05	5392.16	7.16	0	0	84.12	420.21	323.32	180.09		27.39	0	794.08											75/day for day 1-10		65/day for days 21-100	0	100	20 coinsurance		50	75	20 coin - complex					5	10	20	20	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20	75 glasses/95 contacts	20		30	0	20											75		43.58	0	100	0.2		50	75	0.09					5	10	20	20	0	0	0.2	0	0	15	20	0	20		30	0	20											750	57.37		43.58	0	90.06	0.2		43.42	75	0.09					5	10	20	20	0	0	0.2	0	0	15	20	0	20		30	0	20											0	6.08	-	3.1	-	1.55	3.01	-	1.1	1.71	6.61	-	-	-	-	3.76	1.39	0.27	1.55	-	-	1.43	-	-	0.11	0.7	-	0.3	-	0.07	-	1.32	-	-	-	-	-	-	-	-	-	-	34.04	6.08	-	3.1	-	1.55	3.01	-	1.1	1.71	6.61	-	-	-	-	3.76	1.39	0.27	1.55	-	-	1.43	-	-	0.11	0.7	-	0.3	-	0.07	-	1.32	-	-	-	-	-	-	-	-	-	-	34.04
H0564_007_0	2006											2100											D		D	V	T	Coin		V	V	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O											0	0		0	0	0	0		0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0											-	1401.28		1065.53	822.76	237.21	17.88		192.62	173.11	65.66					9585.62	1775.42	170.43	988.65	1894.39	5735.29	7.18	0	0	84.12	420.21	323.32	180.09		33.54	0	794.08											75/day		80/day for days 21-100	0	100	20 coinsurance		50	100	20 coin - complex					5	10	10	10	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20-Oct	75 glasses/95 contacts	10		30	0	20											75		53.63	0	100	0.2		50	100	0.09					5	10	10	10	0	0	0.2	0	0	15	20	0	10		30	0	20											2100	71.53		53.63	0	96.87	0.2		48.31	100	0.09					5	10	10	10	0	0	0.2	0	0	15	20	0	10		30	0	20											0	8.35	-	4.76	-	1.91	3.58	-	0.78	1.44	5.91	-	-	-	-	3.99	1.48	0.14	0.82	-	-	1.44	-	-	0.11	0.7	-	0.15	-	0.08	-	1.32	-	-	-	-	-	-	-	-	-	-	36.97	8.35	-	4.76	-	1.91	3.58	-	0.78	1.44	5.91	-	-	-	-	3.99	1.48	0.14	0.82	-	-	1.44	-	-	0.11	0.7	-	0.15	-	0.08	-	1.32	-	-	-	-	-	-	-	-	-	-	36.97
H0564_009_0	2006											0											Ded		Ded	V	Ded	Ded		V	Ded	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O											0	50.81		3.69		2.68	2.2			6.63																																	66.02				1201.02				224.42		113.12					8561.52	1585.74	152.22	883.02	1691.99	5122.55	9.04	0	0	79.92	399.2	307.15	171.09		29.49	0	754.38														0				50		20 coin - complex					10	25	25	25	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20/25	75 glasses/95 contacts	25		30	0	25											0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	10	25	25	25	0	0	0.2	0	0	15	20	0	30	0	30	0	25											0	0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	10	25	25	25	0	0	0.2	0	0	15	20	0	30	0	30	0	25											2000	-	-	-	-	-	-	-	0.94	-	10.18	-	-	-	-	7.13	3.3	0.32	1.84	-	-	1.81	-	-	0.1	0.67	-	0.43	-	0.07	-	1.57	-	-	-	-	-	-	-	-	-	-	28.36	50.81	-	3.69	-	2.68	2.2	-	0.94	6.63	10.18	-	-	-	-	7.13	3.3	0.32	1.84	-	-	1.81	-	-	0.1	0.67	-	0.43	-	0.07	-	1.57	-	-	-	-	-	-	-	-	-	-	94.38
H0564_023_0	2006											0											Ded		Ded	V	Ded	Ded		V	Ded	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O											0	0		0		4.58	12.97			17.47																																	35.02				1530.58				244.49		85.15					21015.69	3807.85	365.53	2120.41	4063	13667.56	8.4	0	0	84.12	237.48	182.73	180.09		37.32	0	794.08														0				50		20 coin - complex					15	20	20	20	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20	75 glasses/95 contacts	20		30	0	20											0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	15	20	20	20	0	0	0.2	0	0	15	20	0	30	0	30	0	20											0	0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	15	20	20	20	0	0	0.2	0	0	15	20	0	30	0	30	0	20											2000	-	-	-	-	-	-	-	1.02	-	7.66	-	-	-	-	26.27	6.35	0.61	3.53	-	-	1.68	-	-	0.11	0.4	-	0.45	-	0.09	-	1.32	-	-	-	-	-	-	-	-	-	-	49.49	-	-	-	-	4.58	12.97	-	1.02	17.47	7.66	-	-	-	-	26.27	6.35	0.61	3.53	-	-	1.68	-	-	0.11	0.4	-	0.45	-	0.09	-	1.32	-	-	-	-	-	-	-	-	-	-	84.51
H0564_037_0	2006											2000											D		D	V	T	Coin		V	V	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O											0	0		0	0	0	0		0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0											-	1738.39		1140.03	2039.68	243.14	20.51		292.97	263.3	114.59					11491.8	2128.48	204.32	1185.25	2610.46	7903.22	15.15	0	0	98.28	420.21	323.32	210.4		42.75	0	927.73											200/day		25/day for days 21-100	0	100	20 coinsurance		50	200	20 coin - complex					30	30	30	30	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20/30	75 glasses/95 contacts	30		30	0	30											200		25	0	100	0.2		50	200	0.09					30	30	30	30	0	0	0.2	0	0	15	20	0	30		30	0	30											2000	177.71		25	0	96.79	0.2		48.38	200	0.09					30	30	30	30	0	0	0.2	0	0	15	20	0	30		30	0	30											0	25.74	-	2.38	-	1.96	4.1	-	1.18	4.39	10.31	-	-	-	-	28.73	5.32	0.51	2.96	-	-	3.03	-	-	0.12	0.7	-	0.53	-	0.11	-	2.32	-	-	-	-	-	-	-	-	-	-	94.39	25.74	-	2.38	-	1.96	4.1	-	1.18	4.39	10.31	-	-	-	-	28.73	5.32	0.51	2.96	-	-	3.03	-	-	0.12	0.7	-	0.53	-	0.11	-	2.32	-	-	-	-	-	-	-	-	-	-	94.39
H0564_038_0	2006											0											Ded		Ded	V	Ded	Ded		V	Ded	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O											0	52.18		7.66		3.06	2			6.01																																	70.9				1928.86				282.6		123.23					11193.05	2073.15	199.01	1154.44	2404.41	7279.41	16.24	0	0	90.85	420.21	323.32	194.5		86	0	857.61														0				50		20 coin - complex					25	25	25	25	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20/25	75 glasses/95 contacts	25		30	0	25											0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	25	25	25	25	0	0	0.2	0	0	15	20	0	30	0	30	0	25											0	0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	25	25	25	25	0	0	0.2	0	0	15	20	0	30	0	30	0	25											2000	-	-	-	-	-	-	-	1.18	-	11.09	-	-	-	-	23.32	4.32	0.41	2.41	-	-	3.25	-	-	0.11	0.7	-	0.49	-	0.22	-	1.79	-	-	-	-	-	-	-	-	-	-	49.28	52.18	-	7.66	-	3.06	2	-	1.18	6.01	11.09	-	-	-	-	23.32	4.32	0.41	2.41	-	-	3.25	-	-	0.11	0.7	-	0.49	-	0.22	-	1.79	-	-	-	-	-	-	-	-	-	-	120.18
H0564_039_0	2006											0											Ded		Ded	V	Ded	Ded		V	Ded	Coin					P	P	P	P	P	P	Coin	O	V	P	V	V	V		V	O	O											0	54.7		3.98		2.89	2.37			7.14																																	71.07				1453.87				271.67		152.02					9534.82	1670.03	160.31	929.96	2048.2	6200.98	12.15	0	0	96.74	483.24	371.82	207.1		35.7	0	913.2														0				50		20 coinsurance					25	30	30	30	0	0	20 coinsurance	0	0	0/30/40 for cleaning x-rays	20/30	75 glasses/95 contacts	30		30	0	30											0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	25	30	30	30	0	0	0.2	0	0	15	20	0	30	0	30	0	30											0	0	0	0	0	0	0	0	50	0	0.09	0	0	0	0	25	30	30	30	0	0	0.2	0	0	15	20	0	30	0	30	0	30											2000	-	-	-	-	-	-	-	1.13	-	13.68	-	-	-	-	19.86	4.18	0.4	2.32	-	-	2.43	-	-	0.12	0.81	-	0.52	-	0.09	-	2.28	-	-	-	-	-	-	-	-	-	-	47.83	54.7	-	3.98	-	2.89	2.37	-	1.13	7.14	13.68	-	-	-	-	19.86	4.18	0.4	2.32	-	-	2.43	-	-	0.12	0.81	-	0.52	-	0.09	-	2.28	-	-	-	-	-	-	-	-	-	-	118.9
H0564_040_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	462.79	4.97	63.69	0	9.51	25.63	1.79	5.52	24.89	9.73	26.44	0	7.37	26.19	39.07	62.19	3.41	3.59	36.9	193.31	29.46	3.67	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	26.01	0.28	10.17	-	2.22	5.97	0.42	1.29	5.8	2.27	6.16	-	1.72	6.1	9.1	14.49	0.79	0.84	8.6	45.04	6.87	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	154.97	26.01	0.28	10.17	-	2.22	5.97	0.42	1.29	5.8	2.27	6.16	-	1.72	6.1	9.1	14.49	0.79	0.84	8.6	45.04	6.87	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	154.97
H0564_801_0	2006											2000											D		D	V	T	Coin		V	V					Coin	V	V	V	V	V	V	Coin	O																				0	0		0	0	0	0		0	0					0	0	0	0	0	0	0	0	0																				-	926.31		865.02	1211.15	129.08	12.86		200.55	273.38					61.5	10010	12668.9	1407.7	1564.1	2502.5	3128.1	9.94	0																				200/day		25/day for days 21-100	0	100	20 coinsurance		50	200					20 coin - complex only	30	30	30	30	0	0	20 coinsurance	0																				200		16.76	0	100	0.2		50	200					0.09	30	30	30	30	0	0	0.2	0																				2000	177.71		16.76	0	93.15	0.2		47.54	200					0.09	30	30	30	30	0	0	0.2	0																				0	13.72	-	1.21	-	1	2.57	-	0.79	4.56	-	-	-	-	5.53	25.03	31.67	3.52	3.91	-	-	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.5	13.72	-	1.21	-	1	2.57	-	0.79	4.56	0	-	-	-	5.53	25.03	31.67	3.52	3.91	-	-	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.5
H0571_001_0	2006																						D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V		V				V																																																					-	556	10	369.9	0	156	8.94	5.91	393	239	0	0	0	0	0	3689.24	3137.35	156	597	0	986	0	517	0	0	307	0	132	0	0	0	165											copay for days 1-5	copay for days 1-5					20 prosth/supplies 0 diab supplies	50 ER 15 urgent care																																																																												200	200	75	0	100	0.2	0.18	36.37	150	0	0	0	0	0	10	15	15	20	0	15	0	15	0	0	15	0	15	0	0	0	15												9.27	0.17	2.31	-	1.3	1.79	1.09	1.19	2.99	-	-	-	-	-	3.07	3.92	0.2	1	-	1.23	-	0.65	-	-	0.38	-	0.17	-	-	-	0.21	-	-	-	-	-	-	-	-	-	-	30.92	9.27	0.17	2.31	-	1.3	1.79	1.09	1.19	2.99	-	-	-	-	-	3.07	3.92	0.2	1	-	1.23	-	0.65	-	-	0.38	-	0.17	-	-	-	0.21	-	-	-	-	-	-	-	-	-	-	30.92
H0571_002_0	2006																						D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V		V				V																																																					-	576.8	10	382.6	0	160	9.2	6.06	404	247	0	0	0	0	0	3769.8	3210.53	161	612	0	1032	0	527	0	0	312	0	134	0	0	0	176											copay for days 1-5	copay for days 1-5					20 prosth/supplies 0 diab supplies	50 ER 15 urgent care																																																																												200	200	75	0	100	0.2	0.18	36.49	150	0	0	0	0	0	10	15	15	20	0	15	0	15	0	0	15	0	15	0	0	0	15												9.61	0.17	2.39	-	1.33	1.84	1.11	1.23	3.09	-	-	-	-	-	3.14	4.01	0.2	1.02	-	1.29	-	0.66	-	-	0.39	-	0.17	-	-	-	0.22	-	-	-	-	-	-	-	-	-	-	31.87	9.61	0.17	2.39	-	1.33	1.84	1.11	1.23	3.09	-	-	-	-	-	3.14	4.01	0.2	1.02	-	1.29	-	0.66	-	-	0.39	-	0.17	-	-	-	0.22	-	-	-	-	-	-	-	-	-	-	31.87
H0571_005_0	2006																						D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V		V				V																																																					-	755.8	14.7	496.8	0	201	11.7	7.62	520	321	0	0	0	0	0	4756.47	4163.7	216	769	0	1458	0	684	0	0	401	0	172	0	0	0	266											copay for days 1-5	copay for days 1-5					20 prosth/supplies 0 diab supplies	50 ER 10 urgent care																																																																												150	150	75	0	100	0.2	0.18	34.46	100	0	0	0	0	0	5	10	10	20	0	10	0	10	0	0	10	0	10	0	0	0	10												9.45	0.18	3.11	-	1.68	2.34	1.39	1.49	2.68	-	-	-	-	-	1.98	3.47	0.18	1.28	-	1.22	-	0.57	-	-	0.33	-	0.14	-	-	-	0.22	-	-	-	-	-	-	-	-	-	-	31.71	9.45	0.18	3.11	-	1.68	2.34	1.39	1.49	2.68	-	-	-	-	-	1.98	3.47	0.18	1.28	-	1.22	-	0.57	-	-	0.33	-	0.14	-	-	-	0.22	-	-	-	-	-	-	-	-	-	-	31.71
H0571_801_0	2006																						D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V		V				V																																																					-	556	10	369.9	0	156	8.94	5.91	400	239	0	0	0	0	0	3689.24	3237.76	164	597	0	1037	0	540	0	0	321	0	138	0	0	0	174											copay for days 1-5	copay for days 1-5					20 prosth/supplies 0 diab supplies	50 ER 10 urgent care												10 hearing 20 chiro & podiatrist																																																																150	150	75	0	100	0.2	0.18	34	100	0	0	0	0	0	10	10	10	20	0	10	0	10	0	0	10	0	10	0	0	0	10												6.95	0.13	2.31	-	1.3	1.79	1.09	1.13	1.99	-	-	-	-	-	3.07	2.7	0.14	1	-	0.86	-	0.45	-	-	0.27	-	0.12	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	25.44	6.95	0.13	2.31	-	1.3	1.79	1.09	1.13	1.99	-	-	-	-	-	3.07	2.7	0.14	1	-	0.86	-	0.45	-	-	0.27	-	0.12	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	25.44
H0571_802_0	2006																						D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V		V				V																																																					-	556	10	369.9	0	156	8.94	5.91	400	239	0	0	0	0	0	3689.24	3237.76	164	597	0	1037	0	540	0	0	321	0	138	0	0	0	174											copay for days 1-5	copay for days 1-5					20 prosth/supplies 0 diab supplies	50 ER 10 urgent care												10 hearing 20 chiro & podiatrist																																																																150	150	75	0	100	0.2	0.18	34	100	0	0	0	0	0	10	10	10	20	0	10	0	10	0	0	10	0	10	0	0	0	10												6.95	0.13	2.31	-	1.3	1.79	1.09	1.13	1.99	-	-	-	-	-	3.07	2.7	0.14	1	-	0.86	-	0.45	-	-	0.27	-	0.12	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	25.44	6.95	0.13	2.31	-	1.3	1.79	1.09	1.13	1.99	-	-	-	-	-	3.07	2.7	0.14	1	-	0.86	-	0.45	-	-	0.27	-	0.12	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	25.44
H0609_002_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1563.3	40.04	863.23	2315.84	280.47	15.21	123.18	347.1	378.4	0	12.86	0	79.55	582.81	5004.1	3309.91	169.9	262.51	2938.82	6002.06	12.44	0	0	0	86.43	241.07	0	0	0	0	257.1											300 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 150; Outpatient Hospital: 150	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 150; Non-Surgical Cases - ASC: 150	10	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											52.26	109.69	49	0	75	0.2	21.05	49.12	150	0	0.2	0	0	131.77	10	30	30	30	4.05	0	0.2	0	0	0	25	20	0	0	0	0	0											0	52.26	109.69	49	0	75	0.2	21.05	49.12	150	0	0.2	0	0	131.77	10	30	30	30	4.05	0	0.2	0	0	0	25	20	0	0	0	0	0												6.81	0.37	3.52	-	1.75	3.04	0.22	1.42	4.73	-	2.57	-	-	6.4	4.17	8.27	0.42	0.66	0.99	-	2.49	-	-	-	0.18	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.42	6.81	0.37	3.52	-	1.75	3.04	0.22	1.42	4.73	-	2.57	-	-	6.4	4.17	8.27	0.42	0.66	0.99	-	2.49	-	-	-	0.18	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.42
H0609_003_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1332.3	34.13	1621.73	2623.87	317.77	14.24	122.9	350.56	385.81	0	12.04	0	79.37	621.73	5374.4	3750.16	192.5	297.43	3261.69	6639.29	12.34	0	0	0	97.93	273.14	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	19.75	49.12	200	0	0.2	0	0	175.85	15	30	30	30	3.42	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	19.75	49.12	200	0	0.2	0	0	175.85	15	30	30	30	3.42	0	0.2	0	0	0	25	20	0	0	0	0	0												7.74	0.31	6.62	-	1.99	2.85	0.2	1.43	6.43	-	2.41	-	-	9.11	6.72	9.38	0.48	0.74	0.93	-	2.47	-	-	-	0.2	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.47	7.74	0.31	6.62	-	1.99	2.85	0.2	1.43	6.43	-	2.41	-	-	9.11	6.72	9.38	0.48	0.74	0.93	-	2.47	-	-	-	0.2	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.47
H0609_006_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1715.7	43.95	1471.21	2393.59	289.88	20.92	122.87	345.98	458.92	0	17.69	0	79.35	592.3	5603.11	4044.57	175.61	271.33	3484.9	7131.62	12.71	0	0	0	89.33	249.16	0	0	0	0	265.73											200 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											34.84	109.69	49	0	75	0.2	29.03	49.12	100	0	0.2	0	0	89.56	5	10	30	30	4.7	0	0.2	0	0	0	25	20	0	0	0	0	0											0	34.84	109.69	49	0	75	0.2	29.03	49.12	100	0	0.2	0	0	89.56	5	10	30	30	4.7	0	0.2	0	0	0	25	20	0	0	0	0	0												4.98	0.4	6.01	-	1.81	4.18	0.3	1.42	3.82	-	3.54	-	-	4.42	2.33	3.37	0.44	0.68	1.36	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.21	4.98	0.4	6.01	-	1.81	4.18	0.3	1.42	3.82	-	3.54	-	-	4.42	2.33	3.37	0.44	0.68	1.36	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.21
H0609_007_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1385.82	35.5	1188.34	2412.68	292.19	17.29	123.85	348.72	370.68	0	14.62	0	79.98	597.08	5213.35	3448.32	177.01	273.49	3060.37	6253.04	12.5	0	0	0	90.05	251.15	0	0	0	0	267.85											300 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 150; Outpatient Hospital: 150	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 150; Non-Surgical Cases - ASC: 150	10	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											52.26	109.69	49	0	75	0.2	23.8	49.12	150	0	0.2	0	0	132.11	10	30	30	30	4.42	0	0.2	0	0	0	25	20	0	0	0	0	0											0	52.26	109.69	49	0	75	0.2	23.8	49.12	150	0	0.2	0	0	132.11	10	30	30	30	4.42	0	0.2	0	0	0	25	20	0	0	0	0	0												6.04	0.32	4.85	-	1.83	3.46	0.25	1.43	4.63	-	2.92	-	-	6.57	4.34	8.62	0.44	0.68	1.13	-	2.5	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.63	6.04	0.32	4.85	-	1.83	3.46	0.25	1.43	4.63	-	2.92	-	-	6.57	4.34	8.62	0.44	0.68	1.13	-	2.5	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.63
H0609_011_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1569.04	40.19	2069.28	2352.41	284.9	15.74	122.82	350.32	449.18	0	13.31	0	79.31	592.77	4818.38	3362.18	172.59	266.66	2912.92	5952.41	10.73	0	0	0	87.8	244.88	0	0	0	0	0											600 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											104.53	109.69	49	0	75	0.2	21.85	49.12	200	0	0.2	0	0	174.69	15	30	30	30	4.23	0	0.2	0	0	0	25	20	0	0	0	0	0											0	104.53	109.69	49	0	75	0.2	21.85	49.12	200	0	0.2	0	0	174.69	15	30	30	30	4.23	0	0.2	0	0	0	25	20	0	0	0	0	0												13.67	0.37	8.45	-	1.78	3.15	0.22	1.43	7.49	-	2.66	-	-	8.63	6.02	8.41	0.43	0.67	1.03	-	2.15	-	-	-	0.18	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.14	13.67	0.37	8.45	-	1.78	3.15	0.22	1.43	7.49	-	2.66	-	-	8.63	6.02	8.41	0.43	0.67	1.03	-	2.15	-	-	-	0.18	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.14
H0609_012_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1320.82	33.83	1132.6	2403.28	291.06	16.79	123.36	347.36	353.29	0	14.2	0	79.66	594.76	4922.57	3434.88	176.32	272.42	2975.23	6081.12	12.71	0	0	0	89.69	250.17	0	0	0	0	0											600 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											104.53	109.69	49	0	75	0.2	23.21	49.12	200	0	0.2	0	0	174.66	15	30	30	30	4.42	0	0.2	0	0	0	25	20	0	0	0	0	0											0	104.53	109.69	49	0	75	0.2	23.21	49.12	200	0	0.2	0	0	174.66	15	30	30	30	4.42	0	0.2	0	0	0	25	20	0	0	0	0	0												11.51	0.31	4.62	-	1.82	3.36	0.24	1.42	5.89	-	2.84	-	-	8.66	6.15	8.59	0.44	0.68	1.1	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.77	11.51	0.31	4.62	-	1.82	3.36	0.24	1.42	5.89	-	2.84	-	-	8.66	6.15	8.59	0.44	0.68	1.1	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.77
H0609_013_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1494.59	38.28	1090.47	2404.31	291.18	14.51	123.36	354.6	374.54	0	12.27	0	79.66	569	4924.68	3436.36	176.39	272.54	2978.03	6083.73	12.71	0	0	0	89.73	250.28	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	20.05	49.12	200	0	0.2	0	0	173.51	15	30	30	30	3.81	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	20.05	49.12	200	0	0.2	0	0	173.51	15	30	30	30	3.81	0	0.2	0	0	0	25	20	0	0	0	0	0												8.68	0.35	4.45	-	1.82	2.9	0.21	1.45	6.24	-	2.45	-	-	8.23	6.16	8.59	0.44	0.68	0.95	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.75	8.68	0.35	4.45	-	1.82	2.9	0.21	1.45	6.24	-	2.45	-	-	8.23	6.16	8.59	0.44	0.68	0.95	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.75
H0609_014_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1385.82	35.5	1188.34	2403.28	291.06	17.29	123.36	347.36	370.68	0	14.63	0	79.66	594.76	5193.04	3516.1	176.32	272.42	3125.62	6383.34	12.71	0	0	0	89.69	250.17	0	0	0	0	266.8											200 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	25	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											34.84	109.69	49	0	75	0.2	23.9	49.12	100	0	0.2	0	0	89.57	10	25	30	30	4.33	0	0.2	0	0	0	25	20	0	0	0	0	0											0	34.84	109.69	49	0	75	0.2	23.9	49.12	100	0	0.2	0	0	89.57	10	25	30	30	4.33	0	0.2	0	0	0	25	20	0	0	0	0	0												4.02	0.32	4.85	-	1.82	3.46	0.25	1.42	3.09	-	2.93	-	-	4.44	4.33	7.33	0.44	0.68	1.13	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.65	4.02	0.32	4.85	-	1.82	3.46	0.25	1.42	3.09	-	2.93	-	-	4.44	4.33	7.33	0.44	0.68	1.13	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.65
H0609_015_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1563.3	40.04	863.23	2315.84	280.47	15.21	123.18	347.1	378.4	0	12.86	0	79.55	582.81	5829.77	4558.87	169.9	262.51	3770.45	7667.83	12.44	0	0	0	86.43	241.07	0	0	0	0	257.1											0 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	109.69	49	0	75	0.2	21.05	49.12	0	0	0.2	0	0	4.56	0	0	30	30	3.16	0	0.2	0	0	0	25	20	0	0	0	0	0											0	0	109.69	49	0	75	0.2	21.05	49.12	0	0	0.2	0	0	4.56	0	0	30	30	3.16	0	0.2	0	0	0	25	20	0	0	0	0	0												-	0.37	3.52	-	1.75	3.04	0.22	1.42	-	-	2.57	-	-	0.22	-	-	0.42	0.66	0.99	-	2.49	-	-	-	0.18	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.26	-	0.37	3.52	-	1.75	3.04	0.22	1.42	-	-	2.57	-	-	0.22	-	-	0.42	0.66	0.99	-	2.49	-	-	-	0.18	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.26
H0609_017_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1524.4	39.05	1307.17	2643.61	320.16	19.21	135.7	382.1	407.75	0	16.25	0	87.63	654.23	6188.37	4467.04	193.95	299.67	3849.29	7876.53	12.71	0	0	0	98.66	275.19	180.47	39.04	0	0	293.48											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	24.14	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.91	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	24.14	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.91	0	0.2	0	0	0	25	20	25	0	0	0	0												1.11	0.36	5.34	-	2	3.84	0.27	1.56	1.7	-	3.25	-	-	2.56	2.58	3.72	0.48	0.75	1.25	-	2.54	-	-	-	0.21	0.46	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.37	1.11	0.36	5.34	-	2	3.84	0.27	1.56	1.7	-	3.25	-	-	2.56	2.58	3.72	0.48	0.75	1.25	-	2.54	-	-	-	0.21	0.46	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.37
H0609_018_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1385.82	35.5	1188.34	2412.68	292.19	17.87	123.85	348.72	370.68	0	15.11	0	79.98	597.08	5213.35	3652.16	177.01	273.49	3203.9	6563.57	12.71	0	0	0	90.05	251.15	0	0	0	0	267.85											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	24.6	49.12	100	0	0.2	0	0	89.57	10	20	30	30	4.37	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	24.6	49.12	100	0	0.2	0	0	89.57	10	20	30	30	4.37	0	0.2	0	0	0	25	20	0	0	0	0	0												8.05	0.32	4.85	-	1.83	3.57	0.25	1.43	3.09	-	3.02	-	-	4.46	4.34	6.09	0.44	0.68	1.17	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.75	8.05	0.32	4.85	-	1.83	3.57	0.25	1.43	3.09	-	3.02	-	-	4.46	4.34	6.09	0.44	0.68	1.17	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.75
H0609_019_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1385.82	35.5	1188.34	2403.28	291.06	17.45	123.36	347.36	370.68	0	14.76	0	79.66	594.76	5625.79	4060.95	176.32	272.42	3512.84	7160.48	12.71	0	0	0	89.69	250.17	0	0	0	0	266.8											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	24.11	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.89	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	24.11	49.12	50	0	0.2	0	0	47.02	5	10	30	30	3.89	0	0.2	0	0	0	25	20	0	0	0	0	0												1.01	0.32	4.85	-	1.82	3.49	0.25	1.42	1.54	-	2.95	-	-	2.33	2.34	3.38	0.44	0.68	1.14	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.12	1.01	0.32	4.85	-	1.82	3.49	0.25	1.42	1.54	-	2.95	-	-	2.33	2.34	3.38	0.44	0.68	1.14	-	2.54	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.12
H0609_801_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.31	0.38	0.03	0.21	0.62		0.59		0.04	0.48	1.29	2.49	0.15	0.04	0.52	0.27	0.44	1.01																				8.88	1474.17	37.76	1360.78	2419.01	13.31	16.39	1.47	12.82	37.52	0	25.29	0	1.89	20.59	55.46	106.68	2.63	1.73	22.29	11.44	18.72	43.32	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	13.18	0.35	6.35	-	2.66	3.28	0.29	2.56	7.5	-	5.06	-	0.38	4.12	11.09	21.34	1.31	0.35	4.46	2.29	3.74	8.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.97	13.18	0.35	6.35	-	2.97	3.66	0.33	2.78	8.12	-	5.65	-	0.42	4.6	12.39	23.82	1.47	0.39	4.98	2.55	4.18	9.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.86
H0609_803_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.31	0.38	0.03	0.21	0.62		0.59		0.04	0.48	1.29	2.49	0.15	0.04	0.52	0.27	0.44	1.01																				8.88	1474.17	37.76	1360.78	2419.01	13.31	16.39	1.47	12.82	37.52	0	25.29	0	1.89	20.59	55.46	106.68	2.63	1.73	22.29	11.44	18.72	43.32	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	13.18	0.35	6.35	-	2.66	3.28	0.29	2.56	7.5	-	5.06	-	0.38	4.12	11.09	21.34	1.31	0.35	4.46	2.29	3.74	8.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.97	13.18	0.35	6.35	-	2.97	3.66	0.33	2.78	8.12	-	5.65	-	0.42	4.6	12.39	23.82	1.47	0.39	4.98	2.55	4.18	9.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.86
H0609_804_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.31	0.38	0.03	0.21	0.62		0.59		0.04	0.48	1.29	2.49	0.15	0.04	0.52	0.27	0.44	1.01																				8.88	1474.17	37.76	1360.78	2419.01	13.31	16.39	1.47	12.82	37.52	0	25.29	0	1.89	20.59	55.46	106.68	2.63	1.73	22.29	11.44	18.72	43.32	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	13.18	0.35	6.35	-	2.66	3.28	0.29	2.56	7.5	-	5.06	-	0.38	4.12	11.09	21.34	1.31	0.35	4.46	2.29	3.74	8.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.97	13.18	0.35	6.35	-	2.97	3.66	0.33	2.78	8.12	-	5.65	-	0.42	4.6	12.39	23.82	1.47	0.39	4.98	2.55	4.18	9.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.86
H0609_805_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.31	0.38	0.03	0.21	0.62		0.59		0.04	0.48	1.29	2.49	0.15	0.04	0.52	0.27	0.44	1.01																				8.88	1474.17	37.76	1360.78	2419.01	13.31	16.39	1.47	12.82	37.52	0	25.29	0	1.89	20.59	55.46	106.68	2.63	1.73	22.29	11.44	18.72	43.32	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	13.18	0.35	6.35	-	2.66	3.28	0.29	2.56	7.5	-	5.06	-	0.38	4.12	11.09	21.34	1.31	0.35	4.46	2.29	3.74	8.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.97	13.18	0.35	6.35	-	2.97	3.66	0.33	2.78	8.12	-	5.65	-	0.42	4.6	12.39	23.82	1.47	0.39	4.98	2.55	4.18	9.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.86
H0620_002_0	2006											200											D	D	D	P	P	P	P	V	V	P	P	V	P	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	948.46				1552.11																																					25 first 8 days				15 per trip																																					25				5																																						17.23				3.45																																						1.36	-	-	-	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.81	1.36	-	-	-	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.81
H0621_001_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1972.66	365.15	1187.25	0	373.57	2037.44	3456.04	748.41	261.8	7360.65	818.04	143.5	0	3115.1	3726.11	3176	1732.91	464.38	16.2	11298.56	14.16	31.11	0	0	0	0	0	0	0	0	0											MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS	MCR FFS																				143.77	56.29	58.3	0	75.1	28.22	27.94	140.75	320.25	8.99	76.51	83.34	0	59	16.62	19.95	20.41	24.2	0.23	22.25	0.23	17.95	0	0	0	0	0	0	0	0	0												143.77	56.29	58.3	0	75.1	28.22	27.94	140.75	320.25	8.99	76.51	83.34	0	59	16.62	19.95	20.41	24.2	0.23	22.25	0.23	17.95	0	0	0	0	0	0	0	0	0												23.63	1.71	5.77	-	2.34	4.79	8.05	8.78	6.99	5.51	5.22	1	-	15.32	5.16	5.28	2.95	0.94	3.78	20.95	3.3	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	131.5	23.63	1.71	5.77	-	2.34	4.79	8.05	8.78	6.99	5.51	5.22	1	-	15.32	5.16	5.28	2.95	0.94	3.78	20.95	3.3	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	131.5
H0623_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1050.93	22.26	1100.2	512.82	143.76	18.05	1.36	405.09	320.95				17.5	1977.73	6344.87	11065.18					4.45			8.54	0		0					55.31	1.17	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-100	10-100	35-100					0.2			25 - 75								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	35.85	11.77	36.28					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					118.88	119.04	11.78	9.99	99.87	0.2	0.2	40.65	116.35				0	35.8	11.75	36.23					0.2			0.35	0		0					118.88	119.04	0	0	0	0	0				0	10.41	0.22	1.08	0.43	1.2	3.6	0.27	1.37	3.11	-	-	-	-	5.9	6.21	33.41	-	-	-	-	0.89	-	-	3.01	-	-	-	-	-	-	-	0.55	0.01	-	-	-	-	-	-	-	-	71.68	10.41	0.22	1.08	0.43	1.2	3.6	0.27	1.37	3.11	-	-	-	-	5.9	6.21	33.41	-	-	-	-	0.89	-	-	3.01	-	-	-	-	-	-	-	0.55	0.01	-	-	-	-	-	-	-	-	71.68
H0623_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1044.52	22.13	1093.49	509.69	142.88	18.5	1.39	402.62	318.99				17.39	1965.67	6306.16	10997.68					4.45			8.54	0		0					54.97	1.16	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-100	10-100	35-100					0.2			25 - 75								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	35.82	11.77	36.28					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	35.82	11.77	36.28					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0				0	10.36	0.22	1.07	0.42	1.19	3.7	0.28	1.37	3.1	-	-	-	-	5.87	6.18	33.25	-	-	-	-	0.89	-	-	3.01	-	-	-	-	-	-	-	0.55	0.01	-	-	-	-	-	-	-	-	71.46	10.36	0.22	1.07	0.42	1.19	3.7	0.28	1.37	3.1	-	-	-	-	5.87	6.18	33.25	-	-	-	-	0.89	-	-	3.01	-	-	-	-	-	-	-	0.55	0.01	-	-	-	-	-	-	-	-	71.46
H0623_003_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1024.29	21.7	1072.31	499.82	140.11	16.88	1.27	394.82	312.82				17.06	1927.6	6184.04	10784.7					4.45			8.54	0		0					53.91	1.14	0	0	0	0	0				125 per day (1-5)	125 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-100	10-100	35-100					0.2			25 - 75								125 per day (1-5)	125 per day (1-5)	0	0	0	0	0				85.03	85.03	11.79	10	100	0.2	0.2	40.7	116.5				0	35.71	11.77	36.28					0.2			0.35	0		0					85.03	85.03	0	0	0	0	0					85.03	85.03	11.79	10	100	0.2	0.2	40.7	116.5				0	35.71	11.77	36.28					0.2			0.35	0		0					85.03	85.03	0	0	0	0	0				0	7.26	0.15	1.05	0.42	1.17	3.38	0.25	1.34	3.04	-	-	-	-	5.74	6.06	32.6	-	-	-	-	0.89	-	-	3.01	-	-	-	-	-	-	-	0.38	0.01	-	-	-	-	-	-	-	-	66.75	7.26	0.15	1.05	0.42	1.17	3.38	0.25	1.34	3.04	-	-	-	-	5.74	6.06	32.6	-	-	-	-	0.89	-	-	3.01	-	-	-	-	-	-	-	0.38	0.01	-	-	-	-	-	-	-	-	66.75
H0623_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	257.34	5.85	1131.57	527.44	147.86	19.19	1.44	416.64	330.1				18	2034.13	6525.78	11380.69					4.45			0	0		0					13.54	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.75	25.2	35					20			0	0		0					600	600	0	0	0	0	0					599.93	600	8.8	10	99.99	0.25	0.25	45.19	199.98				0	34.75	25.19	35					20			0	0		0					599.93	600	0	0	0	0	0				0	12.87	0.29	0.83	0.44	1.23	4.8	0.36	1.57	5.5	-	-	-	-	5.89	13.7	33.19	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	82.25	12.87	0.29	0.83	0.44	1.23	4.8	0.36	1.57	5.5	-	-	-	-	5.89	13.7	33.19	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	82.25
H0623_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	256.36	5.83	1127.24	525.42	147.29	19.11	1.44	415.05	328.84				17.93	2026.35	6500.85	11337.21					4.45			0	0		0					13.49	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.73	25.2	35					20			0	0		0					600	600	0	0	0	0	0					597.63	600	8.77	9.96	99.6	0.25	0.25	45.02	199.21				0	34.59	25.1	34.86					20			0	0		0					597.63	600	0	0	0	0	0				0	12.77	0.29	0.82	0.44	1.22	4.76	0.36	1.56	5.46	-	-	-	-	5.84	13.6	32.94	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	81.63	12.77	0.29	0.82	0.44	1.22	4.76	0.36	1.56	5.46	-	-	-	-	5.84	13.6	32.94	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	81.63
H0623_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	257.34	5.85	1131.57	527.44	147.86	19.19	1.44	416.64	330.1				18	2034.13	6525.78	11380.69					4.45			0	0		0					13.54	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.75	25.2	35					20			0	0		0					600	600	0	0	0	0	0					599.93	600	8.8	10	99.99	0.25	0.25	45.19	199.98				0	34.75	25.19	35					20			0	0		0					599.93	600	0	0	0	0	0				0	12.87	0.29	0.83	0.44	1.23	4.8	0.36	1.57	5.5	-	-	-	-	5.89	13.7	33.19	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	82.25	12.87	0.29	0.83	0.44	1.23	4.8	0.36	1.57	5.5	-	-	-	-	5.89	13.7	33.19	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	82.25
H0623_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	256.36	5.83	1127.24	525.42	147.29	19.11	1.44	415.05	328.84				17.93	2026.35	6500.85	11337.21					4.45			0	0		0					13.49	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.73	25.2	35					20			0	0		0					600	600	0	0	0	0	0					597.63	600	8.77	9.96	99.6	0.25	0.25	45.02	199.21				0	34.59	25.1	34.86					20			0	0		0					597.63	600	0	0	0	0	0				0	12.77	0.29	0.82	0.44	1.22	4.76	0.36	1.56	5.46	-	-	-	-	5.84	13.6	32.94	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	81.63	12.77	0.29	0.82	0.44	1.22	4.76	0.36	1.56	5.46	-	-	-	-	5.84	13.6	32.94	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	81.63
H0624_001_0	2006											450											D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		P			T	V	V	P	V	P																																																								-	2309.29	530.32			311.27	30.22	26.61	868.42	348.26	1764.33	868.15	59.46	2.95	2259.18	123.5	3989.71	1125.36	713.7		1151.62																						75 per Day	75 per Day	0/day		100	20	20	35	25	10	10	50	20	50		25	35 indiv/25 group	10		25																						75	75			100	0.2	0.2	35	25	10	10	50	0.2	46.38	25	25	32.5	13.58		25																							26.48	26.48			35.3	0.2	0.2	12.36	8.83	3.53	3.53	17.65	0.07	16.37	25	8.83	11.47	4.79		8.83																							5.09	1.17	-	-	0.92	6.04	5.32	0.89	0.26	0.52	0.26	0.09	0.21	3.08	0.26	2.93	1.08	0.29	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.25	5.09	1.17	-	-	0.92	6.04	5.32	0.89	0.26	0.52	0.26	0.09	0.21	3.08	0.26	2.93	1.08	0.29	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.25
H0624_002_0	2006											4000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-	1488.02	75.67			144.88	11.61	12.84	301.74	365.54	1441.79	680.84	45.1	0.38	1045	4254.53	5565.91	270.12	846.2																								125	12500			50	20	20	50	200	30	30	50	20	50	10	30	35 indiv/25 group	30																								125	125			50	0.2	0.2	50	200	30	30	50	0.2	45.96	10	30	32.5	30																									100.74	100.74			40.29	0.16	0.16	40.29	161.18	24.18	24.18	40.29	0.16	37.04	8.06	24.18	26.19	24.18																									12.49	0.64	-	-	0.49	1.87	2.07	1.01	4.91	2.9	1.37	0.15	0.06	3.23	2.86	11.21	0.59	1.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.56	12.49	0.64	-	-	0.49	1.87	2.07	1.01	4.91	2.9	1.37	0.15	0.06	3.23	2.86	11.21	0.59	1.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.56
H0624_003_0	2006											4000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-	1415.44	71.98			137.81	11.04	12.21	287.03	347.71	1371.46	647.63	42.9	0.36	994.02	4046.99	5294.4	256.95	804.92																								125	12500			50	20	20	50	200	30	30	50	20	50	10	30	35 indiv/25 group	30																								125	125			50	0.2	0.2	50	200	30	30	50	0.2	45.96	10	30	32.5	30																									102.06	102.06			40.83	0.16	0.16	40.83	163.3	24.5	24.5	40.83	0.16	37.53	8.17	24.5	26.54	24.5																									12.04	0.61	-	-	0.47	1.8	1.99	0.98	4.73	2.8	1.32	0.15	0.06	3.11	2.75	10.81	0.57	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.83	12.04	0.61	-	-	0.47	1.8	1.99	0.98	4.73	2.8	1.32	0.15	0.06	3.11	2.75	10.81	0.57	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.83
H0630_004_1	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	Coin				V		V			O		S	S									0																																										-	203.71	4.49	555.41	517.46	10.13	3.26	11	276.91	116.43		603.51	0.05		38.86	4605.98	2289.73	178.49	322.77		681.73	0.31				407.51		0.67			6.07		576.76	789.62									700	700	200	0	20	20	20	50	350	0	150	20	0	15	20	35	20	20		15	0.2				20		20			15		10	35									700	700	200	0	0.2	0.2	0.2	50	350	0	150	0.2	0	15	20	35	20	20	0	15	0.2				20		20			15		10	35									2950	693	700	200	0	0.2	0.2	0.2	50	350	0	150	0.2	0	15	19.7	35	20	20	0	15	0.2				20		20			15		10	35										11.76	0.26	9.26	-	2.03	0.65	2.2	1.15	3.4	-	7.54	0	-	0.05	7.56	6.68	0.3	0.54	-	0.85	0.06	-	-	-	0.68	-	0	-	-	0.01	-	0.48	2.3	-	-	-	-	-	-	-	-	57.77	11.76	0.26	9.26	-	2.03	0.65	2.2	1.15	3.4	-	7.54	0	-	0.05	7.56	6.68	0.3	0.54	-	0.85	0.06	-	-	-	0.68	-	0	-	-	0.01	-	0.48	2.3	-	-	-	-	-	-	-	-	57.77
H0630_004_2	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	Coin				V		V			O		S	S									0																																										-	211.92	5.24	602.84		9.37	3.48	10.95	295.93	160.86		729.28	0.01		37.25	4591.6	2461.66	256.67	292.34		647.26	0.31				311.95		1.54			5.98		400.79	628.98									700	700	200	0	20	20	20	50	350	0	150	20	0	15	20	35	20	20		15	0.2				20		20			15		10	35									700	700	200	0	0.2	0.2	0.2	50	350	0	150	0.2	0	15	20	35	20	20	0	15	0.2				20		20			15		10	35									2950	677.95	677.95	200	0	0.2	0.2	0.2	50	350	0	150	0.2	0	15	19.56	35	20	20	0	15	0.2				20		20			15		10	35									0	11.97	0.3	10.05	-	1.87	0.7	2.19	1.23	4.69	-	9.12	0	-	0.05	7.48	7.18	0.43	0.49	-	0.81	0.06	-	-	-	0.52	-	0	-	-	0.01	-	0.33	1.83	-	-	-	-	-	-	-	-	61.31	11.97	0.3	10.05	-	1.87	0.7	2.19	1.23	4.69	-	9.12	0	-	0.05	7.48	7.18	0.43	0.49	-	0.81	0.06	-	-	-	0.52	-	0	-	-	0.01	-	0.33	1.83	-	-	-	-	-	-	-	-	61.31
H0630_006_1	2006	Part B Rx	Part B Rx									2000	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	Coin				V		V			O		S	S									0																																										-	312.75	6.1	902.71	0	11.26	5.31	10.9	390.92	161.56		771.81	0.01		74.29	6103.18	3406.25	399.18	325.47		1024.17	0.84				502.95		4.72			5.9		1103.18	1411.56									350	350	100	0	20	20	20	50	150	0	0	20	0	0	15	25	15	15		10	0.2				15		15			0		10	25									350	350	100	0	0.2	0.2	0.2	50	150	0	100	0.01	0	5	15	25	15	15	0	10	0.2				15		15			20		10	25									2000	324.62	350	92.71	0	0.2	0.2	0.2	50	150	0	92.72	0.01	0	5	13.91	23.2	15	15	0	10	0.2				15		15			20		10	25										8.46	0.18	6.97	-	2.25	1.06	2.18	1.63	2.02	-	5.96	0	-	0.03	7.07	6.59	0.5	0.41	-	0.85	0.17	-	-	-	0.63	-	0.01	-	-	0.01	-	0.92	2.94	-	-	-	-	-	-	-	-	50.84	8.46	0.18	6.97	-	2.25	1.06	2.18	1.63	2.02	-	5.96	0	-	0.03	7.07	6.59	0.5	0.41	-	0.85	0.17	-	-	-	0.63	-	0.01	-	-	0.01	-	0.92	2.94	-	-	-	-	-	-	-	-	50.84
H0630_006_2	2006	Part B Rx	Part B Rx	Adjust for OOP Max								2000	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	Coin				V		V			O		S	S									0																																										-	351.78	8.46	1029		9.19	8.75	11.22	353.22	109.26	227.55	860.59	0.01		72.88	6229.08	3761.13	456.5	352.07		992.62	1.58				357.03		3.82			6.36		897.61	1117.53									350	350	100	0	20	20	20	50	150	0	0	0.2	0	0	15	25	15	15		10	0.2				15		15			10		10	25									350	350	100	0	0.2	0.2	0.2	50	150	0	100	0.01	0	5	15	25	15	15	0	10	0.2				15		15			20		10	25									2000	326.9	350	93.46	0	0.2	0.2	0.2	50	150	0	93.39	0.01	0	5	14.02	23.36	15	15	0	10	0.2				15		15			20		10	25										9.58	0.25	8.01	-	1.84	1.75	2.24	1.47	1.37	-	6.7	0	-	0.03	7.28	7.32	0.57	0.44	-	0.83	0.32	-	-	-	0.45	-	0	-	-	0.01	-	0.75	2.33	-	-	-	-	-	-	-	-	53.53	9.58	0.25	8.01	-	1.84	1.75	2.24	1.47	1.37	-	6.7	0	-	0.03	7.28	7.32	0.57	0.44	-	0.83	0.32	-	-	-	0.45	-	0	-	-	0.01	-	0.75	2.33	-	-	-	-	-	-	-	-	53.53
H0630_007_0	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	Coin				V		V			O		S	S									0																																										-	222.84	5.51	602.84		1.88	0.7	2.19	295.93	160.86		729.28	0.01		37.25	4591.6	2461.66	256.67	292.34		647.26	0.06				311.95		1.54			5.98		400.79	628.98									700	700	200	0	20	20	20	50	350	0	150	20	0	15	20	35	20	20		15	0.2				20		20			15		10	35									9.3	5.13	5.03	0	1.88	0.7	2.19	50	350	0	150	0.01	0	15	20	35	20	20	0	15	0.06									15												2950	630	5.13	160	0	1.83	0.68	2.14	50	350	0	150	0.01	0	15	20	35	20	20	0	15	0.06									13.5		149.7	95.39										11.7	0	8.04	-	3.44	0.48	4.69	1.23	4.69	-	9.12	0	-	0.05	7.65	7.18	0.43	0.49	-	0.81	0	-	-	-	-	-	-	-	-	0.01	-	5	5	-	-	-	-	-	-	-	-	70	11.7	0	8.04	-	3.44	0.48	4.69	1.23	4.69	-	9.12	0	-	0.05	7.65	7.18	0.43	0.49	-	0.81	0	-	-	-	-	-	-	-	-	0.01	-	5	5	-	-	-	-	-	-	-	-	70
H0630_801_1	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	S				V		V			O		S	S									0																																										-	204.83	2.23	481.18	456.95	1.63	2.18	0.73	247.7	139.59	5564.22	1544.72	0.01	27.86	48.48	4745.05	2947.06	97.24	334.35	119.81	637.22	1.16				455		12.82			49.32												750	750	100	0	0	0	0	50	0	0	0	0.2	0	0	20	40	20	20	0	10	Coins				20		20			0												750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20												2950	750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20													12.8	0.14	4.01	-	0.33	0.44	0.15	1.03	0	-	0.03	0	-	0.02	7.91	9.82	0.16	0.56	-	0.53	0	-	-	-	0.76	-	0.02	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	38.78	12.8	0.14	4.01	-	0.33	0.44	0.15	1.03	0	-	0.03	0	-	0.02	7.91	9.82	0.16	0.56	-	0.53	0	-	-	-	0.76	-	0.02	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	38.78
H0630_801_2	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	Coin				V		V			O		S	S									0																																										-	199.1	2.11	429.49	444.65	1.63	2.18	0.73	261.1	172.96	5244.31	1567.08	0.01	8.24	50.72	4592.17	2910.6	189.63	354.23	125.14	592.05	0.31				322.52		9.32			27.07												750	750	100	0	20	20	20	50	20	0	0	20	0	0	20	40	20	20	0	10	20				20		20			0												750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20												2950	750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20													12.44	0.13	3.58	-	0.33	0.44	0.15	1.09	0	-	0.03	0	-	0.02	7.65	9.7	0.32	0.59	-	0.49	0.06	-	-	-	0.54	-	0.02	-	-	0.05	-	-	-	-	-	-	-	-	-	-	-	37.62	12.44	0.13	3.58	-	0.33	0.44	0.15	1.09	0	-	0.03	0	-	0.02	7.65	9.7	0.32	0.59	-	0.49	0.06	-	-	-	0.54	-	0.02	-	-	0.05	-	-	-	-	-	-	-	-	-	-	-	37.62
H0630_802_1	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	S				V		V			O		S	S									0																																										-	204.83	2.23	481.18	456.95	1.63	2.18	0.73	247.7	139.59	5564.22	1544.72	0.01	27.86	48.48	4745.05	2947.06	97.24	334.35	119.81	637.22	1.16				455		12.82			49.32												750	750	100	0	20	20	20	50	0	0	0	0.2	0	0	20	40	20	20	0	10	10				20		20			0												750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20												2950	750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	2	20	40	20	20	0	10	0.2				20		20			20													12.8	0.14	4.01	-	0.33	0.44	0.15	1.03	0	-	0.03	0	-	0.01	7.91	9.82	0.16	0.56	-	0.53	0	-	-	-	0.76	-	0.02	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	38.77	12.8	0.14	4.01	-	0.33	0.44	0.15	1.03	0	-	0.03	0	-	0.01	7.91	9.82	0.16	0.56	-	0.53	0	-	-	-	0.76	-	0.02	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	38.77
H0630_802_2	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	Coin				V		V			O		S	S									0																																										-	199.1	2.11	429.49	444.65	1.63	2.18	0.73	261.1	172.96	5244.31	1567.08	0.01	8.24	50.72	4592.17	2910.6	189.63	354.23	125.14	592.05	1.1				322.52		9.32			27.07												750	750	100	0	20	20	20	50	20	0	0	20	0	0	20	40	20	20	0	10	10				20		20			0												750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10					20		20			20												2950	750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10					20		20			20													12.44	0.13	3.58	-	0.33	0.44	0.15	1.09	0	-	0.03	0	-	0.02	7.65	9.7	0.32	0.59	-	0.49	-	-	-	-	0.54	-	0.02	-	-	0.05	-	-	-	-	-	-	-	-	-	-	-	37.55	12.44	0.13	3.58	-	0.33	0.44	0.15	1.09	0	-	0.03	0	-	0.02	7.65	9.7	0.32	0.59	-	0.49	-	-	-	-	0.54	-	0.02	-	-	0.05	-	-	-	-	-	-	-	-	-	-	-	37.55
H0630_803_1	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	S				V		V			O		S	S									0																																										-	204.83	2.23	481.18	456.95	1.63	2.18	0.73	247.7	139.59	5564.22	1544.72	0.01	27.86	48.48	4745.05	2947.06	97.24	334.35	119.81	637.22	1.16				455		12.82			49.32												750	750	100	0	20	20	20	50	20	0	0	20	0	0	20	40	20	20	0	10	10				20		20			0												750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20												2950	750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20													12.8	0.14	4.01	-	0.33	0.44	0.15	1.03	0	-	0.03	0	-	0.02	7.91	9.82	0.16	0.56	-	0.53	0	-	-	-	0.76	-	0.02	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	38.78	12.8	0.14	4.01	-	0.33	0.44	0.15	1.03	0	-	0.03	0	-	0.02	7.91	9.82	0.16	0.56	-	0.53	0	-	-	-	0.76	-	0.02	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	38.78
H0630_803_2	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	S				V		V			O		S	S									0																																										-	199.1	2.11	429.49	444.65	1.63	2.18	0.73	261.1	172.96	5244.31	1567.08	0.01	8.24	50.72	4592.17	2910.6	189.63	354.23	125.14	592.05	1.1				322.52		9.32			27.07												750	750	100	0	20	20	20	50	20	0	0	20	0	0	20	40	20	20	0	10	20				20		20			0												750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20												2950	750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20													12.44	0.13	3.58	-	0.33	0.44	0.15	1.09	0	-	0.03	0	-	0.02	7.65	9.7	0.32	0.59	-	0.49	0	-	-	-	0.54	-	0.02	-	-	0.05	-	-	-	-	-	-	-	-	-	-	-	37.55	12.44	0.13	3.58	-	0.33	0.44	0.15	1.09	0	-	0.03	0	-	0.02	7.65	9.7	0.32	0.59	-	0.49	0	-	-	-	0.54	-	0.02	-	-	0.05	-	-	-	-	-	-	-	-	-	-	-	37.55
H0630_804_1	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	S				V		V			O		S	S									0																																										-	204.83	2.23	481.18	456.95	1.63	2.18	0.73	247.7	139.59	5564.22	1544.72	0.01	27.86	48.48	4745.05	2947.06	97.24	334.35	119.81	637.22	1.16				455		12.82			49.32												750	750	100	0	20	20	20	50	0.2	0	0	20	0	0	20	40	20	20	0	10	10				20		20			0												750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20												2950	750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	2	20	40	20	20	0	10	0.2				20		20			20													12.8	0.14	4.01	-	0.33	0.44	0.15	1.03	0	-	0.03	0	-	0.01	7.91	9.82	0.16	0.56	-	0.53	0	-	-	-	0.76	-	0.02	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	38.77	12.8	0.14	4.01	-	0.33	0.44	0.15	1.03	0	-	0.03	0	-	0.01	7.91	9.82	0.16	0.56	-	0.53	0	-	-	-	0.76	-	0.02	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	38.77
H0630_804_2	2006	Part B Rx	Part B Rx									2950	Generic	Brand									A	A	D	V	Coin	Coin	Coin	V	V	O	V	O	V	V	V	V	V	V		V	S				V		V			O		S	S									0																																										-	199.1	2.11	429.49	444.65	1.63	2.18	0.73	261.1	172.96	5244.31	1567.08	0.01	8.24	50.72	4592.17	2910.6	189.63	354.23	125.14	592.05	1.1				322.52		9.32			27.07												750	750	100	0	20	20	20	50	0	0	0	20	0	0	20	40	20	20	0	10	0.2				20		20			0												750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20												2950	750	750	100	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	5	20	40	20	20	0	10	0.2				20		20			20													12.44	0.13	3.58	-	0.33	0.44	0.15	1.09	0	-	0.03	0	-	0.02	7.65	9.7	0.32	0.59	-	0.49	0	-	-	-	0.54	-	0.02	-	-	0.05	-	-	-	-	-	-	-	-	-	-	-	37.55	12.44	0.13	3.58	-	0.33	0.44	0.15	1.09	0	-	0.03	0	-	0.02	7.65	9.7	0.32	0.59	-	0.49	0	-	-	-	0.54	-	0.02	-	-	0.05	-	-	-	-	-	-	-	-	-	-	-	37.55
H0710_001_0	2006	OP Facility - Emergency	OP Facility - Other	OP Facility - Other	Professional	Professional						900		Other	Other	PCP	Specialist excl. MH						D	D	D	P	P	Coin	Coin	V	V	V	V	V	Coin	V	P	P	V	P		P	S	P	P		P	P	P					V	V	P	P	P																																																-	1650.58				1908.98	20.51	7.73	191.59	109.96	3287.1	170.69	26.72	0.18	242.68	54.24	22843.82	1172.26	6.04		2134.89		1290.88			25.19		211.66					106.17	0.07	0.07	3.49	343.3						125/day				100/trip	20	0	35	0/25 SNF/Non-SNF	0/25 SNF/Non-SNF	0/25 SNF/Non-SNF	0/100 SNF/Non-SNF	0.2	0/100 SNF/Non-SNF	0/15 SNF/Non-SNF	0/25 SNF/Non-SNF	0/35/25 SNF/Non-SNF; Ind/Grp	0/25 SNF/Non-SNF		0/25 SNF/Non-SNF		0/25 SNF/Non-SNF			0/25 SNF/Non-SNF		0/20 SNF/Non-SNF					25	35	0/35/25 SNF/Non-SNF; Ind/Grp	0/10 SNF/Non-SNF	0/25 SNF/Non-SNF						125				33.33	0.2	0.2	35	1.25	1.25	1.25	5	0.2	5	0.75	1.25	1.5	1.25		1.25		1.25			1.25		1					25	35	1.5	0.5	1.25							47.07				12.55	0.08	0.08	13.18	0.47	0.47	0.47	1.88	0.08	1.88	0.28	0.47	0.56	0.47		0.47		0.47			1.25		1					9.41	13.18	0.56	0.19	1.25							6.48	-	-	-	2	1.54	0.58	0.21	0	0.13	0.01	0	0.01	0.04	0	0.9	0.06	0	-	0.08	-	0.05	-	-	0	-	0.02	-	-	-	-	0.08	0	0	0	0.04	-	-	-	-	-	12.23	6.48	-	-	-	2	1.54	0.58	0.21	0	0.13	0.01	0	0.01	0.04	0	0.9	0.06	0	-	0.08	-	0.05	-	-	0	-	0.02	-	-	-	-	0.08	0	0	0	0.04	-	-	-	-	-	12.23
H0710_002_0	2006											400	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		P			T	V	V	P	V	P																																																								-	2247.02	516.02	830.07		309.77	30.54	26.89	864.21	346.57	1755.77	863.94	59.17	2.99	2248.22		3715.66	1068.41	686.46		835.92																						75/day	75/day	114/day		100	20	20	35	25	10	10	50	20	50		25	35 indiv/25 group	10		25																						75	75	60.08		100	0.2	0.2	35	25	10	10	50	0.2	46.38		25	32.5	13.53		25																							21.15	21.15	16.95		28.2	0.06	0.06	9.87	7.05	2.82	2.82	14.1	0.06	13.08		7.05	9.17	3.82		7.05																							3.96	0.91	1.17	-	0.73	1.72	1.52	0.71	0.2	0.41	0.2	0.07	0.17	2.45	-	2.18	0.82	0.22	-	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.94	3.96	0.91	1.17	-	0.73	1.72	1.52	0.71	0.2	0.41	0.2	0.07	0.17	2.45	-	2.18	0.82	0.22	-	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.94
H0712_001_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1233.42	23.39	1167.15	2247.42	364.45	20077.98	20609.53	205.47	181.99	1524.34	600.35	0	36.6	412.13	6301.12	9246.64	196.33	250.59	3323.03	12384.98	289.96	689.23	0	0	325.59	253.64	139.54	16.4	0	100	26.17											150 days 1 to 7	150 days 1 to 7	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 25	Eff. copay 15 to 100	0	0	Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 copay	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											113	112.75	75.87	0	100	1.1	1.41	50	116.67	5.4	35.77	0	0	4.91	7.42	18.58	24	30	0	4.3	32.73	19.82	0	0	25	25	25	0	0	0	1.63											N/A	113	112.75	75.87	0	100	1.1	1.41	50	116.67	5.4	35.77	0	0	4.91	7.42	18.58	24	30	0	4.3	32.73	19.82	0	0	25	25	25	0	0	0	1.63												11.61	0.22	7.38	-	3.04	1.83	2.42	0.86	1.77	0.69	1.79	-	-	0.17	3.89	14.32	0.39	0.63	-	4.43	0.79	1.14	-	-	0.68	0.53	0.29	-	-	-	0	-	-	-	-	-	-	-	-	-	-	58.87	11.61	0.22	7.38	-	3.04	1.83	2.42	0.86	1.77	0.69	1.79	-	-	0.17	3.89	14.32	0.39	0.63	-	4.43	0.79	1.14	-	-	0.68	0.53	0.29	-	-	-	0	-	-	-	-	-	-	-	-	-	-	58.87
H0712_002_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1314.32	25.09	1276.59	2247.29	392.66	21666.59	22314.04	271.65	242.83	2048.65	801.54	0	48.11	543.97	5952.57	8716.23	164.89	211.21	3401.04	10332.4	381.16	713.17	0	0	313.29	263.97	134.27	17.04	0	100	25.28											150 days 1 to 7	150 days 1 to 7	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 25	Eff. copay 15 to 100	0		Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 copay	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											113	112.75	75.87	0	100	1.12	1.43	50	116.67	5.28	35.72	0	0	4.96	7.4	18.51	24	30	0	4.35	26.03	18.42	0	0	25	25	25	0	0	0	1.75											N/A	113	112.75	75.87	0	100	1.12	1.43	50	116.67	5.28	35.72	0	0	4.96	7.4	18.51	24	30	0	4.35	26.03	18.42	0	0	25	25	25	0	0	0	1.75												12.38	0.24	8.07	-	3.27	2.03	2.66	1.13	2.36	0.9	2.39	-	-	0.22	3.67	13.44	0.33	0.53	-	3.74	0.83	1.09	-	-	0.65	0.55	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	60.77	12.38	0.24	8.07	-	3.27	2.03	2.66	1.13	2.36	0.9	2.39	-	-	0.22	3.67	13.44	0.33	0.53	-	3.74	0.83	1.09	-	-	0.65	0.55	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	60.77
H0712_003_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1302.26	25.47	1277.83	2459.6	385.8	21375.91	21910.37	200.69	179.27	1511.53	591.7	0	35.56	401.93	6094.87	8944.78	194.63	247.2	3485.18	13285.37	281.72	667.49	0	0	313.52	247.85	134.36	15.9	0	100	24.97											150 days 1 to 7	150 days 1 to 7	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 25	Eff. copay 15 to 100	0	0	Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 copay	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											113	112.75	75.87	0	100	1.12	1.42	50	116.67	5.29	35.72	0	0	4.96	7.46	18.79	24	30	0	3.96	32.61	19.8	0	0	25	25	25	0	0	0	1.66											N/A	113	112.75	75.87	0	100	1.12	1.42	50	116.67	5.29	35.72	0	0	4.96	7.46	18.79	24	30	0	3.96	32.61	19.8	0	0	25	25	25	0	0	0	1.66												12.26	0.24	8.08	-	3.22	2	2.6	0.84	1.74	0.67	1.76	-	-	0.17	3.79	14.01	0.39	0.62	-	4.38	0.77	1.1	-	-	0.65	0.52	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	60.07	12.26	0.24	8.08	-	3.22	2	2.6	0.84	1.74	0.67	1.76	-	-	0.17	3.79	14.01	0.39	0.62	-	4.38	0.77	1.1	-	-	0.65	0.52	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	60.07
H0712_005_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1782.29	32.47	2016.11	3764.71	1583.01	28883.84	29686.4	325.2	277.7	2450.1	946.8	0	56.69	635.78	10077.92	14581.88	298.43	427.76	5314.11	19154.97	449.12	1174.15	0	0	0	0	0	0	0	100	301.95											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.09	175.1	54.11	0	15.28	0	0	42.01	218.51	0	69.17	0	3.63	42.51	0	0	17.13	0	0	1.64	33.02	0	0	0	0	0	0	0	0	0	0.18											N/A	180.09	175.1	54.11	0	15.28	0	0	42.01	218.51	0	69.17	0	3.63	42.51	0	0	17.13	0	0	1.64	33.02	0	0	0	0	0	0	0	0	0	0.18												26.75	0.47	9.09	-	2.02	-	-	1.14	5.06	-	5.46	-	0.02	2.25	-	-	0.43	-	-	2.63	1.24	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	56.54	26.75	0.47	9.09	-	2.02	-	-	1.14	5.06	-	5.46	-	0.02	2.25	-	-	0.43	-	-	2.63	1.24	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	56.54
H0712_006_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1876.71	35.56	2142.28	3623.67	1682.91	30917.99	31850.71	421.25	350.51	3170.05	1204.26	0	69.63	786.68	9246.86	13348.77	247.33	354.77	5316.21	15977.63	551.61	1151.36	0	0	0	0	0	0	0	100	276.02											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.1	175.1	54.11	0	15.33	0	0	32.66	166.16	0	52.28	0	2.83	32.59	0	0	16.52	0	0	1.55	25.78	0	0	0	0	0	0	0	0	0	0.15											N/A	180.1	175.1	54.11	0	15.33	0	0	32.66	166.16	0	52.28	0	2.83	32.59	0	0	16.52	0	0	1.55	25.78	0	0	0	0	0	0	0	0	0	0.15												28.17	0.52	9.66	-	2.15	-	-	1.15	4.85	-	5.25	-	0.02	2.14	-	-	0.34	-	-	2.06	1.19	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.48	28.17	0.52	9.66	-	2.15	-	-	1.15	4.85	-	5.25	-	0.02	2.14	-	-	0.34	-	-	2.06	1.19	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.48
H0712_007_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1809.11	32.94	2167.92	4061.57	1612.64	29438.28	30244.86	323.86	276.62	2439.84	943.01	0	56.49	633.43	9761.75	14093.01	289.76	415.17	5452	19650.34	447.49	1156.16	0	0	0	0	0	0	0	100	295.83											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.08	175.1	54.11	0	15.73	0	0	42.12	219.09	0	69.36	0	3.64	42.62	0	0	16.76	0	0	1.52	33.11	0	0	0	0	0	0	0	0	0	0.19											N/A	180.08	175.1	54.11	0	15.73	0	0	42.12	219.09	0	69.36	0	3.64	42.62	0	0	16.76	0	0	1.52	33.11	0	0	0	0	0	0	0	0	0	0.19												27.15	0.48	9.77	-	2.11	-	-	1.14	5.05	-	5.45	-	0.02	2.25	-	-	0.4	-	-	2.49	1.23	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.56	27.15	0.48	9.77	-	2.11	-	-	1.14	5.05	-	5.45	-	0.02	2.25	-	-	0.4	-	-	2.49	1.23	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.56
H0712_008_0	2006											3000											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1225.66	22.81	1183.73	2238.81	362.78	19923.62	20463.08	210.38	185.48	1566.13	635.44	0	37.58	422.34	6456.78	9425.69	204.72	261.93	3394.39	12459.88	297.75	704.15	0	0	333.14	260.26	142.78	16.89	0	100	26.93											100 days 1 to 7	100 days 1 to 7	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 75	Eff. copay 0 to 15	Eff. copay 0 to 50	0	0	Eff. copay 0 to 50	Eff. copay 0 to 5	Eff. copay 0 to 15	Eff. copay 05 to 15	15		Eff. copay 20 coins. 0 to 25 copay	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											75.33	75.17	37.93	0	50	1.11	1.43	50	58.33	3.24	11.91	0	0	2.44	3.93	9.44	14	15	0	3.01	33.02	19.79	0	0	25	25	25	0	0	0	1.62											3000	67.9	67.75	34.19	0	45.07	1	1.29	45.07	52.58	2.92	10.74	0	0	2.2	3.54	8.51	12.62	13.52	0	2.71	29.76	17.84	0	0	22.53	22.53	22.53	0	0	0	1.46												6.94	0.13	3.37	-	1.36	1.65	2.2	0.79	0.81	0.38	0.57	-	-	0.08	1.9	6.68	0.22	0.3	-	2.82	0.74	1.05	-	-	0.63	0.49	0.27	-	-	-	0	-	-	-	-	-	-	-	-	-	-	33.37	6.94	0.13	3.37	-	1.36	1.65	2.2	0.79	0.81	0.38	0.57	-	-	0.08	1.9	6.68	0.22	0.3	-	2.82	0.74	1.05	-	-	0.63	0.49	0.27	-	-	-	0	-	-	-	-	-	-	-	-	-	-	33.37
H0712_009_0	2006											3000											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1300.73	24.67	1291.28	2224.78	387.77	21371.79	22013.72	269.56	240.58	2054.24	829.14	0	47.79	539.95	6018.53	8772.92	170.97	219.15	3430.03	10388.61	378.61	711.84	0	0	313.6	263.87	134.4	17.06	0	100	25.36											100 days 1 to 7	100 days 1 to 7	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 75	Eff. copay 0 to 15	Eff. copay 0 to 50	0	0	Eff. copay 0 to 50	Eff. copay 0 to 5	Eff. copay 0 to 15	Eff. copay 5 to 15	15		Eff. copay 20 coins. 0 to 25 copay	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											75.33	75.17	37.93	0	50	1.12	1.43	50	58.33	3.14	11.83	0	0	2.48	3.9	9.17	14	15	0	2.96	26.08	18.45	0	0	25	25	25	0	0	0	1.75											3000	67.75	67.6	34.11	0	44.97	1.01	1.29	44.97	52.46	2.82	10.64	0	0	2.23	3.5	8.25	12.59	13.49	0	2.66	23.46	16.59	0	0	22.48	22.48	22.48	0	0	0	1.57												7.34	0.14	3.67	-	1.45	1.8	2.36	1.01	1.05	0.48	0.74	-	-	0.1	1.76	6.03	0.18	0.25	-	2.3	0.74	0.98	-	-	0.59	0.49	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	33.72	7.34	0.14	3.67	-	1.45	1.8	2.36	1.01	1.05	0.48	0.74	-	-	0.1	1.76	6.03	0.18	0.25	-	2.3	0.74	0.98	-	-	0.59	0.49	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	33.72
H0712_010_0	2006											3000											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1243.61	23.21	1243.44	2371.89	370.9	20389.45	20930.69	208.55	183.98	1554.36	630.5	0	37.24	418.62	6233.45	9082.99	198.69	254.27	3489.59	12828.74	295.05	691.34	0	0	326.27	258.94	139.83	16.8	0	100	26.38											100 days 1 to 7	100 days 1 to 7	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 75	Eff. copay 0 to 15	Eff. copay 0 to 50	0		Eff. copay 0 to 50	Eff. copay 0 to 5	Eff. copay 0 to 15	Eff. copay 5 to 15	15		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											75.33	75.17	37.93	0	50	1.14	1.46	50	58.33	3.23	11.91	0	0	2.44	3.98	9.56	14	15	0	2.79	33.11	19.74	0	0	25	25	25	0	0	0	1.65											3000	67.87	67.72	34.18	0	45.05	1.03	1.32	45.05	52.55	2.91	10.73	0	0	2.2	3.58	8.62	12.61	13.51	0	2.52	29.83	17.79	0	0	22.52	22.52	22.52	0	0	0	1.49												7.03	0.13	3.54	-	1.39	1.74	2.3	0.78	0.81	0.38	0.56	-	-	0.08	1.86	6.52	0.21	0.29	-	2.69	0.73	1.02	-	-	0.61	0.49	0.26	-	-	-	0	-	-	-	-	-	-	-	-	-	-	33.44	7.03	0.13	3.54	-	1.39	1.74	2.3	0.78	0.81	0.38	0.56	-	-	0.08	1.86	6.52	0.21	0.29	-	2.69	0.73	1.02	-	-	0.61	0.49	0.26	-	-	-	0	-	-	-	-	-	-	-	-	-	-	33.44
H0712_011_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1749.35	32.69	1979.89	3621.83	508.12	27923.21	28677.88	294.41	259.8	2234.18	885.94	0	52.57	590.93	9188.86	13344.28	293.8	375.54	4854.96	17796.66	416.43	982.08	0	0	464.02	375.09	198.87	23.5	0	100	37.46											75 days 1 to 7	75 days 1 to 7	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 75	Eff. copay 0 to 25	Eff. copay 15 to 100	0		Eff. copay 0 to 50	Eff. Copay 0 to	Eff. copay 0 to 10	Eff. copay 05 to 10	10		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											56.5	56.37	37.93	0	100	1.1	1.42	50	66.67	5.29	35.74	0	0	2.44	0.4	6.48	9.5	10	0	2.68	33.02	19.78	0	0	25	25	25	0	0	0	0.39											N/A	56.5	56.37	37.93	0	100	1.1	1.42	50	66.67	5.29	35.74	0	0	2.44	0.4	6.48	9.5	10	0	2.68	33.02	19.78	0	0	25	25	25	0	0	0	0.39												8.24	0.15	6.26	-	4.23	2.56	3.4	1.23	1.44	0.99	2.64	-	-	0.12	0.31	7.21	0.23	0.31	-	3.98	1.15	1.62	-	-	0.97	0.78	0.41	-	-	-	0	-	-	-	-	-	-	-	-	-	-	48.22	8.24	0.15	6.26	-	4.23	2.56	3.4	1.23	1.44	0.99	2.64	-	-	0.12	0.31	7.21	0.23	0.31	-	3.98	1.15	1.62	-	-	0.97	0.78	0.41	-	-	-	0	-	-	-	-	-	-	-	-	-	-	48.22
H0712_012_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1858.87	35.76	2120.77	3512.9	546.58	30196.53	31097.91	378.89	339.27	2964.78	1164.23	0	67.04	758.5	8502.56	12326.49	243.8	311.54	4906.48	14811.82	531.07	983.46	0	0	429.9	376.7	184.24	23.37	0	100	34.61											75 days 1 to 7	75 days 1 to 7	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 75	Eff. copay 0 to 25	Eff. copay 15 to 100	0		Eff. copay 0 to 50	Eff. Copay 0 to	Eff. copay 0 to 10	Eff. copay 05 to 10	10		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											56.5	56.37	37.93	0	100	1.12	1.42	50	66.67	5.09	35.66	0	0	2.48	0.38	6.27	9.5	10	0	2.62	25.98	18.35	0	0	25	25	25	0	0	0	0.39											N/A	56.5	56.37	37.93	0	100	1.12	1.42	50	66.67	5.09	35.66	0	0	2.48	0.38	6.27	9.5	10	0	2.62	25.98	18.35	0	0	25	25	25	0	0	0	0.39												8.75	0.17	6.7	-	4.55	2.81	3.68	1.58	1.88	1.26	3.46	-	-	0.16	0.27	6.44	0.19	0.26	-	3.24	1.15	1.5	-	-	0.9	0.78	0.38	-	-	-	0	-	-	-	-	-	-	-	-	-	-	50.12	8.75	0.17	6.7	-	4.55	2.81	3.68	1.58	1.88	1.26	3.46	-	-	0.16	0.27	6.44	0.19	0.26	-	3.24	1.15	1.5	-	-	0.9	0.78	0.38	-	-	-	0	-	-	-	-	-	-	-	-	-	-	50.12
H0712_013_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1783.21	33.53	2139.34	3920.58	519.89	28612.44	29368.32	291.09	257.23	2215.59	877.72	0	51.93	584.12	8848.03	12823.07	284.98	364.15	4990.69	18366.69	411.38	960.25	0	0	452.25	371.62	193.82	23.24	0	100	36.5											75 days 1 to 7	75 days 1 to 7	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 75	Eff. copay 0 to 25	Eff. copay 15 to 100	0		Eff. copay 0 to 50	Eff. Copay 0 to	Eff. copay 0 to 10	Eff. copay 05 to 10	10		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											56.5	56.37	37.93	0	100	1.13	1.45	50	66.67	5.27	35.73	0	0	2.45	0.4	6.56	9.5	10	0	2.48	33.11	19.72	0	0	25	25	25	0	0	0	0.39											N/A	56.5	56.37	37.93	0	100	1.13	1.45	50	66.67	5.27	35.73	0	0	2.45	0.4	6.56	9.5	10	0	2.48	33.11	19.72	0	0	25	25	25	0	0	0	0.39												8.4	0.16	6.76	-	4.33	2.7	3.56	1.21	1.43	0.97	2.61	-	-	0.12	0.3	7.01	0.23	0.3	-	3.8	1.14	1.58	-	-	0.94	0.77	0.4	-	-	-	0	-	-	-	-	-	-	-	-	-	-	48.72	8.4	0.16	6.76	-	4.33	2.7	3.56	1.21	1.43	0.97	2.61	-	-	0.12	0.3	7.01	0.23	0.3	-	3.8	1.14	1.58	-	-	0.94	0.77	0.4	-	-	-	0	-	-	-	-	-	-	-	-	-	-	48.72
H0752_002_0	2006											0											D	D	D		Coin			V	P		Coin			V	V	V	Coin	V		V																						0																																										-	1684.97	53.42	1431.72		6.6			209.5	320.51		40.71			383.8	6048.73	6253.69	2.44	359.92		120.28																						135/day up to 2025 max per admit	135/day up to 2025 max per admit	0 for 1st 5 days; 125/day from days 6-100		20			50	300 per visit		20 coins			25	15	25	50	25		250 IP surgery 200 Am Surg Phys																						125.99	82.27	99.53		20			41.35	247.99		6.7			23.93	14.95	24.94	49.3	24.64		236.7																						0	125.99	82.27	99.53		20			41.35	247.99		6.7			23.93	14.95	24.94	49.3	24.64		236.7																							17.69	0.37	11.87	-	1.32	-	-	0.72	6.62	-	2.71	-	-	0.77	7.53	13	1.2	0.74	-	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.92	17.69	0.37	11.87	-	1.32	-	-	0.72	6.62	-	2.71	-	-	0.77	7.53	13	1.2	0.74	-	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.92
H0752_801_0	2006											0											D	D	D		Coin			V	P		Coin			V	V	V	Coin	V		V																						0																																										-	1693.7	53.7	1431.72		6.6			174.43	266.85		40.71			385.75	6048.81	6253.69	2.44	359.92		120.28																						135/day up to 2025 max per admit	135/day up to 2025 max per admit	0 for 1st 5 days; 125/day from days 6-100		20			50	300 per visit		20 coins			25	15	25	50	25		250 IP surgery 200 Am Surg Phys																						125.99	82.27	99.53		0.2			49.92	299.37		0.07			23.93	14.95	24.94	0.38	24.64		236.7																						0	125.99	82.27	99.53		0.2			49.92	299.37		0.07			23.93	14.95	24.94	0.38	24.64		236.7																							17.78	0.37	11.87	-	1.32	-	-	0.73	6.66	-	2.72	-	-	0.77	7.53	13	0.93	0.74	-	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.79	17.78	0.37	11.87	-	1.32	-	-	0.73	6.66	-	2.72	-	-	0.77	7.53	13	0.93	0.74	-	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.79
H0755_001_0	2006											490											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1642.62	29.36	1297.05	0	214.55	7.64	0.72	277.15	234.5	0	896.5	0	0.34	287.95	5109.41	6790.51	256.96	376.86	0	315.2	9	1009.81	0	0	384.16	0	211.86	0	0	0	0											Per Day: 1-14	Per Day: 1-14	50 / Day Days 21-100		50 per	20 per	20 per	50 ER / 25 UC	50 ASC / 50 OP	0	0 - 75 per		20 per	25 OP SA / 0 Cardiac Rehab	10 PCP	15 SCP / 15 Chiro / 15 Podiatrist	25 MH	15 Therapy		15 Hearing / 0 Preventive	20 per	15 Vision/0 Blook			15		15				0											35	35	11.92	0	50	0.16	0.2	38.87	50	0	32.71	0	0.2	15.94	10	14.98	25	15	0	5.26	0.2	8.88	0	0	15	0	15	0	0	0	0											490	26.14	26.14	8.9	0	50	0.16	0.2	38.87	50	0	32.71	0	0.2	15.94	10	14.98	25	15	0	5.26	0.2	8.88	0	0	15	0	15	0	0	0	0											0	3.58	0.06	0.96	-	0.89	1.25	0.14	0.9	0.98	-	2.44	-	0.07	0.38	4.26	8.48	0.54	0.47	-	0.14	1.8	0.75	-	-	0.48	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.83	3.58	0.06	0.96	-	0.89	1.25	0.14	0.9	0.98	-	2.44	-	0.07	0.38	4.26	8.48	0.54	0.47	-	0.14	1.8	0.75	-	-	0.48	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.83
H0755_020_0	2006											490											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											490	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1507.93	26.95	1190.69	0	196.96	7.01	0.66	254.43	215.27	0	822.99	0	0.31	264.34	4685.26	6233.69	235.89	327.36	0	289.35	8.26	927.01	0	0	354.3	0	195.39	0	0	0	0											Per Day: 1-14	Per Day: 1-14	50 / Day Days 21-100		75 per	20 per	20 per	50 ER / 25 UC	50 ASC / 50 OP	0	0 - 75 per		20 per	25 OP SA / 0 Cardiac Rehab	10 PCP	15 SCP / 15 Chiro / 15 Podiatrist	25 MH	25 Therapy		15 Hearing / 0 Preventive	20 per	15 Vision/0 Blook			15		15				0											35	35	11.92	0	75	0.16	0.2	38.87	50	0	32.71	0	0.2	25	9.92	15.02	25	25	0	5.26	0.2	8.88	0	0	12.88	0	12.88	0	0	0	0											980	25.93	25.93	8.83	0	75	0.16	0.2	38.87	50	0	32.71	0	0.2	25	9.92	15.02	25	25	0	5.26	0.2	8.88	0	0	12.88	0	12.88	0	0	0	0											0	3.26	0.06	0.88	-	1.23	1.14	0.13	0.82	0.9	-	2.24	-	0.06	0.55	3.87	7.8	0.49	0.68	-	0.13	1.65	0.69	-	-	0.38	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.18	3.26	0.06	0.88	-	1.23	1.14	0.13	0.82	0.9	-	2.24	-	0.06	0.55	3.87	7.8	0.49	0.68	-	0.13	1.65	0.69	-	-	0.38	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.18
H0755_021_0	2006											none											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1228.09	16.59	1625.53	0	197.11	8.98	9.02	389.55	378.77	0	1245.17	0	0.2	384.39	4139.5	5307.01	195.96	273	0	254.36	8.56	700.09	0	0	442.71	0	189.8	0	0	0	0											125 copay / day days 1 - 8	125 copay / day days 1 - 8	1-15: 0/Day 16-100: 75/Day		75 copay	20 DME/Prosthetics; 20 Diabetic Supplies	20 DME/Prosthetics; 20 Diabetic Supplies	50 ER / 25 UC	100 ASC / 100 OP		150 CT Scan; 200 MRI; 200 Nuclear Med; 20 Therapeutic; 20 X-Rays		20 coinsurance	25 OP SA	15 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	25 Therapy	150 CT Scan; 200 MRI; 200 Nuclear Med; 20 Therapeutic; 20 X-Rays	25 Hearing / 0 Preventive	20 coinsurance	25 Vision			25 copay		25 copay				0											125	125	25.96	0	75	0.2	0.2	41.56	100	0	59.65	0	0.2	25	15	24.96	25	25	0	8.79	0.2	22.23	0	0	25	0	25	0	0	0	0											none	125	125	25.96	0	75	0.2	0.2	41.56	100	0	59.65	0	0.2	25	15	24.96	25	25	0	8.79	0.2	22.23	0	0	25	0	25	0	0	0	0											0	12.79	0.17	3.52	-	1.23	1.8	1.8	1.35	3.16	-	6.19	-	0.04	0.8	5.17	11.04	0.41	0.57	-	0.19	1.71	1.3	-	-	0.92	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.55	12.79	0.17	3.52	-	1.23	1.8	1.8	1.35	3.16	-	6.19	-	0.04	0.8	5.17	11.04	0.41	0.57	-	0.19	1.71	1.3	-	-	0.92	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.55
H0755_022_0	2006											1800											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1368.3	24.46	1091.36	0	182.37	6.49	0.61	235.58	199.32	0	762.02	0	0.29	244.76	4118.86	5478.42	218.42	303.11	0	254.55	7.65	831.02	0	0	308.98	0	170.4	0	0	0	0											Per Day: 1-6	Per Day: 1-6	75 / Day Days 16-100		75 per	20 per	20 per	50 ER / 25 UC	100 ASC / 100 OP	0	0 - 200 per		20 per	25 OP SA / 0 Cardiac Rehab	15 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	25 Therapy		25 Hearing / 0 Preventive	20 per	25 Vision/0 Blook			25		25				0											150	150	25.96	0	75	0.2	0.2	38.87	100	0	66.09	0	0.2	25	15	24.96	25	25	0	8.74	0.2	14.47	0	0	25	0	25	0	0	0	0											1800	120.87	120.87	20.92	0	75	0.2	0.2	38.87	100	0	66.09	0	0.2	25	15	24.96	25	25	0	8.74	0.2	14.47	0	0	25	0	25	0	0	0	0											0	13.78	0.25	1.9	-	1.14	1.3	0.12	0.76	1.66	-	4.2	-	0.06	0.51	5.15	11.39	0.46	0.63	-	0.19	1.53	1	-	-	0.64	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.02	13.78	0.25	1.9	-	1.14	1.3	0.12	0.76	1.66	-	4.2	-	0.06	0.51	5.15	11.39	0.46	0.63	-	0.19	1.53	1	-	-	0.64	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.02
H0755_023_0	2006											1800											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1368.3	24.46	1091.36	0	182.37	6.49	0.61	235.58	199.32	0	762.02	0	0.29	244.76	4118.86	5478.42	218.42	303.11	0	254.55	7.65	831.02	0	0	308.98	0	170.4	0	0	0	0											Per Day: 1-6	Per Day: 1-6	75 / Day Days 16-100		75 per	20 per	20 per	50 ER / 25 UC	100 ASC / 100 OP	0	0 - 200 per		20 per	25 OP SA / 0 Cardiac Rehab	15 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	25 Therapy		25 Hearing / 0 Preventive	20 per	25 Vision/0 Blook		0	25		25				0											150	150	25.96	0	75	0.2	0.2	38.87	100	0	66.09	0	0.2	25	15	24.96	25	25	0	8.74	0.2	14.47	0	0	25	0	25	0	0	0	0											1800	120.87	120.87	20.92	0	75	0.2	0.2	38.87	100	0	66.09	0	0.2	25	15	24.96	25	25	0	8.74	0.2	14.47	0	0	25	0	25	0	0	0	0											0	13.78	0.25	1.9	-	1.14	1.3	0.12	0.76	1.66	-	4.2	-	0.06	0.51	5.15	11.39	0.46	0.63	-	0.19	1.53	1	-	-	0.64	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.02	13.78	0.25	1.9	-	1.14	1.3	0.12	0.76	1.66	-	4.2	-	0.06	0.51	5.15	11.39	0.46	0.63	-	0.19	1.53	1	-	-	0.64	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.02
H0755_801_0	2006											none											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	669.53	9.28	1278.78	0	244.61	9.74	0.91	283.62	232.87	0	936.75	0	0.35	298.5	4473.69	6017.06	244.9	339.88	0	279	8.6	653.55	0	0	0	0	0	0	0	0	0											Per Day: 1-6	Per Day: 1-6	50 per Day		75 per	20 per	20 per	50 ER / 25 UC	200 ASC / 200 OP	0	0 - 75 per		20 per	40 OP SA / 0 Cardiac Rehab	40 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	20 per	40 Vision/0 Blook		0	0		0				0											300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											none	300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											0	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74
H0755_802_0	2006											none											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	669.53	9.28	1278.78	0	244.61	9.74	0.91	283.62	232.87	0	936.75	0	0.35	298.5	4473.69	6017.06	244.9	339.88	0	279	8.6	653.55	0	0	0	0	0	0	0	0	0											Per Day: 1-6	Per Day: 1-6	50 per Day		75 per	20 per	20 per	50 ER / 25 UC	200 ASC / 200 OP	0	0 - 75 per		20 per	40 OP SA / 0 Cardiac Rehab	40 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	20 per	40 Vision/0 Blook		0	0		0				0											300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											none	300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											0	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74
H0755_803_0	2006											none											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	669.53	9.28	1278.78	0	244.61	9.74	0.91	283.62	232.87	0	936.75	0	0.35	298.5	4473.69	6017.06	244.9	339.88	0	279	8.6	653.55	0	0	0	0	0	0	0	0	0											Per Day: 1-6	Per Day: 1-6	50 per Day		75 per	20 per	20 per	50 ER / 25 UC	200 ASC / 200 OP	0	0 - 75 per		20 per	40 OP SA / 0 Cardiac Rehab	40 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	20 per	40 Vision/0 Blook		0	0		0				0											300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											none	300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											0	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74
H0755_804_0	2006											none											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	669.53	9.28	1278.78	0	244.61	9.74	0.91	283.62	232.87	0	936.75	0	0.35	298.5	4473.69	6017.06	244.9	339.88	0	279	8.6	653.55	0	0	0	0	0	0	0	0	0											Per Day: 1-6	Per Day: 1-6	50 per Day		75 per	20 per	20 per	50 ER / 25 UC	200 ASC / 200 OP	0	0 - 75 per		20 per	40 OP SA / 0 Cardiac Rehab	40 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	20 per	40 Vision/0 Blook		0	0		0				0											300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											none	300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											0	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74
H0755_805_0	2006											none											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	669.53	9.28	1278.78	0	244.61	9.74	0.91	283.62	232.87	0	936.75	0	0.35	298.5	4473.69	6017.06	244.9	339.88	0	279	8.6	653.55	0	0	0	0	0	0	0	0	0											Per Day: 1-6	Per Day: 1-6	50 per Day		75 per	20 per	20 per	50 ER / 25 UC	200 ASC / 200 OP	0	0 - 75 per		20 per	40 OP SA / 0 Cardiac Rehab	40 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	20 per	40 Vision/0 Blook		0	0		0				0											300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											none	300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											0	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74
H0755_806_0	2006											none											D	D	D	V	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	669.53	9.28	1278.78	0	244.61	9.74	0.91	283.62	232.87	0	936.75	0	0.35	298.5	4473.69	6017.06	244.9	339.88	0	279	8.6	653.55	0	0	0	0	0	0	0	0	0											Per Day: 1-6	Per Day: 1-6	50 per Day		75 per	20 per	20 per	50 ER / 25 UC	200 ASC / 200 OP	0	0 - 75 per		20 per	40 OP SA / 0 Cardiac Rehab	40 PCP	40 SCP / 40 Chiro / 40 Podiatrist	40 MH	40 Therapy		40 Hearing / 0 Preventive	20 per	40 Vision/0 Blook		0	0		0				0											300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											none	300	300	25.96	0	150	0.2	0.2	38.89	200	0	66.09	0	0.2	40	39.99	39.92	40	35.63	0	14.15	0.2	36.56	0	0	0	0	0	0	0	0	0											0	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74	16.74	0.23	2.77	-	3.06	1.95	0.18	0.92	3.88	-	5.16	-	0.07	0.99	14.91	20.02	0.82	1.01	-	0.33	1.72	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.74
H0901_001_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1700.72	17.18	1327.43	1337.27	229.06	2.11	0.02	241.73	49.02	854.34	273.92	0	66.01	41.72	2976.62	10120.32	0.41	688.52	614.4	0	292.41	725.34			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-10 75/d 11-100 days																																							122.35	122.35	47.6	20	100	0.2	0.2	48	100	30	50	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	47.6	20	100	0.2	0.2	48	100	30	50	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	17.34	0.18	5.27	2.23	1.91	0.42	0	0.97	0.41	2.14	1.14	-	0.17	0.1	3.72	25.3	0	1.72	1.54	-	1.1	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.46	17.34	0.18	5.27	2.23	1.91	0.42	0	0.97	0.41	2.14	1.14	-	0.17	0.1	3.72	25.3	0	1.72	1.54	-	1.1	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.46
H0901_002_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1759.39	17.77	1360.43	1370.51	234.75	2.17	0.02	247.74	50.24	885.48	284.42	0	68.41	43.24	3090.72	10597.41	0.43	720.98	643.36	0	299.68	743.37			0	0	0	0	0	0	0											250/admission	250/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0												40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0											0	5.98	0.06	8.03	2.28	1.96	0.43	0	0.99	0.42	1.48	1.42	-	0.11	0.07	2.58	17.66	0	1.2	1.07	-	1.12	1.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.12	5.98	0.06	8.03	2.28	1.96	0.43	0	0.99	0.42	1.48	1.42	-	0.11	0.07	2.58	17.66	0	1.2	1.07	-	1.12	1.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.12
H0901_003_0	2006											4000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																					27.39	0.28							0.57																																	28.23	1654.59	16.71	1306.84	1316.53	225.51	2.08	0.02	237.99	48.13	850.6	273.38	0	65.72	41.53	2968.99	10180.01	0.41	692.58	618.02	0	287.87	714.09			0	0	0	0	0	0	0											15 Coin	15 Coin	0/d 1-9 75/d 10-19 125 20-100 days																																							277.5	277.5	70.85	20	100	0.2	0.2	48	112.5	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0												207	207	52.85	14.92	74.59	0.15	0.15	35.81	83.92	14.92	44.76	0	14.92	14.92	7.46	14.92	14.92	14.92	14.92	0	45	14.92			0	0	0	0	0	0	0											500	28.54	0.29	5.76	1.64	1.4	0.31	0	0.71	0.34	1.06	1.02	-	0.08	0.05	1.85	12.66	0	0.86	0.77	-	1.08	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.29	55.93	0.56	5.76	1.64	1.4	0.31	0	0.71	0.91	1.06	1.02	-	0.08	0.05	1.85	12.66	0	0.86	0.77	-	1.08	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.53
H0901_004_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1700.72	17.18	1327.43	1337.27	229.06	2.11	0.02	241.73	49.02	854.34	273.92	0	66.01	41.72	2976.62	10120.32	0.41	688.52	614.4	0	292.41	725.34			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	17.34	0.18	7.84	2.23	1.91	0.42	0	0.97	0.41	2.14	1.48	-	0.17	0.1	3.72	25.3	0	1.72	1.54	-	1.1	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.37	17.34	0.18	7.84	2.23	1.91	0.42	0	0.97	0.41	2.14	1.48	-	0.17	0.1	3.72	25.3	0	1.72	1.54	-	1.1	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.37
H0901_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1735.39	17.53	1334.99	1303.43	234.49	2.17	0.02	244.79	49.66	914.81	280.13	0	67.56	42.7	2701.33	10247.61	0.41	697.18	622.12	0	299.34	742.53																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																				0	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84
H0901_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1735.39	17.53	1334.99	1303.43	234.49	2.17	0.02	244.79	49.66	914.81	280.13	0	67.56	42.7	2701.33	10247.61	0.41	697.18	622.12	0	299.34	742.53																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																				0	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84
H0901_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1735.39	17.53	1334.99	1303.43	234.49	2.17	0.02	244.79	49.66	914.81	280.13	0	67.56	42.7	2701.33	10247.61	0.41	697.18	622.12	0	299.34	742.53																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																				0	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84
H0902_001_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				5000																																										-	1626.83	16.43	1269.75	1279.16	219.1	2.02	0.02	231.23	46.89	817.22	261.76	0	63.14	39.9	2847.29	9680.59	0.39	658.61	587.7	0	279.7	693.82			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	16.59	0.17	7.5	2.13	1.83	0.4	0	0.92	0.39	2.04	1.42	-	0.16	0.1	3.56	24.2	0	1.65	1.47	-	1.05	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.31	16.59	0.17	7.5	2.13	1.83	0.4	0	0.92	0.39	2.04	1.42	-	0.16	0.1	3.56	24.2	0	1.65	1.47	-	1.05	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.31
H0902_002_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				3500																																										-	1548.8	15.64	1197.59	1206.47	206.65	1.91	0.02	218.09	44.22	779.49	246.9	0	60.22	38.06	2720.78	9328.95	0.38	634.68	566.35	0	263.81	654.39			0	0	0	0	0	0	0											250/admission	250/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0												40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0											0	5.26	0.05	7.07	2.01	1.72	0.38	0	0.87	0.37	1.3	1.23	-	0.1	0.06	2.27	15.55	0	1.06	0.94	-	0.99	1.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.34	5.26	0.05	7.07	2.01	1.72	0.38	0	0.87	0.37	1.3	1.23	-	0.1	0.06	2.27	15.55	0	1.06	0.94	-	0.99	1.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.34
H0902_003_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				5000																																										-	1626.37	16.43	1269.39	1278.8	219.04	2.02	0.02	231.17	46.87	816.99	266.02	0	63.12	39.89	2846.49	9677.87	0.39	658.42	587.54	0	279.62	693.63			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	16.58	0.17	7.49	2.13	1.83	0.4	0	0.92	0.39	2.04	1.44	-	0.16	0.1	3.56	24.19	0	1.65	1.47	-	1.05	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.32	16.58	0.17	7.49	2.13	1.83	0.4	0	0.92	0.39	2.04	1.44	-	0.16	0.1	3.56	24.19	0	1.65	1.47	-	1.05	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.32
H0902_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1527.14	15.43	1174.79	1147.02	206.35	1.91	0.02	215.42	43.7	805.04	246.52	0	59.45	37.57	2377.17	9017.9	0.36	613.52	547.47	0	263.42	653.43																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance																															143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																				0	18.29	0.18	9.79	3.35	2.58	0.57	0.01	0.9	0.55	0.54	2.02	-	0.17	0.11	6.93	26.3	0	1.79	1.6	-	1.48	1.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.06	18.29	0.18	9.79	3.35	2.58	0.57	0.01	0.9	0.55	0.54	2.02	-	0.17	0.11	6.93	26.3	0	1.79	1.6	-	1.48	1.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.06
H0902_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1527.14	15.43	1174.79	1147.02	206.35	1.91	0.02	215.42	43.7	805.04	246.52		59.45	37.57	2377.17	9017.9	0.36	613.52	547.47		263.42	653.43																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																				0	18.29	0.18	9.79	3.35	2.58	0.57	0.01	0.9	0.55	0.54	2.02	-	0.17	0.11	6.93	26.3	0	1.79	1.6	-	1.48	1.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.06	18.29	0.18	9.79	3.35	2.58	0.57	0.01	0.9	0.55	0.54	2.02	-	0.17	0.11	6.93	26.3	0	1.79	1.6	-	1.48	1.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.06
H0902_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1527.14	15.43	1174.79	1147.02	206.35	1.91	0.02	215.42	43.7	805.04	246.52		59.45	37.57	2377.17	9017.9	0.36	613.52	547.47		263.42	653.43																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																				0	18.29	0.18	9.79	3.35	2.58	0.57	0.01	0.9	0.55	0.54	2.02	-	0.17	0.11	6.93	26.3	0	1.79	1.6	-	1.48	1.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.06	18.29	0.18	9.79	3.35	2.58	0.57	0.01	0.9	0.55	0.54	2.02	-	0.17	0.11	6.93	26.3	0	1.79	1.6	-	1.48	1.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.06
H1013_011_0	2006																								D			Coin	Coin	V	V		V			V							S			V							V																																																					-			748.04			0.39	4.03	191.03	71.72		55.11			110.75							920.58			2281.46							10													25/day (days 8-25)			non-std items only	non-std items only		Hospital only		Hospital only			Hospital only							20 Coinsurance			Copays vary by service category																				10.83			0.2	0.2	50	100		50			25							14.57			52.36							20														10.83			0.2	0.2	50	100		50			25							14.57			52.36							20												-	-	0.68	-	-	0.08	0.81	0.8	0.6	-	0.23	-	-	0.23	-	-	-	-	-	-	1.12	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.5	-	-	0.68	-	-	0.08	0.81	0.8	0.6	-	0.23	-	-	0.23	-	-	-	-	-	-	1.12	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.5
H1013_021_0	2006																								D			Coin	Coin	V	V					V							S			V							V																																																					-			775.23			0.39	4.03	224.99	56.18		83.8			137.95							222.18			2281.46							10													25/day (days 8-25)			non-std items only	non-std items only		Hospital only		Hospital only			Hospital only							20 coinsurance			Copays vary by service category																				10.83			0.2	0.2	50	100		50			25							13.07			52.36							20														10.83			0.2	0.2	50	100		50			25							13.07			52.36							20												-	-	0.7	-	-	0.08	0.81	0.94	0.47	-	0.35	-	-	0.29	-	-	-	-	-	-	0.24	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	13.84	-	-	0.7	-	-	0.08	0.81	0.94	0.47	-	0.35	-	-	0.29	-	-	-	-	-	-	0.24	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	13.84
H1013_022_0	2006																						D		D			Coin	Coin	V	V		V		V	V						V	S			V							O																																																					-	1782.76		806.9			0.39	4.03	198.57	107.21		71.3		3.84	155.03						8918.59	1406.35			2281.46							10											50/day (days 1-5)		50/day (days 8-25)			non-std items only	non-std items only		Hospital only		Hospital only		Hospital only	Hospital only							20 coinsurance			Copays vary by service category							Travel benefit											33.6		21.66			0.2	0.2	50	250		100		50	50						20	10.07			52.36							20												33.6		21.66			0.2	0.2	50	250		100		50	50						20	10.07			52.36							20												4.99	-	1.46	-	-	0.08	0.81	0.83	2.23	-	0.59	-	0.02	0.65	-	-	-	-	-	14.86	1.18	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	37.66	4.99	-	1.46	-	-	0.08	0.81	0.83	2.23	-	0.59	-	0.02	0.65	-	-	-	-	-	14.86	1.18	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	37.66
H1013_023_0	2006																								D			Coin	Coin	V	V		V		V	V							S			V							V																																																					-			828.25			0.39	4.03	199.67	105.86		70.27		3.91	151.24							943.6			2281.46							10.25													25/day (days 8-25)			non-std items only	non-std items only		Hospital only		Hospital only		Hospital only	Hospital only							20 Coinsurance			Copays vary by service category																				10.83			0.2	0.2	50	100		50		25	25							14.65			52.36							20														10.83			0.2	0.2	50	100		50		25	25							14.65			52.36							20												-	-	0.75	-	-	0.08	0.81	0.83	0.88	-	0.29	-	0.01	0.32	-	-	-	-	-	-	1.15	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	15.08	-	-	0.75	-	-	0.08	0.81	0.83	0.88	-	0.29	-	0.01	0.32	-	-	-	-	-	-	1.15	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	15.08
H1013_024_0	2006																																													V																																																												-																								2285.84																																																																																		15.56																																										15.56																			-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.96
H1013_025_0	2006																								D			Coin	Coin	V	V		V			V							S			V							V																																																					-			766.48			4.03	0.39	203.04	67.9		60.8			117.76							769.51			2281.46							10													25/day (days 8-25)			non-std items only	non-std items only		Hospital only		Hospital only			Hospital only							20 Coinsurance			Copays vary by service category							Travel benefit													10.83			0.2	0.2	50	100		50			25							11.3			52.36							20														10.83			0.2	0.2	50	100		50			25							11.3			52.36							20												-	-	0.69	-	-	0.81	0.08	0.85	0.57	-	0.25	-	-	0.25	-	-	-	-	-	-	0.72	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.18	-	-	0.69	-	-	0.81	0.08	0.85	0.57	-	0.25	-	-	0.25	-	-	-	-	-	-	0.72	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.18
H1013_026_0	2006																								D			Coin	Coin	V	V		V		V	V	V	V					S			V					Coin																																																							-			679.44			3.3	0.32	163.79	105.86		57.65		3.21	124.07	3664.62	7167.48					773.95			1871.27					154.77															25/day (days 8-25)			non-std items only	non-std items only		Hospital only		Hospital only		Hospital only	Hospital only							20 Coinsurance			Copays vary by service category					100 deductible; 30 coinsurance															10.83			0.2	0.2	50	100		50		25	25	5	35					14.65			52.36					0.3																10.83			0.2	0.2	50	100		50		25	25	5	35					14.65			52.36					0.3														-	-	0.61	-	-	0.66	0.06	0.68	0.88	-	0.24	-	0.01	0.26	1.53	20.91	-	-	-	-	0.94	-	-	8.16	-	-	-	-	46.43	-	-	-	-	-	-	-	-	-	-	-	-	81.38	-	-	0.61	-	-	0.66	0.06	0.68	0.88	-	0.24	-	0.01	0.26	1.53	20.91	-	-	-	-	0.94	-	-	8.16	-	-	-	-	46.43	-	-	-	-	-	-	-	-	-	-	-	-	81.38
H1016_001_0	2006																						D	D	D	P	T	Coin	Coin	V	V	V	V	V	V	V	P	P	V	P	P	P	S	O	T	P	P	P	P	P	O	V	Coin																																																					-	1479.69	5.92	747.94	1775.21	242.07	0.11	0.01	193.83	243.39	126.44	1100.32	58.39	1078.08	1474.08	7341.05	12066.67	0.48	76.24	3290.35	0	537.19	0	0	0	1.75	0	31.13	0	0	6.56	0											50/Day for Days 1-7	50/Day for Days 1-7	110 for Days 21-100	No Cost Sharing	50/Trip	20/Device	20/Device	50 per ER Visit; 25 per Urgent Care Visit	100/Episode	No Cost Sharing	25 Copayment	No Cost Sharing	No Cost Sharing	25 Copayment for Diagnostic Testing; 10 Copayment for OP Rehab	0/Visit Copayment	10/Visit Copayment	10/Visit Copayment	10/Visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	Not Covered	10/Visit Copayment	10/Visit Copayment	10/Visit Copayment; 40 frame allowance	10/Visit Copayment	No Cost Sharing	Not Applicable	No Cost Sharing	No Cost Sharing											39.25	39.25	37.32	0	50	0.2	0.2	49.44	100	0	25	0	0	0.15	0.02	3.15	10	10	0	0	0	0	0	10	10	10	10	0	0	0	0												39.25	39.25	37.32	0	50	0.2	0.2	49.44	100	0	25	0	0	0.15	0.02	3.15	10	10	0	0	0	0	0	10	10	10	10	0	0	0	0												4.84	0.02	2.33	-	1.01	0.02	0	0.8	2.03	-	2.29	-	-	0.02	0.01	3.16	0	0.06	-	-	-	-	-	-	0	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.62	4.84	0.02	2.33	-	1.01	0.02	0	0.8	2.03	-	2.29	-	-	0.02	0.01	3.16	0	0.06	-	-	-	-	-	-	0	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.62
H1016_002_0	2006																						D	D	D	P	T	Coin	Coin	V	V	V	V	V	V	V	P	P	V	P	P	P	S	O	T	P	P	P	P	P	O	V	Coin																																																					-	1538.84	5.41	607.03	2333.93	257.36	0.11	0.02	253.83	300.23	158.83	1250.37	112.34	445.49	1243.49	7277.36	14129.05	3.29	111.22	4018.35	0	617.21	0	0	0	1.69	0	33.31	0	0	7.23	0											150/Day for Days 1-7	150/Day for Days 1-7	110 for Days 21-100	No Cost Sharing	50/Trip	20/Device	20/Device	50 per ER Visit; 25 per Urgent Care Visit	150/Episode	No Cost Sharing	25 Copayment	No Cost Sharing	No Cost Sharing	25 Copayment for Diagnostic Testing; 20 Copayment for OP Rehab	0/Visit Copayment	20/Visit Copayment	20/Visit Copayment	20/Visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	20/Visit Copayment	20/Visit Copayment	10/Visit Copayment; 40 frame allowance	20/Visit Copayment	No Cost Sharing	Not Applicable	No Cost Sharing	No Cost Sharing											139.49	139.49	26.69	0	50	0.2	0.2	48.68	150	0	25	0	0	0.27	0.09	6.4	20	20	0	0	0	0	0	20	20	10	20	0	0	0	0												139.49	139.49	26.69	0	50	0.2	0.2	48.68	150	0	25	0	0	0.27	0.09	6.4	20	20	0	0	0	0	0	20	20	10	20	0	0	0	0												17.89	0.06	1.35	-	1.07	0.02	0	1.03	3.75	-	2.6	-	-	0.03	0.05	7.54	0.01	0.19	-	-	-	-	-	-	0	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.66	17.89	0.06	1.35	-	1.07	0.02	0	1.03	3.75	-	2.6	-	-	0.03	0.05	7.54	0.01	0.19	-	-	-	-	-	-	0	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.66
H1016_017_0	2006																						D	D	D	P	T	Coin	Coin	V	V	V	V	V	V	V	P	P	V	P	P	P	S	O	T	P	P	P	P	P	O	V	Coin																																																					-	0	0	0	2333.93	257.36	0.11	0.02	253.83	300.23	158.83	1250.37	112.34	445.49	1243.49	7277.36	14129.05	3.29	111.22	4018.35	0	617.21	0	0	0	1.69	0	33.31	0	0	7.23	0														No Cost Sharing	50/Trip	20/Device	20/Device	50 per ER Visit; 25 per Urgent Care Visit	150/Episode	No Cost Sharing	25 Copayment	No Cost Sharing	No Cost Sharing	25 Copayment for Diagnostic Testing; 20 Copayment for OP Rehab	0/Visit Copayment	20/Visit Copayment	20/Visit Copayment	20/Visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	Not Covered	20/Visit Copayment	20/Visit Copayment	10/Visit Copayment; 40 frame allowance	20/Visit Copayment	No Cost Sharing	Not Applicable	No Cost Sharing	No Cost Sharing											0	0	0	0	50	0.2	0.2	48.68	150	0	25	0	0	0.27	0.09	6.4	20	20	0	0	0	0	0	20	20	10	20	0	0	0	0												0	0	0	0	1.07	0.02	0	1.03	3.75	0	2.6	0	0	0.03	0.05	7.54	0.01	0.19	0	0	0	0	0	0	0	0	0.06	0	0	0	0												-	-	-	-	0.02	0	0	0.02	0.09	-	0.27	-	-	0	0.03	8.88	0	0	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9.33	-	-	-	-	0.02	0	0	0.02	0.09	-	0.27	-	-	0	0.03	8.88	0	0	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9.33
H1019_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1835.31	11.1	916.21	2419.04	384.92	389.15	29.29	1204.76	908.4				0	876.47	9710.92	6341.14					4.45			1.95	1100		0					96.6	0	34314.01	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1-6) 25 per day (7-25)	0	50	0	0	25	100				0	0-50	0	May-50					0			0	0							250 per day (1-5)	0 per day (0-0)	0	0	0	0	0				0	0	11.59	0	50	0	0	25	100				0	9.1	0	3.46					0			0	0		0					170.05	0	0	0	0	0	0					0	0	11.59	0	50	0	0	25	100				0	9.1	0	3.46					0			0	0		0					170.05	0	0	0	0	0	0				0	-	-	0.88	-	1.6	-	-	2.51	7.57	-	-	-	-	0.66	-	1.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.37	-	-	-	-	-	-	-	-	-	16.43	-	-	0.88	-	1.6	-	-	2.51	7.57	-	-	-	-	0.66	-	1.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.37	-	-	-	-	-	-	-	-	-	16.43
H1019_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1966.21	11.25	1018.82	2502.17	412.5	663.99	49.98	967.37	726.61				4.21	1005.55	10045.18	6559.07					4.45			1.95	1100		0					103.48	0.59	16231	0	0	0	0				0 per day (1-90)	0 per day (1-90)	0 per day (1-6) 25 per day (7-25)	0	50	0	0	0-25	0				0	0	0	0					0			0	0							0 per day (1-90)	0 per day (1-90)	0	0	0	0	0				0	0	11.59	0	50	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0					0	0	11.59	0	50	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0				0	-	-	0.98	-	1.72	-	-	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.31	-	-	0.98	-	1.72	-	-	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.31
H1019_004_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1628.37	9.85	812.9	2146.28	341.52	345.27	25.99	1068.92	805.97				0	777.64	8615.97	5626.15					4.45			1.95	1100		0					85.7	0.52	30444.95	0	0	0	0				150 per day (1-5)	150 per day (1-5)	0 per day (1-6) 25 per day (7-25)	0	50	0	0	25	100				0	0-50	0	Oct-50					0			0	0							150 per day (1-5)	150 per day (1-5)	0	0	0	0	0				102.03	102.03	11.59	0	50	0	0	25	100				0	9.1	0	7.83					0			0	0		0					102.03	102.03	0	0	0	0	0					102.03	102.03	11.59	0	50	0	0	25	100				0	9.1	0	7.83					0			0	0		0					102.03	102.03	0	0	0	0	0				0	13.85	0.08	0.78	-	1.42	-	-	2.23	6.72	-	-	-	-	0.59	-	3.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.73	0	-	-	-	-	-	-	-	-	30.07	13.85	0.08	0.78	-	1.42	-	-	2.23	6.72	-	-	-	-	0.59	-	3.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.73	0	-	-	-	-	-	-	-	-	30.07
H1019_005_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1485.99	8.5	769.99	1828.4	310.55	485.19	36.52	728.28	547.02				3.07	757.02	7340.24	4792.86					4.45			1.95	1100		0					78.21	0.45	11860.36	0	0	0	0				0 per day (1-7)	0 per day (1-7)	0 per day (1-6) 25 per day (7-25)	0	50	0	0	0-25	0				0	0	0	0					0			0	0							0 per day (1-7)	0 per day (1-7)	0	0	0	0	0				0	0	11.59	0	50	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0					0	0	11.59	0	50	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0				0	-	-	0.74	-	1.29	-	-	1.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.25	-	-	0.74	-	1.29	-	-	1.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.25
H1019_006_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2149.91	12.3	1114.02	2735.96	451.04	726.02	54.65	1057.76	794.49				4.6	1099.5	10983.73	7171.9					4.45			1.95	1100		0					113.15	0.65	17747.51	0	0	0	0				0 per day (1-90)	0 per day (1-90)	0 per day (1-6) 25 per day (7-25)	0	50	0	0	0-25	0				0	0	0	0					0			0	0							0 per day (1-90)	0 per day (1-90)	0	0	0	0	0				0	0	11.59	0	50	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0					0	0	11.59	0	50	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0				0	-	-	1.08	-	1.88	-	-	1.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.72	-	-	1.08	-	1.88	-	-	1.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.72
H1019_007_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1984.82	12	1981.69	2616.1	416.27	420.85	31.68	1302.9	982.4				0	947.87	10502.01	6857.71					4.45			1.95	1100		0					104.46	0.63	37109.35	0	0	0	0				0 per day (1-90)	0 per day (1-90)	0 per day (1-0) 0 per day (1-100)	0	0	0	0	25-50	0				0	0	0	0					0			0	0							250 per day (1-5)	0 per day (1-90)	0	0	0	0	0				0	0	0	0	0	0	0	45	0				0	0	0	0					0			0	0		0					170.05	0	0	0	0	0	0					0	0	0	0	0	0	0	45	0				0	0	0	0					0			0	0		0					170.05	0	0	0	0	0	0				0	-	-	-	-	-	-	-	4.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.48	-	-	-	-	-	-	-	-	-	6.37	-	-	-	-	-	-	-	4.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.48	-	-	-	-	-	-	-	-	-	6.37
H1019_008_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2443.1	13.97	1265.94	3090.92	512.2	820.22	61.74	1201.19	902.23				5.2	1248.59	12408.76	8102.38					4.45			1.95	1100		0					128.58	0.74	20050.07	0	0	0	0				0 per day (1-90)	0 per day (1-90)	0 per day (1-0) 0 per day (1-100)	0	0	0	0	0-50	0				0	0	0	0					0			0	0							0 per day (1-90)	0 per day (1-90)	0	0	0	0	0				0	0	0	0	0	0	0	40	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0					0	0	0	0	0	0	0	40	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0				0	-	-	-	-	-	-	-	4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4	-	-	-	-	-	-	-	4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4
H1019_010_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1464.04	10.49	1295.23	2262.21	313.72	116.76	8.79	1224.08	840.97				0	1082.78	9083.37	5929.45					4.45			1.95	1100		0					77.05	0.55	14352.56	0	0	0	0				25 per day (1-7)	25 per day (1-7)	0 per day (1-4) 25 per day (5-25)	0	75	0	0	25-50	0-50				0	0-10	0	0-10					0			0	0							25 per day (1-7)	25 per day (1-7)	0	0	0	0	0				5.31	19.49	4.45	0	75	0	0	45	16.5				0	0.4	0	1.44					0			0	0		0					19.49	19.49	0	0	0	0	0					5.31	19.49	4.45	0	75	0	0	45	16.5				0	0.4	0	1.44					0			0	0		0					19.49	19.49	0	0	0	0	0				0	0.65	0.02	0.48	-	1.96	-	-	4.59	1.16	-	-	-	-	0.04	-	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.13	0	-	-	-	-	-	-	-	-	9.72	0.65	0.02	0.48	-	1.96	-	-	4.59	1.16	-	-	-	-	0.04	-	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.13	0	-	-	-	-	-	-	-	-	9.72
H1019_011_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1212.38	8.69	1072.6	1817.06	259	93.78	7.06	1010.58	694.3				0	893.93	7295.96	4762.67					4.45			1.95	1100		0					63.81	0.46	11528.28	0	0	0	0				150 per day (1-7)	150 per day (1-7)	0 per day (1-4) 50 per day (5-25)	0	75	20	20	25-50	0-100				0	0-20	0	15-20					0			0	0							150 per day (1-7)	150 per day (1-7)	0	0	0	0	0				116.94	116.94	29.2	0	75	20	20	45	33				0	17	0	15.1					0			0	0		0					116.94	116.94	0	0	0	0	0					116.94	116.94	29.2	0	75	20	20	45	33				0	17	0	15.1					0			0	0		0					116.94	116.94	0	0	0	0	0				0	11.81	0.08	2.61	-	1.62	0.16	0.01	3.79	1.91	-	-	-	-	1.27	-	5.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.62	0	-	-	-	-	-	-	-	-	29.88	11.81	0.08	2.61	-	1.62	0.16	0.01	3.79	1.91	-	-	-	-	1.27	-	5.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.62	0	-	-	-	-	-	-	-	-	29.88
H1019_014_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1071.2	9.08	670.77	1845.16	189.15	1511.29	0.07	1086.09	1017.79				33.38	317.42	6565.71	3097.89					4.45			1.95	2200		0					56.38	0.48	12773.94	0	0	0	0				100 per day (1-5)	100 per day (1-5)	0 per day (1-6) 75 per day (7-25)	20	100	0	20	25-50	75-100				0	0-75	0	20-75					0			0	35-75							100 per day (1-5)	100 per day (1-5)	0	0	0	0	0				31.58	68.02	34.76	20	100	0	0.2	45	71.68				0	11.8	0	21.08					0			0	30		0					68.02	68.02	0	0	0	0	0					31.58	68.02	34.76	20	100	0	0.2	45	71.68				0	11.8	0	21.08					0			0	30		0					68.02	68.02	0	0	0	0	0				0	2.82	0.05	1.94	3.08	1.58	-	0.01	4.07	6.08	-	-	-	-	0.31	-	5.44	-	-	-	-	-	-	-	-	5.5	-	-	-	-	-	-	0.32	0	-	-	-	-	-	-	-	-	31.21	2.82	0.05	1.94	3.08	1.58	-	0.01	4.07	6.08	-	-	-	-	0.31	-	5.44	-	-	-	-	-	-	-	-	5.5	-	-	-	-	-	-	0.32	0	-	-	-	-	-	-	-	-	31.21
H1019_015_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1081.86	9.17	677.44	1863.52	191.03	1526.33	0.07	1096.9	1027.92				33.71	320.58	6631.04	3128.71					4.45			1.95	2200		0					56.94	0.48	12901.05	0	0	0	0				75 per day (1-5)	75 per day (1-5)	0 per day (1-6) 50 per day (7-25)	20	100	0	20	25-50	50-75				0	0-75	0	20-75					0			0	35-75							75 per day (1-5)	75 per day (1-5)	0	0	0	0	0				36.81	51.02	17.18	20	99.88	0	0.2	45	62.57				0	11.8	0	21.08					0			0	30		0					51.02	51.02	0	0	0	0	0					36.81	51.02	17.18	20	99.88	0	0.2	45	62.57				0	11.8	0	21.08					0			0	30		0					51.02	51.02	0	0	0	0	0				0	3.32	0.04	0.97	3.11	1.59	-	0.01	4.11	5.36	-	-	-	-	0.32	-	5.5	-	-	-	-	-	-	-	-	5.5	-	-	-	-	-	-	0.24	0	-	-	-	-	-	-	-	-	30.07	3.32	0.04	0.97	3.11	1.59	-	0.01	4.11	5.36	-	-	-	-	0.32	-	5.5	-	-	-	-	-	-	-	-	5.5	-	-	-	-	-	-	0.24	0	-	-	-	-	-	-	-	-	30.07
H1019_016_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1076.54	9.13	1348.23	1854.37	190.09	1518.83	0.07	1091.51	1022.87				33.54	319	6598.46	3113.34					4.45			1.95	2200		0					56.66	0.48	0	0	0	0	0				200 per day (1-7)	200 per day (1-7)	25 per day (1-9) 100 per day (10-100)	20	100	0	20	25-50	75-150				0	0-75	0-75	Oct-75					0			0 - 0	35-75							200 per day (1-7)	200 per day (1-7)	0	0	0	0	0				155.92	155.92	29.17	20	100	0	0.2	45	99.75				0	11.8	1.47	11.28					0			0	30		0					155.92	155.92	0	0	0	0	0					155.92	155.92	29.17	20	100	0	0.2	45	99.75				0	11.8	1.47	11.28					0			0	30		0					155.92	155.92	0	0	0	0	0				0	13.99	0.12	3.28	3.09	1.58	-	0.01	4.09	8.5	-	-	-	-	0.31	0.81	2.93	-	-	-	-	-	-	-	-	5.5	-	-	-	-	-	-	0.74	0.01	-	-	-	-	-	-	-	-	44.96	13.99	0.12	3.28	3.09	1.58	-	0.01	4.09	8.5	-	-	-	-	0.31	0.81	2.93	-	-	-	-	-	-	-	-	5.5	-	-	-	-	-	-	0.74	0.01	-	-	-	-	-	-	-	-	44.96
H1019_018_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1628.96	9.85	1626.4	2147.06	341.64	345.39	26	1069.31	806.26				0	777.92	8619.11	5628.2					4.45			1.95	1100		0					85.73	0.52	30456.05	0	0	0	0				150 per day (1-5)	150 per day (1-5)	0 per day (1-6) 25 per day (7-25)	0	50	0	0	25	100				0	0-50	0	20-50					0			0 - 0	0							150 per day (1-5)	150 per day (1-5)	0	0	0	0	0				102.03	102.03	5.79	0	50	0	0	25	100				0	9.1	0	20.59					0			0	0		0					102.03	102.03	0	0	0	0	0					102.03	102.03	5.79	0	50	0	0	25	100				0	9.1	0	20.59					0			0	0		0					102.03	102.03	0	0	0	0	0				0	13.85	0.08	0.79	-	1.42	-	-	2.23	6.72	-	-	-	-	0.59	-	9.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.73	0	-	-	-	-	-	-	-	-	36.07	13.85	0.08	0.79	-	1.42	-	-	2.23	6.72	-	-	-	-	0.59	-	9.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.73	0	-	-	-	-	-	-	-	-	36.07
H1019_019_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1307.58	7.48	1355.1	1524.08	271.63	404.43	30.44	637.01	478.47				2.56	662.15	6118.54	3995.14					4.45			1.95	1100		0					68.82	0.39	9886.33	0	0	0	0				0 per day (1-7)	0 per day (1-7)	0 per day (1-6) 25 per day (7-25)	0	50	0	0	0-25	0				0	0	0	0					0			0 - 0	0							0 per day (1-7)	0 per day (1-7)	0	0	0	0	0				0	0	5.79	0	50	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0					0	0	5.79	0	50	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0				0	-	-	0.65	-	1.13	-	-	1.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.85	-	-	0.65	-	1.13	-	-	1.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.85
H1019_020_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1312.15	9.4	2321.72	1901.85	279.4	98.16	7.39	1090.19	748.99				0	964.35	7636.43	4984.92					4.45			1.95	1100		0					69.06	0.49	12066.26	0	0	0	0				0 per day (1-90)	0 per day (1-90)	0 per day (1-4) 50 per day (5-25)	0	75	20	20	25-50	0-100				0	0-20	0	0-20					0			0 - 0	0							0 per day (1-90)	0 per day (1-90)	0	0	0	0	0				0	0	14.6	0	75	20	20	45	33				0	17	0	0.39					0			0	0		0					0	0	0	0	0	0	0					0	0	14.6	0	75	20	20	45	33				0	17	0	0.39					0			0	0		0					0	0	0	0	0	0	0				0	-	-	2.82	-	1.75	0.16	0.01	4.09	2.06	-	-	-	-	1.37	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.42	-	-	2.82	-	1.75	0.16	0.01	4.09	2.06	-	-	-	-	1.37	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.42
H1019_021_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				0	1132.7	8.12	2004.2	1641.75	241.19	84.73	6.38	941.09	646.56				0	832.46	6592.06	4303.17					4.45			1.95	1100		0					59.62	0.43	10416.06	0	0	0	0				150 per day (1-7)	150 per day (1-7)	0 per day (1-4) 50 per day (5-25)	0	75	20	20	25-50	25-100				0	0-20	0	20					0			0 - 0	0							150 per day (1-7)	150 per day (1-7)	0	0	0	0	0				116.94	116.94	14.6	0	75	20	20	45	49.75				0	17	0	20					0			0	0		0					116.94	116.94	0	0	0	0	0					116.94	116.94	14.6	0	75	20	20	45	49.75				0	17	0	20					0			0	0		0					116.94	116.94	0	0	0	0	0				0	11.04	0.08	2.44	-	1.51	0.14	0.01	3.53	2.68	-	-	-	-	1.18	-	7.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.58	0	-	-	-	-	-	-	-	-	30.36	11.04	0.08	2.44	-	1.51	0.14	0.01	3.53	2.68	-	-	-	-	1.18	-	7.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.58	0	-	-	-	-	-	-	-	-	30.36
H1019_022_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1136.18	9.63	1422.91	1957.09	200.62	1602.97	0.08	1151.97	1079.53				35.4	336.67	6963.99	3285.8					4.45			1.95	2200		0					59.8	0.51	13548.81	0	0	0	0				50 per day (1-7)	50 per day (1-7)	25 per day (1-9) 50 per day (10-100)	0	50	0	20	25-50	25-50				0	0-50	0	0-50					0			0 - 0	35-75							50 per day (1-7)	50 per day (1-7)	0	0	0	0	0				38.98	38.98	18.06	0	50	0	0.2	45	33.25				0	10.1	0	0.98					0			0	30		0					38.98	38.98	0	0	0	0	0					38.98	38.98	18.06	0	50	0	0.2	45	33.25				0	10.1	0	0.98					0			0	30		0					38.98	38.98	0	0	0	0	0				0	3.69	0.03	2.14	-	0.84	-	0.02	4.32	2.99	-	-	-	-	0.28	-	0.27	-	-	-	-	-	-	-	-	5.5	-	-	-	-	-	-	0.19	0	-	-	-	-	-	-	-	-	20.27	3.69	0.03	2.14	-	0.84	-	0.02	4.32	2.99	-	-	-	-	0.28	-	0.27	-	-	-	-	-	-	-	-	5.5	-	-	-	-	-	-	0.19	0	-	-	-	-	-	-	-	-	20.27
H1026_001_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T	O		V	V					V	V	V	V	V		V	S											V	V	O	V	V																																																-	1982.31	36.03	1310.26		219.15	20.64		257.21	393.74					1073.3	2980.91	2836.07	53.23	18.84		366.36	47.5											1.63	0.34	32.39	409.1	0						250 for 1st 5 days	250 for 1st 5 days	100 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary																					166.99	167.08	53.95		100	500		50	250					70	15	30	30	30		30	20.55											25	30	5	100	30							166.99	167.08	53.95		100	500		50	250					70	15	30	30	30		30	20.55											25	30	5	100	30							27.59	0.5	5.89	-	1.83	0.86	-	1.07	8.2	-	-	-	-	6.26	3.73	7.09	0.13	0.05	-	0.92	0.08	-	-	-	-	-	-	-	-	-	-	0	0	0.01	3.41	-	-	-	-	-	-	67.62	27.59	0.5	5.89	-	1.83	0.86	-	1.07	8.2	-	-	-	-	6.26	3.73	7.09	0.13	0.05	-	0.92	0.08	-	-	-	-	-	-	-	-	-	-	0	0	0.01	3.41	-	-	-	-	-	-	67.62
H1026_002_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T	O		V	V					V	V	V	V	V		V	S											V	V	O	V	V																																																-	1745.69	28.46	728.3		129.15	16.65		183.82	557.98					1073.3	2233.47	1740.51	33.07	12.84		414.11	38.64											1.03	0	52.01	244.86	0						250 for 1st 5 days	250 for 1st 5 days	100 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary																					159.57	160.12	67.03		100	500		50	250					80	15	30	30	30		30	21.33											25	30	5	100	30							159.57	160.12	67.03		100	500		50	250					80	15	30	30	30		30	21.33											25	30	5	100	30							23.21	0.38	4.07	-	1.08	0.69	-	0.77	11.62	-	-	-	-	7.16	2.79	4.35	0.08	0.03	-	1.04	0.07	-	-	-	-	-	-	-	-	-	-	0	-	0.02	2.04	-	-	-	-	-	-	59.4	23.21	0.38	4.07	-	1.08	0.69	-	0.77	11.62	-	-	-	-	7.16	2.79	4.35	0.08	0.03	-	1.04	0.07	-	-	-	-	-	-	-	-	-	-	0	-	0.02	2.04	-	-	-	-	-	-	59.4
H1026_004_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T	O		V	V					V	V	V	V	V		V	S											V	V	O	V	V																																																-	1720.69	20.06	1252.69		145.02	13.81		214.2	389.93					1073.3	2967.7	2736.01	34.6	14.03		435.85	48.35											1.67	0.4	79.82	412.91	0						250 for 1st 5 days	250 for 1st 5 days	100 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary																					168.46	170.37	60.35		100	500		50	250					75	15	30	30	30		30	20.76											25	30	5	100	30							168.46	170.37	60.35		100	500		50	250					75	15	30	30	30		30	20.76											25	30	5	100	30							24.16	0.28	6.3	-	1.21	0.58	-	0.89	8.12	-	-	-	-	6.71	3.71	6.84	0.09	0.04	-	1.09	0.08	-	-	-	-	-	-	-	-	-	-	0	0	0.03	3.44	-	-	-	-	-	-	63.57	24.16	0.28	6.3	-	1.21	0.58	-	0.89	8.12	-	-	-	-	6.71	3.71	6.84	0.09	0.04	-	1.09	0.08	-	-	-	-	-	-	-	-	-	-	0	0	0.03	3.44	-	-	-	-	-	-	63.57
H1026_008_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T	O		V	V					V	V	V	V	V		V	S											V	V	O	V	V																																																-	1982.31	36.03	1310.26		219.15	20.64		257.21	393.74					1073.3	2980.91	2836.07	53.23	18.84		366.36	47.5											1.63	0.34	32.39	409.1	0						250 for 1st 5 days	250 for 1st 5 days	100 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary																					166.99	167.08	53.95		100	500		50	250					70	15	30	30	30		30	20.55											25	30	5	100	30							166.99	167.08	53.95		100	500		50	250					70	15	30	30	30		30	20.55											25	30	5	100	30							27.59	0.5	5.89	-	1.83	0.86	-	1.07	8.2	-	-	-	-	6.26	3.73	7.09	0.13	0.05	-	0.92	0.08	-	-	-	-	-	-	-	-	-	-	0	0	0.01	3.41	-	-	-	-	-	-	67.62	27.59	0.5	5.89	-	1.83	0.86	-	1.07	8.2	-	-	-	-	6.26	3.73	7.09	0.13	0.05	-	0.92	0.08	-	-	-	-	-	-	-	-	-	-	0	0	0.01	3.41	-	-	-	-	-	-	67.62
H1026_009_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T	O		V	V					V	V	V	V	V		V	S											V	V	O	V	V																																																-	1745.69	28.46	728.3		129.15	16.65		183.82	557.98					1073.3	2233.47	1740.51	33.07	12.84		414.11	38.64											1.03	0	52.01	244.86	0						250 for 1st 5 days	250 for 1st 5 days	100 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary																					159.57	160.12	67.03		100	500		50	250					80	15	30	30	30		30	21.33											25	30	5	100	30							159.57	160.12	67.03		100	500		50	250					80	15	30	30	30		30	21.33											25	30	5	100	30							23.21	0.38	4.07	-	1.08	0.69	-	0.77	11.62	-	-	-	-	7.16	2.79	4.35	0.08	0.03	-	1.04	0.07	-	-	-	-	-	-	-	-	-	-	0	-	0.02	2.04	-	-	-	-	-	-	59.4	23.21	0.38	4.07	-	1.08	0.69	-	0.77	11.62	-	-	-	-	7.16	2.79	4.35	0.08	0.03	-	1.04	0.07	-	-	-	-	-	-	-	-	-	-	0	-	0.02	2.04	-	-	-	-	-	-	59.4
H1026_011_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T	O		V	V					V	V	V	V	V		V	S											V	V	O	V	V																																																-	1720.69	20.06	1252.69		145.02	13.81		214.2	389.93					1073.3	2967.7	2736.01	34.6	14.03		435.85	48.35											1.67	0.4	79.82	412.91	0						250 for 1st 5 days	250 for 1st 5 days	100 for days 7-25		0	0		ER	outpatient facility					non-surgical outpatient visit	0	0	0	0		0	15 generic 30 formulary 50 non-formulary											0	0	0	0	0						168.46	170.37	60.35		100	500		50	250					75	15	30	30	30		30	20.76											25	30	5	100	30							168.46	170.37	60.35		100	500		50	250					75	15	30	30	30		30	20.76											25	30	5	100	30							24.16	0.28	6.3	-	1.21	0.58	-	0.89	8.12	-	-	-	-	6.71	3.71	6.84	0.09	0.04	-	1.09	0.08	-	-	-	-	-	-	-	-	-	-	0	0	0.03	3.44	-	-	-	-	-	-	63.57	24.16	0.28	6.3	-	1.21	0.58	-	0.89	8.12	-	-	-	-	6.71	3.71	6.84	0.09	0.04	-	1.09	0.08	-	-	-	-	-	-	-	-	-	-	0	0	0.03	3.44	-	-	-	-	-	-	63.57
H1026_025_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T			V	V					V	V	V	V	V		V	S			V		V						V	V	O	V	V																																																-	1982.31	36.03	1310.26		219.15			257.21	393.74					1073.3	2980.91	2836.07	53.23	18.84		366.36	47.5			464		427.5						1.63	0.34	32.39	409.1	0						200 for 1st 5 days	200 for 1st 5 days	50 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary			A range of copays for a range of services constituting comprehensive coverage		50 copay for progressive lenses																133.59	133.67	26.98		100			50	250					50	15	30	30	30		30	20.55			57.16		50						25	30	5	100	30							133.59	133.67	26.98		100			50	250					50	15	30	30	30		30	20.55			57.16		50						25	30	5	100	30							22.07	0.4	2.95	-	1.83	-	-	1.07	8.2	-	-	-	-	4.47	3.73	7.09	0.13	0.05	-	0.92	0.08	-	-	2.21	-	1.78	-	-	-	-	-	0	0	0.01	3.41	-	-	-	-	-	-	60.4	22.07	0.4	2.95	-	1.83	-	-	1.07	8.2	-	-	-	-	4.47	3.73	7.09	0.13	0.05	-	0.92	0.08	-	-	2.21	-	1.78	-	-	-	-	-	0	0	0.01	3.41	-	-	-	-	-	-	60.4
H1026_026_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T			V	V					V	V	V	V	V		V	S			V		V						V	V	O	V	V																																																-	1745.69	28.46	728.3		129.15			183.82	557.98					1073.3	2233.47	1740.51	33.07	12.84		414.11	38.64			464		427.5						1.03	0	52.01	244.86	0						200 for 1st 5 days	200 for 1st 5 days	50 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary			A range of copays for a range of services constituting comprehensive coverage		50 copay for progressive lenses																127.65	128.1	33.52		100			50	250					50	15	30	30	30		30	21.33			57.16		50						25	30	5	100	30							127.65	128.1	33.52		100			50	250					50	15	30	30	30		30	21.33			57.16		50						25	30	5	100	30							18.57	0.3	2.03	-	1.08	-	-	0.77	11.62	-	-	-	-	4.47	2.79	4.35	0.08	0.03	-	1.04	0.07	-	-	2.21	-	1.78	-	-	-	-	-	0	-	0.02	2.04	-	-	-	-	-	-	53.26	18.57	0.3	2.03	-	1.08	-	-	0.77	11.62	-	-	-	-	4.47	2.79	4.35	0.08	0.03	-	1.04	0.07	-	-	2.21	-	1.78	-	-	-	-	-	0	-	0.02	2.04	-	-	-	-	-	-	53.26
H1026_027_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T			V	V					V	V	V	V	V		V	S			V		V						V	V	O	V	V																																																-	1720.69	20.06	1252.69		145.02			214.2	389.93					1073.3	2967.7	2736.01	34.6	14.03		435.85	48.35			464		427.5						1.67	0.4	79.82	412.91	0						200 for 1st 5 days	200 for 1st 5 days	50 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary			A range of copays for a range of services constituting comprehensive coverage		50 copay for progressive lenses																134.77	136.29	30.17		100			50	250					50	15	30	30	30		30	20.76			57.16		50						25	30	5	100	30							134.77	136.29	30.17		100			50	250					50	15	30	30	30		30	20.76			57.16		50						25	30	5	100	30							19.32	0.23	3.15	-	1.21	-	-	0.89	8.12	-	-	-	-	4.47	3.71	6.84	0.09	0.04	-	1.09	0.08	-	-	2.21	-	1.78	-	-	-	-	-	0	0	0.03	3.44	-	-	-	-	-	-	56.71	19.32	0.23	3.15	-	1.21	-	-	0.89	8.12	-	-	-	-	4.47	3.71	6.84	0.09	0.04	-	1.09	0.08	-	-	2.21	-	1.78	-	-	-	-	-	0	0	0.03	3.44	-	-	-	-	-	-	56.71
H1026_028_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T			V	V					V	V	V	V	V		V	S			V		V						V	V	O	V	V																																																-	1982.31	36.03	1310.26		219.15			257.21	393.74					1073.3	2980.91	2836.07	53.23	18.84		366.36	47.5			464		427.5						1.63	0.34	32.39	409.1	0						200 for 1st 5 days	200 for 1st 5 days	50 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary			A range of copays for a range of services constituting comprehensive coverage		50 copay for progressive lenses																133.59	133.67	26.98		100			50	250					50	15	30	30	30		30	20.55			57.16		50						25	30	5	100	30							133.59	133.67	26.98		100			50	250					50	15	30	30	30		30	20.55			57.16		50						25	30	5	100	30							22.07	0.4	2.95	-	1.83	-	-	1.07	8.2	-	-	-	-	4.47	3.73	7.09	0.13	0.05	-	0.92	0.08	-	-	2.21	-	1.78	-	-	-	-	-	0	0	0.01	3.41	-	-	-	-	-	-	60.4	22.07	0.4	2.95	-	1.83	-	-	1.07	8.2	-	-	-	-	4.47	3.73	7.09	0.13	0.05	-	0.92	0.08	-	-	2.21	-	1.78	-	-	-	-	-	0	0	0.01	3.41	-	-	-	-	-	-	60.4
H1026_029_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T			V	V					V	V	V	V	V		V	S			V		V						V	V	O	V	V																																																-	1745.69	28.46	728.3		129.15			183.82	557.98					1073.3	2233.47	1740.51	33.07	12.84		414.11	38.64			0		1758.98						1.03	0	52.01	244.86	0						200 for 1st 5 days	200 for 1st 5 days	50 for days 7-25					ER	outpatient facility					non-surgical outpatient visit							15 generic 30 formulary 50 non-formulary			A range of copays for a range of services constituting comprehensive coverage		50 copay for progressive lenses																127.65	128.1	1817		100			50	250					50	15	30	30	30		30	21.33			2.21		50						25	30	5	100	30							127.65	128.1	1817		100			50	250					50	15	30	30	30		30	21.33			2.21		50						25	30	5	100	30							18.57	0.3	110.28	-	1.08	-	-	0.77	11.62	-	-	-	-	4.47	2.79	4.35	0.08	0.03	-	1.04	0.07	-	-	-	-	7.33	-	-	-	-	-	0	-	0.02	2.04	-	-	-	-	-	-	164.84	18.57	0.3	110.28	-	1.08	-	-	0.77	11.62	-	-	-	-	4.47	2.79	4.35	0.08	0.03	-	1.04	0.07	-	-	-	-	7.33	-	-	-	-	-	0	-	0.02	2.04	-	-	-	-	-	-	164.84
H1026_030_0	2006	OP Facility - Emergency	OP Facility - Other	Professional - Other	OP Facility - Surgery	OP Facility - Other							Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab						D	D	D		T			V	V					V	V	V	V	V		V	S			V		V						V	V	O	V	V																																																-	1720.69	20.06	1252.69		145.02			214.2	389.93					1073.3	2967.7	2736.01	34.6	14.03		435.85	48.35			464		427.5						1.67	0.4	79.82	412.91	0						200 for 1st 5 days	200 for 1st 5 days	50 for days 7-25		0			ER	outpatient facility					non-surgical outpatient visit	0	0	0	0		0	15 generic 30 formulary 50 non-formulary			A range of copays for a range of services constituting comprehensive coverage		50 copay for progressive lenses																134.77	136.29	30.17		100			50	250					50	15	30	30	30		30	20.76			57.16		50						25	30	5	100	30							134.77	136.29	30.17		100			50	250					50	15	30	30	30		30	20.76			57.16		50						25	30	5	100	30							19.32	0.23	3.15	-	1.21	-	-	0.89	8.12	-	-	-	-	4.47	3.71	6.84	0.09	0.04	-	1.09	0.08	-	-	2.21	-	1.78	-	-	-	-	-	0	0	0.03	3.44	-	-	-	-	-	-	56.71	19.32	0.23	3.15	-	1.21	-	-	0.89	8.12	-	-	-	-	4.47	3.71	6.84	0.09	0.04	-	1.09	0.08	-	-	2.21	-	1.78	-	-	-	-	-	0	0	0.03	3.44	-	-	-	-	-	-	56.71
H1032_002_0	2006											2000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1395.94	27.29	593.84	268.79	196.55	3.46	2.44	269.84	294.95	1658.85	816		470.18	505.65	6264.34	10317.86	174.91	681.35	2965.24	10606.07	9.07	597.4		73.93	456.45	309.32	29.92	3.17		319.28	2.66											100 for 1st 5 days	100 for 1st 5 days	50 for days 15 - 100				20	25 to 50	50 to 100	0			0		0 to 20	25 to 20	0 to 25		0 to 75	0 to 25	0 - 20		Not Covered							0	50											75.11	65.27	10.96	10	100	0	0.2	49.71	90.34	0	50	0	0	25	2.12	11.81	6.83	25	8.42	9.25	0.17	25	0	10	10	10	10	0	0	0	50											none	65.14	65.14	10.55	10	100	0	0.2	49.38	90	0	50		0	25	1.11	10.14	6.8	25	7.94	7.53	0.17	25	0	10	10	10	10	0		0	50												7.58	0.15	0.52	0.22	1.64	-	0.49	1.11	2.21	-	3.4	-	-	1.05	0.58	8.72	0.1	1.42	1.96	6.66	1.54	1.24	-	0.06	0.38	0.26	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	41.33	7.58	0.15	0.52	0.22	1.64	-	0.49	1.11	2.21	-	3.4	-	-	1.05	0.58	8.72	0.1	1.42	1.96	6.66	1.54	1.24	-	0.06	0.38	0.26	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	41.33
H1032_004_0	2006											2000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1713.06	33.49	724.7	314.94	180.36	3.82	2.7	357.61	310.05	1583.27	778.82		448.76	482.61	5575.35	9183.04	155.67	606.41	2639.1	9439.55	7.51	287.54		70	473.88	321.12	20.64	2.19		318.82	3.47											100 for 1st 5 days	100 for 1st 5 days	50 for days 15 - 100				20	25 to 50	50 to 100	0			0		0 to 20	25 to 20	0 to 25		0 to 75	0 to 25	0 - 20		Not Covered							0	50											75.91	65.29	11.01	10	100	0	0.2	50	90.34	0	50	0	0	25	1.76	11.48	6.95	25	8.31	9.01	0.17	25	0	10	10	10	10	0	0	0	50											none	65.14	65.14	10.55	10	100	0	0.2	49.38	90	0	50		0	25	0.98	10.19	6.95	25	7.94	7.68	0.17	25	0	10	10	10	10	0		0	50												9.3	0.18	0.64	0.26	1.5	-	0.54	1.47	2.33	-	3.25	-	-	1.01	0.45	7.8	0.09	1.26	1.75	6.04	1.28	0.6	-	0.06	0.39	0.27	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	40.5	9.3	0.18	0.64	0.26	1.5	-	0.54	1.47	2.33	-	3.25	-	-	1.01	0.45	7.8	0.09	1.26	1.75	6.04	1.28	0.6	-	0.06	0.39	0.27	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	40.5
H1032_006_0	2006											2000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1533.32	29.98	530.52	341.94	169.32	3.52	2.48	263.48	283.99	1582.37	778.38		448.5	482.33	6911.41	11383.64	192.97	751.72	3271.53	11701.62	7.76	666.86		72.83	455.58	308.73	15.38	1.63		323.51	2.7											100 for 1st 5 days	100 for 1st 5 days	50 for days 15 - 100				20	25 to 50	50 to 100						0 to 20	25 to 20	0 to 25		0 to 75	0 to 25	0 to 20																					75.15	65.28	10.92	10	100	0	0.2	49.84	90.29	0	50	0	0	25	1.99	11.65	6.78	25	8.41	9.18	0.17	25	0	10	10	10	10	0	0	0	50											none	65.14	65.14	10.55	10	100	0	0.2	49.38	90	0	50		0	25	0.99	10.01	6.75	25	7.94	7.48	0.17	25	0	10	10	10	10	0		0	50												8.32	0.16	0.47	0.28	1.41	-	0.5	1.08	2.13	-	3.24	-	-	1	0.57	9.49	0.11	1.57	2.16	7.3	1.32	1.39	-	0.06	0.38	0.26	0.01	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	43.24	8.32	0.16	0.47	0.28	1.41	-	0.5	1.08	2.13	-	3.24	-	-	1	0.57	9.49	0.11	1.57	2.16	7.3	1.32	1.39	-	0.06	0.38	0.26	0.01	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	43.24
H1032_008_0	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1910.31	37.35	663.07	261.51	256.9	3.55	2.5	244.99	231.73	1507.42	741.51		427.26	459.49	6382.02	10511.7	228.43	889.85	3872.66	13851.74	14.41	577.82		71.41	481.2	326.09	40.2	4.26		344.22	2.49											0	0	0	0	0	0	0		35	0	35		35		0 - 20	0 - 20		0			0 to 20	0	Not Covered	0	0	0	0			0	0											0	0	0	0	0	0	0	0	35	0	35	0	35	0	1.41	1.04	0	0	0	0	0.17	0	0	10	0	0	0	0	0	0	0											none	0	0	0	0	0	0	0	0	35	0	35		35	0	1.41	1.04	0	0	0	0	0.17	0	0	10	0	0	0	0		0	0												-	-	-	-	-	-	-	-	0.68	-	2.16	-	1.25	-	0.75	0.91	-	-	-	-	2.45	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.25	-	-	-	-	-	-	-	-	0.68	-	2.16	-	1.25	-	0.75	0.91	-	-	-	-	2.45	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.25
H1032_010_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1375.71	26.9	843.02	1115.27	193.06	2.65	1.87	235.9	205.08	1520.54	747.97		430.98	463.49	7665.3	12625.35	214.02	833.72	3628.39	12978.02	7.78	2535.18		69.5	422.2	286.1	99.15	10.52		387.19	1.76											50 for 1st 5 days	50 for 1st 5 days	50 for days 8 - 100					20 to 50	50 to 150						0 to 20	20 to 20	5 to 20		0 to 50	0 to 20	0 to 20																					39.05	32.65	24.24	0	100	0	0.2	49.43	135.33	0	100	0	0	20	1.42	8.7	9.02	20	6.22	6.88	0.17	20	0	10	10	10	10	0	0	0	50											none	32.57	32.57	23.9	0	100	0	0.2	49.26	135	0	100		0	20	0.86	7.78	9	20	5.96	5.93	0.17	20	0	10	10	10	10	0		0	50												3.73	0.07	1.68	-	1.61	-	0.37	0.97	2.31	-	6.23	-	-	0.77	0.55	8.18	0.16	1.39	1.8	6.42	1.32	4.23	-	0.06	0.35	0.24	0.08	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	42.53	3.73	0.07	1.68	-	1.61	-	0.37	0.97	2.31	-	6.23	-	-	0.77	0.55	8.18	0.16	1.39	1.8	6.42	1.32	4.23	-	0.06	0.35	0.24	0.08	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	42.53
H1032_012_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1599.17	31.26	547.76	199.07	169.79	3.52	2.48	265.53	229.54	1338.43	658.38		379.36	407.97	5798.54	9550.66	161.9	630.68	2744.75	9817.43	6.35	587.44		72.83	461.3	312.6	19.89	2.11		333.07	2.64											100 for 1st 5 days	100 for 1st 5 days	75 days 8 to 100	10			20	25 to 50	50 to 150	0					5 to 20	30 to 20	5 to 30		0 to 75	0 to 30	0 -20		Not Covered							0	50											71.6	65.23	36.12	10	100	0	0.2	49.65	135.2	0	100	0	0	30	3.64	12.85	11.8	30	10.2	9.83	0.17	30	0	10	10	10	10	0	0	0	50											none	65.14	65.14	35.85	10	100	0	0.2	49.38	135	0	100		0	30	3.06	11.89	11.8	30	9.93	8.84	0.17	30	0	10	10	10	10	0		0	50												8.68	0.17	1.64	0.17	1.41	-	0.5	1.09	2.58	-	5.49	-	-	1.02	1.48	9.46	0.16	1.58	2.27	7.23	1.08	1.47	-	0.06	0.38	0.26	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	48.2	8.68	0.17	1.64	0.17	1.41	-	0.5	1.09	2.58	-	5.49	-	-	1.02	1.48	9.46	0.16	1.58	2.27	7.23	1.08	1.47	-	0.06	0.38	0.26	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	48.2
H1032_014_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1505.99	29.44	891.38	306.82	174.24	3.43	2.42	249.6	217.62	1396.43	686.92		395.8	425.66	5841.61	9621.59	163.1	635.37	2765.14	9890.35	6.99	706.35		72.83	466.38	316.04	16.05	1.7		336.74	2.67											50 for 1st 5 days	50 for 1st 5 days	50 for days 8 - 100				20	25 to 50	25 to 50						0 to 20	20 - 20	0 to 20		0 to 75	0 to 20	0 - 20																					38.93	32.66	24.3	10	100	0	0.2	49.62	47.71	0	50	0	0	20	1.53	9.1	5.57	20	6.23	7.22	0.17	20	0	10	10	10	10	0	0	0	50											none	32.57	32.57	23.9	10	100	0	0.2	49.38	47.5	0	50		0	20	0.94	8.14	5.55	20	5.96	6.23	0.17	20	0	10	10	10	10	0		0	50												4.09	0.08	1.78	0.26	1.45	-	0.48	1.03	0.86	-	2.86	-	-	0.71	0.46	6.53	0.08	1.06	1.37	5.14	1.19	1.18	-	0.06	0.39	0.26	0.01	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	31.33	4.09	0.08	1.78	0.26	1.45	-	0.48	1.03	0.86	-	2.86	-	-	0.71	0.46	6.53	0.08	1.06	1.37	5.14	1.19	1.18	-	0.06	0.39	0.26	0.01	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	31.33
H1032_019_0	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	Coin		V	V	V	V	V		V	V											none																																										-	1126.94	22.03	571.68	410.05	112.84	3.97	2.8	250.23	348.94	1239.16	609.55		351.22	377.72	6105.36	10056.02	170.47	664.05	2889.99	10336.91	6.3	3.13		71.41	450.42	305.23	18.47	1.96		331.69	2.63											0	0	0	0	0	0	20	25 to 50	35	0	35		35	0 - 0	0 - 20	0 - 20	0 - 0	0	0 to 50	0 to 10	0 -20	0	Not Covered							0	0											0	0	0	0	0	0	0.2	49.38	35	0	35	0	35	0	0.96	0.71	0	0	0	0.53	0.17	0	0	10	10	10	10	0	0	0	50											none	0	0	0	0	0	0	0.2	49.38	35	0	35		35	0	0.96	0.71	0	0	0	0.53	0.17	0	0	10	10	10	10	0		0	50												-	-	-	-	-	-	0.56	1.03	1.02	-	1.78	-	1.02	-	0.49	0.6	-	-	-	0.46	1.07	-	-	0.06	0.38	0.25	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	8.74	-	-	-	-	-	-	0.56	1.03	1.02	-	1.78	-	1.02	-	0.49	0.6	-	-	-	0.46	1.07	-	-	0.06	0.38	0.25	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	8.74
H1032_021_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1709.13	33.41	751.7	304.75	188.94	5	3.53	283.69	402.3	1458.03	717.22		413.26	444.43	6755.6	11127.01	188.62	734.78	3197.78	11437.82	6.99	223.29		72.83	469.77	318.34	20.93	2.22		339.19	2.69											100 for 1st 5 days	100 for 1st 5 days	75 for days 8 - 100				20	25 to 50	50 - 150						5 to 20	30 to 20	5 to 30		0 to 75	0 to 30	0 - 20																					71.44	65.23	36.15	10	100	0	0.2	49.6	135.27	0	100	0	0	30	3.67	12.84	11.77	30	10.21	9.81	0.17	30	0	10	10	10	10	0	0	0	50											none	65.14	65.14	35.85	10	100	0	0.2	49.38	135	0	100		0	30	3.07	11.85	11.75	30	9.93	8.79	0.17	30	0	10	10	10	10	0		0	50												9.28	0.18	2.25	0.25	1.57	-	0.71	1.17	4.53	-	5.98	-	-	1.11	1.73	10.98	0.18	1.84	2.64	8.37	1.19	0.56	-	0.06	0.39	0.27	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	55.26	9.28	0.18	2.25	0.25	1.57	-	0.71	1.17	4.53	-	5.98	-	-	1.11	1.73	10.98	0.18	1.84	2.64	8.37	1.19	0.56	-	0.06	0.39	0.27	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	55.26
H1032_025_0	2006											2500											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1300.76	25.43	739.74	1617.95	410.78	1.87	1.32	431.94	433.41	2599.43	1278.68		736.77	792.35	4186.35	6895.26	116.89	455.33	1981.62	7087.86	8.56	2205.77		79.5	396.85	268.92	173.31	18.39		298	2.59											150 for 1st 5 days	150 for 1st 5 days	100 for days 10 - 30				20	25 to 50					0 - 25		20 to 10	20 to 25	25-Oct		0 to 75	0 - 25	0 - 20									0 to 20												106.53	97.84	38.37	10	100	0.2	0.2	49.49	150	5	150	0	7.66	25	5.8	11.08	13.77	25	10.2	8.56	0.17	25	0	10	20	0	20	0	0	1.76	50											none	97.72	97.72	37.74	10	100	0.2	0.2	49.38	150	5	150		7.5	25	5.21	10.11	13.75	25	9.93	7.57	0.17	25	0	10	20	0	20	0		1.74	50												10.59	0.21	2.33	1.35	3.42	0.37	0.26	1.78	5.42	1.08	15.98	-	0.46	1.65	1.82	5.81	0.13	0.95	1.64	4.47	1.46	4.6	-	0.07	0.66	-	0.29	-	-	0.04	0.01	-	-	-	-	-	-	-	-	-	-	66.85	10.59	0.21	2.33	1.35	3.42	0.37	0.26	1.78	5.42	1.08	15.98	-	0.46	1.65	1.82	5.81	0.13	0.95	1.64	4.47	1.46	4.6	-	0.07	0.66	-	0.29	-	-	0.04	0.01	-	-	-	-	-	-	-	-	-	-	66.85
H1032_028_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1262.35	24.68	467.31	221.47	173.24	3.44	2.43	252.55	260.88	1502.13	738.91		425.76	457.87	6388.94	10523.09	178.39	694.9	3024.22	10817.03	8.23	672.58		74.42	459.47	311.36	29.15	3.09		319.28	2.66											150 for 1st 5 days	150 for 1st 5 days	50 for days 8 - 100				20	25 to 50	50 to 150						0 to 20	20 to 25	0 to 25		0 to 75	0 to 25	0 to 20																					98.07	97.72	23.91	10	100	0	0.2	49.39	135	0	100	0	0	25	1.15	10.21	5	25	7.96	7.6	0.17	25	0	10	10	10	10	0	0	0	50											none	97.72	97.72	23.9	10	100	0	0.2	49.38	135	0	100		0	25	1.11	10.14	5	25	7.94	7.53	0.17	25	0	10	10	10	10	0		0	50												10.28	0.2	0.93	0.18	1.44	-	0.49	1.04	2.93	-	6.16	-	-	0.95	0.59	8.89	0.07	1.45	2	6.79	1.4	1.4	-	0.06	0.38	0.26	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	47.95	10.28	0.2	0.93	0.18	1.44	-	0.49	1.04	2.93	-	6.16	-	-	0.95	0.59	8.89	0.07	1.45	2	6.79	1.4	1.4	-	0.06	0.38	0.26	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	47.95
H1032_029_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1511.3	29.55	585.27	260.07	151.83	3.47	2.45	329.48	283.59	1475.55	725.83		418.22	449.77	5264.05	8670.31	146.98	572.55	2491.75	8912.5	7.09	381.32		66.3	406.91	275.75	19.51	2.07		317.4	2.64											150 for 1st 5 days	150 for 1st 5 days	50 for days 8 - 100				20	25 to 50	50 to 150						0 to 20	20 to 25	0 to 25		0 to 75	0 to 25	0 to 20																					98.08	97.72	23.91	10	100	0	0.2	49.42	135	0	100	0	0	25	1	10.29	7	25	7.95	7.78	0.17	25	0	10	10	10	10	0	0	0	50											none	97.72	97.72	23.9	10	100	0	0.2	49.38	135	0	100		0	25	0.97	10.24	7	25	7.94	7.73	0.17	25	0	10	10	10	10	0		0	50												12.31	0.24	1.17	0.22	1.27	-	0.49	1.36	3.19	-	6.05	-	-	0.94	0.43	7.4	0.09	1.19	1.65	5.74	1.21	0.79	-	0.06	0.34	0.23	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	46.36	12.31	0.24	1.17	0.22	1.27	-	0.49	1.36	3.19	-	6.05	-	-	0.94	0.43	7.4	0.09	1.19	1.65	5.74	1.21	0.79	-	0.06	0.34	0.23	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	46.36
H1032_030_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1369.04	26.77	474.08	263.42	139.65	3.55	2.5	239.14	254.61	1436.26	706.51		407.09	437.8	6382.02	10511.7	178.19	694.15	3020.94	10805.32	7.2	790.44		68.37	427.71	289.84	18.56	1.97		323.51	2.7											150 for 1st 5 days	150 for 1st 5 days	50 for days 8 - 100				20	25 to 50	50 to 150						0 to 20	20 to 25	0 to 25		0 to 75	0 to 25	0 to 20																					98.07	97.72	23.91	10	100	0	0.2	49.4	135	0	100	0	0	25	1.03	10.12	6.8	25	7.96	7.6	0.17	25	0	10	10	10	10	0	0	0	50											none	97.72	97.72	23.9	10	100	0	0.2	49.38	135	0	100		0	25	0.99	10.06	6.8	25	7.94	7.53	0.17	25	0	10	10	10	10	0		0	50												11.15	0.22	0.94	0.22	1.16	-	0.5	0.98	2.86	-	5.89	-	-	0.91	0.53	8.81	0.1	1.45	2	6.78	1.22	1.65	-	0.06	0.36	0.24	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	48.06	11.15	0.22	0.94	0.22	1.16	-	0.5	0.98	2.86	-	5.89	-	-	0.91	0.53	8.81	0.1	1.45	2	6.78	1.22	1.65	-	0.06	0.36	0.24	0.02	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	48.06
H1032_031_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1171.22	24.33	783.35	1014.04	177.87	2.49	1.76	219.07	194.17	1414.88	695.99		401.03	431.28	6622.66	10908.05	184.91	720.32	3134.85	11212.74	7.4	2107.2		65.92	442.41	299.8	94.81	10.06		383.15	1.54											50 for 1st 5 days	50 for 1st 5 days	100 for days 8 - 100				20	25 to 50	50 to 150						0 to 20	20 to 30	15 to 30		0 to 75	0 to 30	0 to 20																					34.98	32.58	47.82	10	100	0	0.2	49.39	140.02	0	150	0	0	30	0.91	11.7	19.1	30	9.94	8.69	0.17	30	0	10	10	10	10	0	0	0	50											none	34.61	32.57	47.8	10	100	0	0.2	49.38	140	0	150		0	30	0.87	11.65	19.1	30	9.93	8.64	0.17	30	0	10	10	10	10	0		0	50												3.38	0.07	3.12	0.85	1.48	-	0.35	0.9	2.27	-	8.7	-	-	1.08	0.48	10.59	0.29	1.8	2.59	8.07	1.26	5.27	-	0.05	0.37	0.25	0.08	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	53.3	3.38	0.07	3.12	0.85	1.48	-	0.35	0.9	2.27	-	8.7	-	-	1.08	0.48	10.59	0.29	1.8	2.59	8.07	1.26	5.27	-	0.05	0.37	0.25	0.08	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	53.3
H1032_032_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	912.76	17.85	426.07	333.62	90.61	3.27	2.31	205.84	287.72	1019.9	501.7		289.08	310.88	4805.4	7914.87	134.17	522.66	2274.64	8135.95	5.29	891.7		59.04	379.89	257.43	15.35	1.63		338.32	2.69											50 for 1st 5 days	50 for 1st 5 days	50 for days 15 - 100				20	25 to 50	0 to 100						0 to 20	20 to 20	0 to 20		0 to 50	0 to 20	0 to 20																					32.92	32.58	10.56	0	100	0	0.2	49.4	92.52	0	100	0	0	20	1.01	8.52	5.85	20	5.97	6.6	0.17	20	0	10	10	10	10	0	0	0	50											none	32.57	32.57	10.55	0	100	0	0.2	49.38	92.5	0	100		0	20	0.98	8.46	5.85	20	5.96	6.53	0.17	20	0	10	10	10	10	0		0	50												2.48	0.05	0.37	-	0.76	-	0.46	0.85	2.22	-	4.18	-	-	0.52	0.39	5.58	0.07	0.87	1.13	4.43	0.9	1.49	-	0.05	0.32	0.21	0.01	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	27.34	2.48	0.05	0.37	-	0.76	-	0.46	0.85	2.22	-	4.18	-	-	0.52	0.39	5.58	0.07	0.87	1.13	4.43	0.9	1.49	-	0.05	0.32	0.21	0.01	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	27.34
H1032_033_0	2006											3000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V		V	V	V	V	V		V	V											none																																										-	1325.96	25.92	764.09	270.94	154.46	3.17	2.24	221.72	193.31	1244.37	612.11		352.7	379.3	5169.26	8514.19	144.33	562.24	2446.88	8752.01	6.23	574.47		65.14	417.17	282.7	14.15	1.5		336.74	2.67											150 for 1st 5 days	150 for 1st 5 days	100 for days 8 - 100				20	25 to 50	50 to 150						20 to 5	20 to 30	5 to 30		0 to 75	0 to 30	0 to 20																					98.09	97.72	47.82	10	100	0	0.2	49.39	135	0	100	0	0	30	3.14	12.13	11.95	30	9.94	9.04	0.17	30	0	10	10	10	10	0	0	0	50											none	97.72	97.72	47.8	10	100	0	0.2	49.38	135	0	100		0	30	3.1	12.07	11.95	30	9.93	8.99	0.17	30	0	10	10	10	10	0		0	50												10.8	0.21	3.04	0.23	1.29	-	0.45	0.91	2.17	-	5.1	-	-	0.95	1.34	8.57	0.14	1.41	2.02	6.55	1.06	1.44	-	0.05	0.35	0.24	0.01	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	48.33	10.8	0.21	3.04	0.23	1.29	-	0.45	0.91	2.17	-	5.1	-	-	0.95	1.34	8.57	0.14	1.41	2.02	6.55	1.06	1.44	-	0.05	0.35	0.24	0.01	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	48.33
H1032_034_0	2006											1500											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1161.33	22.02	1050.83	1764.24	295.49	16229.55	16729.15	211.42	187.89	1628.52	661.11	0	37.58	423.82	6946.65	10413.38	193.3	246.53	3845.85	12377.98	297.74	762.32	0	381	365.64	252.58	156.7	17.01	0	100	27.32																	Eff. copay 20 coins.	50	Eff. Copay 00 to 50	Eff. copay 0 to 15	Eff. copay 0 to 50			Eff. copay 0 to 50	Eff. Copay 0 to 15	Eff. copay 0 to 20	Eff. copay 05 to 15	20		Eff. copay 20 coins. 0 to 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.25	50	33.33	3.12	11.84	0	0	2.46	0.39	11.48	14	20	0	3.59	29.66	8.08	0	21.1	10	10	10	0	0	0	1.5											1500	0	0	0	0	0	0	1.14	45.47	30.31	2.83	10.77	0	0	2.24	0.36	10.44	12.73	18.19	0	3.26	26.97	7.34	0	19.19	9.09	9.09	9.09	0	0	0	1.36												-	-	-	-	-	-	1.59	0.8	0.47	0.38	0.59	-	-	0.08	0.21	9.06	0.21	0.37	-	3.37	0.67	0.47	-	0.61	0.28	0.19	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	19.46	-	-	-	-	-	-	1.59	0.8	0.47	0.38	0.59	-	-	0.08	0.21	9.06	0.21	0.37	-	3.37	0.67	0.47	-	0.61	0.28	0.19	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	19.46
H1032_035_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1101.13	20.56	1051.6	1770.23	280.22	15348.22	15826.31	202.67	179.46	1604.55	655.23	0	36.11	406.54	6846.27	10193.79	205.18	261.9	3791.17	12102.71	286.06	727.07	0	381	348.89	243.12	149.52	16.39	0	100	26.25											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 20 coins.	50	Eff. Copay 0 to 35		Eff. copay 0 to 50	0		Eff. copay 0 to 35				15		Eff. copay 20 coins. 0 to 15	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.25	50	19.1	0	11.72	0	0	19.1	0	0	0	15	0	3.63	29.5	8.06	0	21.1	10	10	10	0	0	0	1.5											N/A	0	0	0	0	0	0	1.25	50	19.1	0	11.72	0	0	19.1	0	0	0	15	0	3.63	29.5	8.06	0	21.1	10	10	10	0	0	0	1.5												-	-	-	-	-	-	1.64	0.84	0.29	-	0.64	-	-	0.65	-	-	-	0.33	-	3.66	0.7	0.49	-	0.67	0.29	0.2	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.53	-	-	-	-	-	-	1.64	0.84	0.29	-	0.64	-	-	0.65	-	-	-	0.33	-	3.66	0.7	0.49	-	0.67	0.29	0.2	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.53
H1032_036_0	2006											2000											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1340.98	26.39	1185.69	1405.44	330.84	18293.25	18857.21	241.78	217.08	1863.5	750.28	0	42.71	483.79	7673.03	11335.43	204.49	259.46	4421.36	13233.01	338.32	851.73	0	381	404.67	279.09	173.43	18.71	0	100	29.72											150 days 1 to 5	150 days 1 to 5	100 days 15 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 100	Eff. copay 0 to 25	Eff. copay 0 to 75	0		Eff. copay 0 to 100	Eff. Copay 0 to	Eff. copay 0 to 30	Eff. copay 25 to 25	30		Eff. copay 20 coins. 0 to 30 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											97.48	97.12	58.72	0	100	0.92	1.21	50	83.33	5.16	17.69	0	0	4.99	0.76	18.11	25	30	0	4.17	26.69	8.04	0	21.1	10	10	10	0	0	0	1.51											2000	72.91	72.64	43.92	0	74.79	0.69	0.91	37.4	62.33	3.86	13.23	0	0	3.73	0.57	13.54	18.7	22.44	0	3.12	19.96	6.02	0	15.78	7.48	7.48	7.48	0	0	0	1.13												8.15	0.16	4.34	-	2.06	1.05	1.42	0.75	1.13	0.6	0.83	-	-	0.15	0.36	12.79	0.32	0.49	-	3.44	0.56	0.43	-	0.5	0.25	0.17	0.11	-	-	-	0	-	-	-	-	-	-	-	-	-	-	40.06	8.15	0.16	4.34	-	2.06	1.05	1.42	0.75	1.13	0.6	0.83	-	-	0.15	0.36	12.79	0.32	0.49	-	3.44	0.56	0.43	-	0.5	0.25	0.17	0.11	-	-	-	0	-	-	-	-	-	-	-	-	-	-	40.06
H1032_037_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1112.34	21.03	1006.57	1689.45	320.14	17613.58	18138.24	218.52	194.39	1749.73	713.38	0	38.82	437.98	7141.68	10473.63	205.23	261.64	4213.38	12566.43	307.56	755.38	0	381	358.79	254.04	153.77	17.48	0	100	26.88											0	0	0		0		Eff. copay 20 coins.	50	0		Eff. copay 0 to 50									Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10		0	0	Eff. copay 0 to 50											0	0	0	0	0	0	1.3	50	0	0	11.69	0	0	0	0	0	0	0	0	1.66	30.51	7.99	0	21.1	10	10	10	0	0	0	1.56											N/A	0	0	0	0	0	0	1.3	50	0	0	11.69	0	0	0	0	0	0	0	0	1.66	30.51	7.99	0	21.1	10	10	10	0	0	0	1.56												-	-	-	-	-	-	1.97	0.91	-	-	0.69	-	-	-	-	-	-	-	-	1.74	0.78	0.5	-	0.67	0.3	0.21	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	7.91	-	-	-	-	-	-	1.97	0.91	-	-	0.69	-	-	-	-	-	-	-	-	1.74	0.78	0.5	-	0.67	0.3	0.21	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	7.91
H1032_038_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1097.45	20.91	967.24	1620.45	316.97	17461.99	17979.09	215.15	191.73	1730.3	705.03	0	38.18	431.08	7068.56	10372.6	203.44	259.04	4185.73	12492.67	302.47	744.29	0	381	353.31	249.31	151.42	17.15	0	100	26.38																	Eff. copay 20 coins.	50			Eff. copay 0 to 50									Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.28	50	0	0	11.67	0	0	0	0	0	0	0	0	1.63	30.11	8	0	21.1	10	10	10	0	0	0	1.56											N/A	0	0	0	0	0	0	1.28	50	0	0	11.67	0	0	0	0	0	0	0	0	1.63	30.11	8	0	21.1	10	10	10	0	0	0	1.56												-	-	-	-	-	-	1.92	0.9	-	-	0.69	-	-	-	-	-	-	-	-	1.69	0.76	0.5	-	0.67	0.29	0.21	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	7.76	-	-	-	-	-	-	1.92	0.9	-	-	0.69	-	-	-	-	-	-	-	-	1.69	0.76	0.5	-	0.67	0.29	0.21	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	7.76
H1032_039_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1112.24	20.87	1010.18	1705.37	320.88	17631.03	18159.68	220.49	195.79	1757.68	717.07	0	39.22	442.07	7160.79	10495.23	205.46	262.26	4208.68	12543.4	310.68	761	0	381	361.62	262.52	154.98	17.68	0	100	27.19																	Eff. copay 20 coins.	50			Eff. copay 0 to 50									Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.32	50	0	0	11.7	0	0	0	0	0	0	0	0	1.69	30.82	7.99	0	21.1	10	10	10	0	0	0	1.56											N/A	0	0	0	0	0	0	1.32	50	0	0	11.7	0	0	0	0	0	0	0	0	1.69	30.82	7.99	0	21.1	10	10	10	0	0	0	1.56												-	-	-	-	-	-	1.99	0.92	-	-	0.7	-	-	-	-	-	-	-	-	1.76	0.8	0.51	-	0.67	0.3	0.22	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	8	-	-	-	-	-	-	1.99	0.92	-	-	0.7	-	-	-	-	-	-	-	-	1.76	0.8	0.51	-	0.67	0.3	0.22	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	8
H1032_040_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1194.14	22.71	630.83	1614.83	271.37	14875.76	15323.61	227.43	164.93	1472.97	614.07	0	33.23	373.97	6779.26	9903.29	233.94	297.51	3720.16	13351.12	263.23	727.1	0	0	0	0	0	0	0	100	24.49											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 00 to 20 coins.	15	Eff. Copay 00 to 35		0	0		Eff. copay 0 to 35	Eff. Copay 0 to	Eff. Copay 0 to	Eff. copay 00 to 00	10		Eff. copay 20 coins. Copay 0 to 10	Eff. copay 20 coins.								0	0	0											0	0	0	0	0	0	0.41	15	23.33	0	0	0	0	1.72	0.46	0.97	0	10	0	4.06	46.07	0	0	0	0	0	0	0	0	0	0											N/A	0	0	0	0	0	0	0.41	15	23.33	0	0	0	0	1.72	0.46	0.97	0	10	0	4.06	46.07	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	0.53	0.28	0.32	-	-	-	-	0.05	0.26	0.8	-	0.25	-	4.52	1.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.02	-	-	-	-	-	-	0.53	0.28	0.32	-	-	-	-	0.05	0.26	0.8	-	0.25	-	4.52	1.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.02
H1032_041_0	2006											1500											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1123.62	21.42	1012.14	1690.43	287.56	15809.64	16294.79	205.32	182.72	1586.06	643.54	0	36.47	411.5	6766.87	10154.36	188.46	240.14	3752.88	12098.07	288.91	740.56	0	381	355.02	244.45	152.15	16.45	0	100	26.46																	Eff. copay 20 coins.	50	Eff. Copay 00 to 50	Eff. copay 0 to 15	Eff. copay 0 to 50			Eff. copay 0 to 50	Eff. Copay 0 to 15	Eff. copay 0 to 20	Eff. copay 05 to 15	20		Eff. copay 20 coins. 0 to 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.22	50	33.33	3.1	11.83	0	0	2.47	0.39	11.13	14	20	0	3.43	29.08	8.08	0	21.1	10	10	10	0	0	0	1.49											1500	0	0	0	0	0	0	1.12	45.74	30.49	2.84	10.82	0	0	2.26	0.36	10.18	12.81	18.29	0	3.14	26.6	7.39	0	19.3	9.15	9.15	9.15	0	0	0	1.37												-	-	-	-	-	-	1.52	0.78	0.46	0.38	0.58	-	-	0.08	0.2	8.61	0.2	0.37	-	3.16	0.64	0.46	-	0.61	0.27	0.19	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	18.63	-	-	-	-	-	-	1.52	0.78	0.46	0.38	0.58	-	-	0.08	0.2	8.61	0.2	0.37	-	3.16	0.64	0.46	-	0.61	0.27	0.19	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	18.63
H1032_042_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1410.78	27.46	865.55	2710.83	301.09	16582.93	17087.8	213.4	190.35	1720.27	678.34	0	37.85	427.49	8372.54	12408.56	272.94	345.69	4657.12	16558.26	299.82	852.82	0	381	417.08	245.24	178.75	16.49	0	100	30.63											50 days 1 to 5	50 days 1 to 5	50 days 15 to 100		100		Eff. copay 20 coins.	50	Eff. Copay 50 to 100	Eff. copay 0 to 5	Eff. copay 15 to 75			Eff. copay 0 to 50	Eff. Copay 0 to 10	Eff. copay 0 to 10	Eff. copay 00 to 5	10		Eff. copay 20 coins. 0 to 10	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											32.49	32.37	29.36	0	100	0	1.39	50	83.33	0.99	29.46	0	0	2.47	0.27	5.09	4.5	10	0	3.32	39.46	8.27	0	21.1	10	10	10	0	0	0	1.29											N/A	32.49	32.37	29.36	0	100	0	1.39	50	83.33	0.99	29.46	0	0	2.47	0.27	5.09	4.5	10	0	3.32	39.46	8.27	0	21.1	10	10	10	0	0	0	1.29												3.82	0.07	2.12	-	2.51	-	1.98	0.89	1.32	0.14	1.67	-	-	0.09	0.19	5.26	0.1	0.29	-	4.58	0.99	0.59	-	0.67	0.35	0.2	0.15	-	-	-	0	-	-	-	-	-	-	-	-	-	-	27.98	3.82	0.07	2.12	-	2.51	-	1.98	0.89	1.32	0.14	1.67	-	-	0.09	0.19	5.26	0.1	0.29	-	4.58	0.99	0.59	-	0.67	0.35	0.2	0.15	-	-	-	0	-	-	-	-	-	-	-	-	-	-	27.98
H1032_043_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1168.17	22.07	756.74	2281.5	257.39	14089.85	14529.81	186.59	165.1	1424.13	563.68	0	33.26	374.33	6757.76	10116.09	217.56	276.89	3688.59	13050.33	263.48	730.13	0	0	0	0	0	0	0	100	26.6											50 days 1 to 5	50 days 1 to 5	50 days 15 to 100		100		Eff. copay 20 coins.	50	Eff. Copay 50 to 100	Eff. copay 0 to 10	Eff. copay 15 to 75	0		Eff. copay 0 to 50	Eff. Copay 0 to	Eff. copay 0 to 15	Eff. copay 00 to 10	15		Eff. copay 20 coins. 0 to 15 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10							0	0	Eff. copay 0 to 50											32.49	32.37	29.36	0	100	0	1.35	50	83.33	2.1	29.63	0	0	2.45	0.4	8.54	9	15	0	3.38	38.13	8.22	0	0	0	0	0	0	0	0	1.33											N/A	32.49	32.37	29.36	0	100	0	1.35	50	83.33	2.1	29.63	0	0	2.45	0.4	8.54	9	15	0	3.38	38.13	8.22	0	0	0	0	0	0	0	0	1.33												3.16	0.06	1.85	-	2.14	-	1.63	0.78	1.15	0.25	1.39	-	-	0.08	0.23	7.2	0.16	0.35	-	3.67	0.84	0.5	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	25.44	3.16	0.06	1.85	-	2.14	-	1.63	0.78	1.15	0.25	1.39	-	-	0.08	0.23	7.2	0.16	0.35	-	3.67	0.84	0.5	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	25.44
H1032_044_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1432.01	28.01	885.46	2738.05	303.15	16712.44	17219.19	214.07	191.2	1731.21	704.85	0	37.93	428.74	8500.02	12726.16	295.81	374.18	4710.29	16879.84	300.52	858.44	0	381	419.9	245.43	179.96	16.5	0	100	30.76																	Eff. copay 20 coins.	50	Eff. Copay 0 to 35		Eff. copay 0 to 50			Eff. Copay 0 to 35				10		Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.39	50	18.6	0	11.65	0	0	18.6	0	0	0	10	0	3.03	39.42	8.28	0	21.1	10	10	10	0	0	0	1.29											N/A	0	0	0	0	0	0	1.39	50	18.6	0	11.65	0	0	18.6	0	0	0	10	0	3.03	39.42	8.28	0	21.1	10	10	10	0	0	0	1.29												-	-	-	-	-	-	2	0.89	0.3	-	0.68	-	-	0.66	-	-	-	0.31	-	4.26	0.99	0.59	-	0.67	0.35	0.2	0.15	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.07	-	-	-	-	-	-	2	0.89	0.3	-	0.68	-	-	0.66	-	-	-	0.31	-	4.26	0.99	0.59	-	0.67	0.35	0.2	0.15	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.07
H1032_058_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1199.25	23.48	852.36	2044.63	287.95	15907.82	16437.13	235.79	211.98	1937.32	787.05	0	41.61	471.68	9010.58	13473.47	317.37	400.47	5111.4	17911.12	329.65	945.48	0	381	461.35	247.15	197.72	16.58	0	100	33.38																	Eff. copay 20 coins.	50			Eff. copay 0 to 50									Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.29	50	0	0	11.61	0	0	0	0	0	0	0	0	1.74	35.71	8.28	0	21.1	10	10	10	0	0	0	1.19											N/A	0	0	0	0	0	0	1.29	50	0	0	11.61	0	0	0	0	0	0	0	0	1.74	35.71	8.28	0	21.1	10	10	10	0	0	0	1.19												-	-	-	-	-	-	1.77	0.98	-	-	0.76	-	-	-	-	-	-	-	-	2.6	0.98	0.65	-	0.67	0.38	0.21	0.16	-	-	-	0	-	-	-	-	-	-	-	-	-	-	9.18	-	-	-	-	-	-	1.77	0.98	-	-	0.76	-	-	-	-	-	-	-	-	2.6	0.98	0.65	-	0.67	0.38	0.21	0.16	-	-	-	0	-	-	-	-	-	-	-	-	-	-	9.18
H1032_059_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1592.29	31.13	1549.44	2488.58	404.96	22373.47	23049.5	286.2	256.39	2331.32	948.24	0	50.62	572.89	10011.39	14997.79	304.75	386.15	5632.98	18218.99	401.03	632.26	0	381	494.51	327.23	211.93	22.49	0	100	36.39											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 20 coins.	50	Eff. Copay 00 to 00		Eff. copay 0 to 50	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											0	0	0	0	0	0	1.24	50	0	0	11.63	0	0	0	0	0	0	0	0	1.68	29.66	8.09	0	21.1	10	10	10	0	0	0	1.48											N/A	0	0	0	0	0	0	1.24	50	0	0	11.63	0	0	0	0	0	0	0	0	1.68	29.66	8.09	0	21.1	10	10	10	0	0	0	1.48												-	-	-	-	-	-	2.37	1.19	-	-	0.92	-	-	-	-	-	-	-	-	2.55	0.99	0.43	-	0.67	0.41	0.27	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	9.99	-	-	-	-	-	-	2.37	1.19	-	-	0.92	-	-	-	-	-	-	-	-	2.55	0.99	0.43	-	0.67	0.41	0.27	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	9.99
H1032_060_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1638.79	32.29	1235.01	2919.5	398.95	22068.39	22804.55	329.06	296.31	2714.09	1102.04	0	58.01	658.09	12555.8	18787.24	443.81	559.59	7136.18	25064.87	459.6	1315.26	0	381	640.96	332.08	274.7	22.81	0	100	46.23											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 20 coins.	50	Eff. Copay 00 to 00		Eff. copay 0 to 50	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											0	0	0	0	0	0	1.29	50	0	0	11.59	0	0	0	0	0	0	0	0	1.74	36.14	8.28	0	21.1	10	10	10	0	0	0	0.33											N/A	0	0	0	0	0	0	1.29	50	0	0	11.59	0	0	0	0	0	0	0	0	1.74	36.14	8.28	0	21.1	10	10	10	0	0	0	0.33												-	-	-	-	-	-	2.46	1.37	-	-	1.06	-	-	-	-	-	-	-	-	3.63	1.38	0.91	-	0.67	0.53	0.28	0.23	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.53	-	-	-	-	-	-	2.46	1.37	-	-	1.06	-	-	-	-	-	-	-	-	3.63	1.38	0.91	-	0.67	0.53	0.28	0.23	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.53
H1032_061_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1624.83	31.82	1684.29	2682.93	454.91	25184.8	25914.67	302.66	271.62	2476.06	1006.51	0	53.47	605.66	10130.88	14900.46	293.26	371.71	6084.02	18205.99	423.63	1048.75	0	381	496.45	345.62	212.77	23.74	0	100	36.56																	Eff. copay 20 coins.	50			Eff. copay 0 to 50									Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.3	50	0	0	11.62	0	0	0	0	0	0	0	0	1.61	30.66	8.01	0	21.1	10	10	10	0	0	0	0.36											N/A	0	0	0	0	0	0	1.3	50	0	0	11.62	0	0	0	0	0	0	0	0	1.61	30.66	8.01	0	21.1	10	10	10	0	0	0	0.36												-	-	-	-	-	-	2.81	1.26	-	-	0.97	-	-	-	-	-	-	-	-	2.44	1.08	0.7	-	0.67	0.41	0.29	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.81	-	-	-	-	-	-	2.81	1.26	-	-	0.97	-	-	-	-	-	-	-	-	2.44	1.08	0.7	-	0.67	0.41	0.29	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.81
H1032_062_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1635.76	31.83	1758.59	2795.04	453.78	25092.06	25823.95	303.99	272.33	2476.45	1007.25	0	53.77	608.5	10108.98	14859.97	292.21	370.8	6050.25	18093.51	425.95	1051.26	0	381	497.79	347.72	213.34	23.89	0	100	36.78											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 20 coins.	50	Eff. Copay 00 to 00		Eff. copay 0 to 50	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											0	0	0	0	0	0	1.32	50	0	0	11.63	0	0	0	0	0	0	0	0	1.64	31	8	0	21.1	10	10	10	0	0	0	0.37											N/A	0	0	0	0	0	0	1.32	50	0	0	11.63	0	0	0	0	0	0	0	0	1.64	31	8	0	21.1	10	10	10	0	0	0	0.37												-	-	-	-	-	-	2.83	1.27	-	-	0.98	-	-	-	-	-	-	-	-	2.47	1.1	0.7	-	0.67	0.41	0.29	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.9	-	-	-	-	-	-	2.83	1.27	-	-	0.98	-	-	-	-	-	-	-	-	2.47	1.1	0.7	-	0.67	0.41	0.29	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.9
H1032_063_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1602.87	31.29	1598.96	2583.66	452.72	25048.62	25777.59	302.72	271.44	2471.33	1004.88	0	53.51	605.87	10083.75	14827.03	291.69	369.93	6045.48	18084.98	423.94	1046.58	0	381	495.34	345.43	212.29	23.73	0	100	36.54											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 20 coins.	50	Eff. Copay 00 to 00		Eff. copay 0 to 50	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											0	0	0	0	0	0	1.29	50	0	0	11.63	0	0	0	0	0	0	0	0	1.6	30.39	8	0	21.1	10	10	10	0	0	0	0.36											N/A	0	0	0	0	0	0	1.29	50	0	0	11.63	0	0	0	0	0	0	0	0	1.6	30.39	8	0	21.1	10	10	10	0	0	0	0.36												-	-	-	-	-	-	2.77	1.26	-	-	0.97	-	-	-	-	-	-	-	-	2.4	1.07	0.7	-	0.67	0.41	0.29	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.73	-	-	-	-	-	-	2.77	1.26	-	-	0.97	-	-	-	-	-	-	-	-	2.4	1.07	0.7	-	0.67	0.41	0.29	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.73
H1032_064_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1500.91	29.33	1058.3	1822.71	413.05	22818.85	23507.65	291.39	261.02	2373.12	965.27	0	51.54	583.3	10210.45	15295.32	310.77	393.81	5744.33	18577.42	408.33	553.5	0	381	504.46	333.89	216.2	22.94	0	100	37.13											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 20 coins.	50	Eff. Copay 00 to 00		Eff. copay 0 to 50	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											0	0	0	0	0	0	1.23	50	0	0	11.63	0	0	0	0	0	0	0	0	1.67	29.69	8.09	0	21.1	10	10	10	0	0	0	1.48											N/A	0	0	0	0	0	0	1.23	50	0	0	11.63	0	0	0	0	0	0	0	0	1.67	29.69	8.09	0	21.1	10	10	10	0	0	0	1.48												-	-	-	-	-	-	2.4	1.21	-	-	0.94	-	-	-	-	-	-	-	-	2.58	1.01	0.37	-	0.67	0.42	0.28	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.07	-	-	-	-	-	-	2.4	1.21	-	-	0.94	-	-	-	-	-	-	-	-	2.58	1.01	0.37	-	0.67	0.42	0.28	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	10.07
H1032_065_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1620	31.67	1592.14	2560.85	408.22	22553.41	23234.24	288.06	258.06	2346.54	954.43	0	50.95	576.63	10091.91	15118.4	307.2	389.26	5678.28	18365.51	403.65	564.71	0	381	498.49	329.86	213.64	22.67	0	100	36.68											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 20 coins.	50	Eff. Copay 00 to 00		Eff. copay 0 to 50	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											0	0	0	0	0	0	1.21	50	0	0	11.63	0	0	0	0	0	0	0	0	1.65	29.1	8.09	0	21.1	10	10	10	0	0	0	1.48											N/A	0	0	0	0	0	0	1.21	50	0	0	11.63	0	0	0	0	0	0	0	0	1.65	29.1	8.09	0	21.1	10	10	10	0	0	0	1.48												-	-	-	-	-	-	2.35	1.2	-	-	0.93	-	-	-	-	-	-	-	-	2.53	0.98	0.38	-	0.67	0.42	0.27	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	9.91	-	-	-	-	-	-	2.35	1.2	-	-	0.93	-	-	-	-	-	-	-	-	2.53	0.98	0.38	-	0.67	0.42	0.27	0.18	-	-	-	0	-	-	-	-	-	-	-	-	-	-	9.91
H1032_066_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1969.98	39.43	1047.8	3388.66	433.7	24034.03	24750.24	302.5	272.15	2489.71	1011.23	0	53.36	605.06	12365.52	18573.18	437.21	551.15	6903.97	25044.32	422.74	789.06	0	381	600.49	339.56	257.35	22.75	0	100	43.42											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 20 coins.	50	Eff. Copay 00 to 00		Eff. copay 0 to 50	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											0	0	0	0	0	0	1.38	50	0	0	11.6	0	0	0	0	0	0	0	0	1.77	39.73	8.3	0	21.1	10	10	10	0	0	0	1.26											N/A	0	0	0	0	0	0	1.38	50	0	0	11.6	0	0	0	0	0	0	0	0	1.77	39.73	8.3	0	21.1	10	10	10	0	0	0	1.26												-	-	-	-	-	-	2.85	1.26	-	-	0.98	-	-	-	-	-	-	-	-	3.7	1.4	0.55	-	0.67	0.5	0.28	0.21	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.41	-	-	-	-	-	-	2.85	1.26	-	-	0.98	-	-	-	-	-	-	-	-	3.7	1.4	0.55	-	0.67	0.5	0.28	0.21	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.41
H1032_068_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1470.67	29.39	1024.67	1627.12	335.82	18616.38	19222.43	268.54	242.37	2059.86	800.52	0	47.27	536.82	7565.41	11214.23	197.9	250.66	4663.85	13028.55	374.51	840.75	0	381	387.09	267.11	165.9	17.89	0	100	28.3											200 days 1 to 5	200 days 1 to 5	100 days 15 to 100	10	100		Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 25	Eff. copay 15 to 75	0		Eff. copay 0 to 100	Eff. Copay 0 to	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											129.98	129.5	58.72	10	100	0	1.26	50	116.67	5.16	29.59	0	0	5.02	6.83	17.24	24	30	0	4.52	27.43	7.81	0	21.1	10	10	10	0	0	0	1.52											N/A	129.98	129.5	58.72	10	100	0	1.26	50	116.67	5.16	29.59	0	0	5.02	6.83	17.24	24	30	0	4.52	27.43	7.81	0	21.1	10	10	10	0	0	0	1.52												15.93	0.32	5.01	1.36	2.8	-	2.02	1.12	2.36	0.89	1.97	-	-	0.22	4.3	16.11	0.4	0.63	-	4.9	0.86	0.55	-	0.67	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	63.09	15.93	0.32	5.01	1.36	2.8	-	2.02	1.12	2.36	0.89	1.97	-	-	0.22	4.3	16.11	0.4	0.63	-	4.9	0.86	0.55	-	0.67	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	63.09
H1032_069_0	2006											2000											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1133.43	21.82	1021.4	1673.61	328.05	18114.31	18665.16	233.77	209.35	1793.03	700.47	0	41.36	467.97	7455.45	11960.81	227.24	288.19	4588.04	14146.21	327.64	855.8	0	381	410.52	280.1	175.94	18.8	0	100	30.22											125 days 1 to 5	125 days 1 to 5	100 days 8 to 100	10	100		Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 25	Eff. copay 15 to 75	0		Eff. copay 0 to 150	Eff. Copay 0 to	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											81.24	80.94	75.87	10	100	0	1.21	50	116.67	5.19	29.62	0	0	7.46	0.85	17.74	24	30	0	4.54	29.25	8.11	0	21.1	10	10	10	0	0	0	1.49											2000	60.78	60.56	56.77	7.48	74.83	0	0.91	37.41	87.3	3.88	22.17	0	0	5.58	0.63	13.28	17.96	22.45	0	3.39	21.89	6.07	0	15.79	7.48	7.48	7.48	0	0	0	1.12												5.74	0.11	4.83	1.04	2.05	-	1.41	0.73	1.52	0.58	1.29	-	-	0.22	0.39	13.23	0.34	0.54	-	4	0.6	0.43	-	0.5	0.26	0.17	0.11	-	-	-	0	-	-	-	-	-	-	-	-	-	-	40.11	5.74	0.11	4.83	1.04	2.05	-	1.41	0.73	1.52	0.58	1.29	-	-	0.22	0.39	13.23	0.34	0.54	-	4	0.6	0.43	-	0.5	0.26	0.17	0.11	-	-	-	0	-	-	-	-	-	-	-	-	-	-	40.11
H1032_070_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1099.03	21.23	1023.49	1710.01	329.61	18218.25	18667.73	166	147.38	1252.59	492.34	0	29.53	332.81	6452.98	9845.02	180.06	229.01	4044.57	12640.69	233.9	707.2	0	381	350.52	265.83	150.22	17.84	0	100	26.02											50 days 1 to 5	50 days 1 to 5	100 days 15 to 100		100		Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 20	Eff. copay 15 to 75	0		Eff. copay 0 to 100	Eff. Copay 0 to	Eff. copay 0 to 25	Eff. copay 10 to 20	25		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											32.49	32.37	58.72	0	100	0	1.24	50	116.67	4.24	29.65	0	0	4.92	0.77	14.37	19	25	0	3.52	35.41	8.37	0	21.1	10	10	10	0	0	0	1.65											N/A	32.49	32.37	58.72	0	100	0	1.24	50	116.67	4.24	29.65	0	0	4.92	0.77	14.37	19	25	0	3.52	35.41	8.37	0	21.1	10	10	10	0	0	0	1.65												2.98	0.06	5.01	-	2.75	-	1.93	0.69	1.43	0.44	1.22	-	-	0.14	0.41	11.79	0.29	0.48	-	3.71	0.69	0.49	-	0.67	0.29	0.22	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	35.82	2.98	0.06	5.01	-	2.75	-	1.93	0.69	1.43	0.44	1.22	-	-	0.14	0.41	11.79	0.29	0.48	-	3.71	0.69	0.49	-	0.67	0.29	0.22	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	35.82
H1032_071_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1326.81	26.16	1328.63	1877.72	329.09	18208.5	18842.39	289.2	260.84	2199.48	855.79	0	50.93	578.18	7863.9	12576.73	267.84	338.49	5161.37	14886.05	403.49	913.12	0	381	421.49	276.26	180.64	18.52	0	100	30.8											250 days 1 to 6	250 days 1 to 6	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 30	Eff. copay 15 to 75	0		Eff. copay 0 to 100	Eff. Copay 0 to	Eff. copay 0 to 35	Eff. copay 20 to 30	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											166.55	165.94	75.87	0	100	0.9	1.22	50	116.67	6.25	29.62	0	0	5.01	7.37	18.66	29	35	0	4.34	26.15	7.82	0	21.1	10	10	10	0	0	0	1.44											N/A	166.55	165.94	75.87	0	100	0.9	1.22	50	116.67	6.25	29.62	0	0	5.01	7.37	18.66	29	35	0	4.34	26.15	7.82	0	21.1	10	10	10	0	0	0	1.44												18.42	0.36	8.4	-	2.74	1.37	1.92	1.2	2.54	1.15	2.11	-	-	0.24	4.83	19.55	0.65	0.99	-	5.38	0.88	0.6	-	0.67	0.35	0.23	0.15	-	-	-	0	-	-	-	-	-	-	-	-	-	-	74.72	18.42	0.36	8.4	-	2.74	1.37	1.92	1.2	2.54	1.15	2.11	-	-	0.24	4.83	19.55	0.65	0.99	-	5.38	0.88	0.6	-	0.67	0.35	0.23	0.15	-	-	-	0	-	-	-	-	-	-	-	-	-	-	74.72
H1032_073_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1357.79	26.76	872.76	1430.9	322.77	17838.88	18424.97	259.62	233.42	1978.01	770.77	0	45.82	519.34	7263.92	10751.65	190.03	241.39	4437.45	12412.4	362.96	814.04	0	381	375.66	261.52	161	17.55	0	100	27.7											200 days 1 to 5	200 days 1 to 5	100 days 15 to 100	10	100		Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 25	Eff. copay 15 to 75	0		Eff. copay 0 to 100	Eff. Copay 0 to	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											129.98	129.5	58.72	10	100	0	1.2	50	116.67	5.21	29.6	0	0	4.99	6.88	16.53	24	30	0	4.18	26.3	7.8	0	21.1	10	10	10	0	0	0	1.52											N/A	129.98	129.5	58.72	10	100	0	1.2	50	116.67	5.21	29.6	0	0	4.99	6.88	16.53	24	30	0	4.18	26.3	7.8	0	21.1	10	10	10	0	0	0	1.52												14.71	0.29	4.27	1.19	2.69	-	1.85	1.08	2.27	0.86	1.9	-	-	0.22	4.16	14.81	0.38	0.6	-	4.32	0.8	0.53	-	0.67	0.31	0.22	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	58.27	14.71	0.29	4.27	1.19	2.69	-	1.85	1.08	2.27	0.86	1.9	-	-	0.22	4.16	14.81	0.38	0.6	-	4.32	0.8	0.53	-	0.67	0.31	0.22	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	58.27
H1032_074_0	2006											2500											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1318.2	25.39	1045.57	1250.64	344.27	18957.66	19536.61	245.09	218.57	1822.21	721.34	0	43.47	491	6908.5	10364.26	173.78	222.21	4129.4	11457.67	344.4	783.91	0	381	364.94	291.07	156.4	19.57	0	0	28.69											150 days 1 to 5	150 days 1 to 5	100 days 10 to 30	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	150	Eff. copay 5 to 25	Eff. copay 15 to 75	0	25	Eff. copay 0 to 150	Eff. Copay 0 to 25	Eff. copay 0 to 25	Eff. copay 20 to 30	25		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.	Eff. copay 0 to 20		21.1	20		20		0	0	Eff. copay 0 to 50											100.7	100.36	37.02	10	100	0.92	1.23	50	150	9.29	29.63	0	25	7.42	7.26	13.86	29	25	0	4.85	28.69	15.67	0	21.1	20	0	20	0	0	0	20.98											2500	78.39	78.13	28.82	7.78	77.85	0.72	0.96	38.92	116.77	7.24	23.07	0	19.46	5.78	5.65	10.79	22.58	19.46	0	3.77	22.33	12.2	0	16.43	15.57	0	15.57	0	0	0	16.34												8.61	0.17	2.51	0.81	2.23	1.13	1.55	0.79	2.13	1.1	1.39	-	0.07	0.24	3.25	9.32	0.33	0.36	-	3.6	0.64	0.8	-	0.52	0.47	-	0.2	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	42.27	8.61	0.17	2.51	0.81	2.23	1.13	1.55	0.79	2.13	1.1	1.39	-	0.07	0.24	3.25	9.32	0.33	0.36	-	3.6	0.64	0.8	-	0.52	0.47	-	0.2	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	42.27
H1032_075_0	2006											2000											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1090.39	21	987.89	1618.97	314.21	17350.18	17877.7	223.85	200.46	1716.94	670.75	0	39.6	448.11	7140.95	11456.26	217.65	276.03	4394.5	13549.47	313.74	819.66	0	381	393.2	268.29	168.51	18	0	100	28.95											125 days 1 to 5	125 days 1 to 5	100 days 8 to 100	10	100		Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 25	Eff. copay 15 to 75	0		Eff. copay 0 to 150	Eff. Copay 0 to	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											81.24	80.94	75.87	10	100	0	1.19	50	116.67	5.19	29.62	0	0	7.46	0.84	17.97	24	30	0	4.54	28.62	8.11	0	21.1	10	10	10	0	0	0	1.49											2000	61.71	61.49	57.64	7.6	75.97	0	0.9	37.98	88.63	3.94	22.5	0	0	5.66	0.64	13.66	18.23	22.79	0	3.45	21.74	6.16	0	16.03	7.6	7.6	7.6	0	0	0	1.13												5.61	0.11	4.74	1.02	1.99	-	1.34	0.71	1.48	0.56	1.26	-	-	0.21	0.38	13.04	0.33	0.52	-	3.9	0.57	0.42	-	0.51	0.25	0.17	0.11	-	-	-	0	-	-	-	-	-	-	-	-	-	-	39.24	5.61	0.11	4.74	1.02	1.99	-	1.34	0.71	1.48	0.56	1.26	-	-	0.21	0.38	13.04	0.33	0.52	-	3.9	0.57	0.42	-	0.51	0.25	0.17	0.11	-	-	-	0	-	-	-	-	-	-	-	-	-	-	39.24
H1032_077_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1265.36	24.6	1156	1348.85	312.93	17258.82	17795.98	230.45	206.19	1871.55	761.55	0	40.79	461.4	7736.32	11290.93	229.25	290.99	4478.91	13261.24	323.16	809.5	0	381	384.93	267.45	164.97	17.96	0	100	28.47											0	0	0		0		Eff. copay 20 coins.	50	0		Eff. copay 0 to 50	0		0	0		0			Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10		0	0	Eff. copay 0 to 50											0	0	0	0	0	0	1.2	50	0	0	11.64	0	0	0	0	0	0	0	0	1.75	26.4	8.03	0	21.1	10	10	10	0	0	0	1.52											N/A	0	0	0	0	0	0	1.2	50	0	0	11.64	0	0	0	0	0	0	0	0	1.75	26.4	8.03	0	21.1	10	10	10	0	0	0	1.52												-	-	-	-	-	-	1.78	0.96	-	-	0.74	-	-	-	-	-	-	-	-	1.93	0.71	0.54	-	0.67	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	8.02	-	-	-	-	-	-	1.78	0.96	-	-	0.74	-	-	-	-	-	-	-	-	1.93	0.71	0.54	-	0.67	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	8.02
H1032_078_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1062.93	20.01	1001.43	1628.37	307.99	16939.69	17463.1	275.42	198.23	1787.84	744.62	0	39.5	445.93	7493.4	11804.63	250.54	318.18	4576.35	13972.16	312.95	808.79	0	381	388.21	268.15	166.38	18.03	0	100	28.87											0	0	0		0		Eff. copay 20 coins.	0	0		0	0		0	0		0			Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10		0	0	0											0	0	0	0	0	0	1.2	0	0	0	0	0	0	0	0	0	0	0	0	1.71	28.97	8.09	0	21.1	10	10	10	0	0	0	0											N/A	0	0	0	0	0	0	1.2	0	0	0	0	0	0	0	0	0	0	0	0	1.71	28.97	8.09	0	21.1	10	10	10	0	0	0	0												-	-	-	-	-	-	1.75	-	-	-	-	-	-	-	-	-	-	-	-	2	0.76	0.55	-	0.67	0.32	0.22	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.4	-	-	-	-	-	-	1.75	-	-	-	-	-	-	-	-	-	-	-	-	2	0.76	0.55	-	0.67	0.32	0.22	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.4
H1032_079_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1351.1	26.47	885.32	1785.53	1071.42	19747.6	20493.52	392.32	318.09	2684.54	1021.66	0	61.99	704.05	6900.64	10430.68	166.66	208.7	3821	9777.57	491.06	935.6	0	0	0	0	0	0	0	0	27.7											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0		Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											123.49	122.86	54.11	0	13.22	0.95	1.24	25.82	128.42	0	40.34	0	0	25.38	6.28	16.59	18.2	35	0	4.18	19.99	0	0	0	0	0	0	0	0	0	0.84											N/A	123.49	122.86	54.11	0	13.22	0.95	1.24	25.82	128.42	0	40.34	0	0	25.38	6.28	16.59	18.2	35	0	4.18	19.99	0	0	0	0	0	0	0	0	0	0.84												13.9	0.27	3.99	-	1.18	1.56	2.12	0.84	3.4	-	3.43	-	-	1.49	3.61	14.42	0.25	0.61	-	3.41	0.82	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.32	13.9	0.27	3.99	-	1.18	1.56	2.12	0.84	3.4	-	3.43	-	-	1.49	3.61	14.42	0.25	0.61	-	3.41	0.82	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.32
H1032_080_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1208.99	22.79	949.35	1228.13	965.21	17645.2	18193.32	245.78	206.3	1718.98	662.02	0	41.39	466.4	6433.97	9724.62	170.89	210.63	3802.81	10666.17	327.93	828.22	0	0	0	0	0	0	0	0	27.57											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.										Eff. copay 20 coins.											124.09	123.47	54.11	0	12.63	0.91	1.22	35.53	182.76	0	57.85	0	0	35.81	6.58	17.68	17.22	35	0	3.62	28.39	0	0	0	0	0	0	0	0	0	1.16											N/A	124.09	123.47	54.11	0	12.63	0.91	1.22	35.53	182.76	0	57.85	0	0	35.81	6.58	17.68	17.22	35	0	3.62	28.39	0	0	0	0	0	0	0	0	0	1.16												12.5	0.23	4.28	-	1.02	1.34	1.84	0.73	3.14	-	3.19	-	-	1.39	3.53	14.33	0.25	0.61	-	3.22	0.78	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	52.38	12.5	0.23	4.28	-	1.02	1.34	1.84	0.73	3.14	-	3.19	-	-	1.39	3.53	14.33	0.25	0.61	-	3.22	0.78	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	52.38
H1032_081_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1355.15	26.83	1205.54	1405.81	999.94	18453.27	19019.52	261.17	218.25	1836.62	698.24	0	42.82	485.44	7531.66	11347.84	210.36	261.44	4348.27	13142.68	339.22	928.77	0	0	0	0	0	0	0	100	29.76											200 days 1 to 4	200 days 1 to 4	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0		Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35 copay	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											115.04	114.45	54.11	0	12.76	0.92	1.21	33.17	170.51	0	54.2	0	0	33.8	6.32	16.98	18.68	35	0	4.03	26.65	0	0	0	0	0	0	0	0	0	1											N/A	115.04	114.45	54.11	0	12.76	0.92	1.21	33.17	170.51	0	54.2	0	0	33.8	6.32	16.98	18.68	35	0	4.03	26.65	0	0	0	0	0	0	0	0	0	1												12.99	0.26	5.44	-	1.06	1.41	1.92	0.72	3.1	-	3.15	-	-	1.37	3.97	16.06	0.33	0.76	-	4.42	0.75	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.71	12.99	0.26	5.44	-	1.06	1.41	1.92	0.72	3.1	-	3.15	-	-	1.37	3.97	16.06	0.33	0.76	-	4.42	0.75	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.71
H1032_082_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1135.05	21.93	1042.08	1718.25	987.8	18193.22	18745.03	248.25	209.83	1761.56	671.8	0	41.39	468.57	7280.25	11927.57	232.98	289.6	4490.66	14025.44	327.93	930.05	0	0	0	0	0	0	0	100	30.25											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0		Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											120.95	120.34	54.11	0	12.61	0.91	1.21	36.2	187.26	0	59.51	0	0	37.03	6.66	16.73	17.51	35	0	3.96	29.24	0	0	0	0	0	0	0	0	0	1.08											N/A	120.95	120.34	54.11	0	12.61	0.91	1.21	36.2	187.26	0	59.51	0	0	37.03	6.66	16.73	17.51	35	0	3.96	29.24	0	0	0	0	0	0	0	0	0	1.08												11.44	0.22	4.7	-	1.04	1.38	1.89	0.75	3.27	-	3.33	-	-	1.45	4.04	16.63	0.34	0.84	-	4.63	0.8	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	56.75	11.44	0.22	4.7	-	1.04	1.38	1.89	0.75	3.27	-	3.33	-	-	1.45	4.04	16.63	0.34	0.84	-	4.63	0.8	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	56.75
H1032_083_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1086.56	20.92	1002.86	1659.05	942.63	17350.18	17877.7	237.92	200.46	1681.86	641.93	0	39.6	448.11	6947.04	11367.81	228.29	276.03	4276.25	13347.8	313.74	887.86	0	0	0	0	0	0	0	100	28.95											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0		Eff. copay 20 coins.	Eff. Copay 0 to	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											126.2	125.56	54.11	0	12.35	0.89	1.19	35.51	183.38	0	58.25	0	0	36.24	6.67	16.97	17.14	35	0	3.94	28.62	0	0	0	0	0	0	0	0	0	1.06											N/A	126.2	125.56	54.11	0	12.35	0.89	1.19	35.51	183.38	0	58.25	0	0	36.24	6.67	16.97	17.14	35	0	3.94	28.62	0	0	0	0	0	0	0	0	0	1.06												11.43	0.22	4.52	-	0.97	1.28	1.77	0.7	3.06	-	3.12	-	-	1.35	3.86	16.08	0.33	0.81	-	4.39	0.75	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	54.63	11.43	0.22	4.52	-	0.97	1.28	1.77	0.7	3.06	-	3.12	-	-	1.35	3.86	16.08	0.33	0.81	-	4.39	0.75	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	54.63
H1032_084_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1225.88	23.64	1231.06	1761.72	923.17	16949.83	17544.01	290.74	242.36	2036.03	775.78	0	47.74	540.6	7348.43	11730.37	257.25	371.07	4720.28	13848.83	378.17	923.03	0	0	0	0	0	0	0	100	29.32											200 days 1 to 4	200 days 1 to 4	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	5		Eff. copay 20 coins.Eff. copay 0 to 35	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											115.03	114.45	54.11	0	12.36	0.89	1.21	32.75	166.98	0	52.66	0	2.85	32.91	6.41	17.82	16.93	5	0	2.3	25.98	0	0	0	0	0	0	0	0	0	0.95											N/A	115.03	114.45	54.11	0	12.36	0.89	1.21	32.75	166.98	0	52.66	0	2.85	32.91	6.41	17.82	16.93	5	0	2.3	25.98	0	0	0	0	0	0	0	0	0	0.95												11.75	0.23	5.55	-	0.95	1.26	1.77	0.79	3.37	-	3.4	-	0.01	1.48	3.93	17.42	0.36	0.15	-	2.65	0.82	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.91	11.75	0.23	5.55	-	0.95	1.26	1.77	0.79	3.37	-	3.4	-	0.01	1.48	3.93	17.42	0.36	0.15	-	2.65	0.82	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.91
H1032_085_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1557.18	28.84	1536.38	2582.75	408.17	22324.3	23027.3	364.18	264.42	2357.81	983.11	0	53.36	600.32	9978.28	14881.82	297.51	380.21	5496.75	17508.46	422.75	1063.79	0	381	509.79	356.81	218.48	24.08	0	100	158.5											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 00 to 20 coins.	0	Eff. Copay 00 to 00		0	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	0											0	0	0	0	0	0	0.35	0	0	0	0	0	0	0	0	0	0	0	0	1.71	28.8	8.04	0	21.1	10	10	10	0	0	0	0											N/A	0	0	0	0	0	0	0.35	0	0	0	0	0	0	0	0	0	0	0	0	1.71	28.8	8.04	0	21.1	10	10	10	0	0	0	0												-	-	-	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	2.5	1.01	0.71	-	0.67	0.42	0.3	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.46	-	-	-	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	2.5	1.01	0.71	-	0.67	0.42	0.3	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.46
H1032_086_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1463.35	27.1	1035.82	1864.05	418.81	22906.08	23627.16	373.47	271.17	2417.97	1008.2	0	54.73	615.64	10238.32	15269.64	305.27	390.12	5640	17964.73	433.54	1091.4	0	381	523.07	366.11	224.17	24.71	0	100	159.5											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0			0	Eff. Copay 00 to 00		0	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.71	29.09	8.04	0	21.1	10	10	10	0	0	0	0											N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.71	29.09	8.04	0	21.1	10	10	10	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.56	1.05	0.73	-	0.67	0.44	0.31	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.56	1.05	0.73	-	0.67	0.44	0.31	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.94
H1032_087_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1509.36	27.95	1474.48	2475.12	399.31	21839.68	22528.05	356.81	259.07	2310.1	963.22	0	52.28	588.17	9761.67	14558.76	291.05	371.96	5377.43	17128.38	414.2	1041	0	381	498.72	349.06	213.74	23.56	0	100	157.66											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 00 to 20 coins.	0	Eff. Copay 00 to 00		0	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	0											0	0	0	0	0	0	0.35	0	0	0	0	0	0	0	0	0	0	0	0	1.71	28.92	8.04	0	21.1	10	10	10	0	0	0	0											N/A	0	0	0	0	0	0	0.35	0	0	0	0	0	0	0	0	0	0	0	0	1.71	28.92	8.04	0	21.1	10	10	10	0	0	0	0												-	-	-	-	-	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	2.45	1	0.7	-	0.67	0.42	0.29	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.35	-	-	-	-	-	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	2.45	1	0.7	-	0.67	0.42	0.29	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.35
H1032_088_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1888.48	36.31	1079.13	3311.6	436.27	23965.02	24706.35	387.8	279.78	2515.54	1048.01	0	55.95	630.96	12117.46	18142.68	415.99	527.51	6664.17	23671.58	443.22	1238.25	0	381	604.45	361.21	259.05	24.33	0	100	164.69											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 00 to 20 coins.	0	Eff. Copay 00 to 00		0	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	0											0	0	0	0	0	0	0.38	0	0	0	0	0	0	0	0	0	0	0	0	1.82	39.46	8.24	0	21.1	10	10	10	0	0	0	0											N/A	0	0	0	0	0	0	0.38	0	0	0	0	0	0	0	0	0	0	0	0	1.82	39.46	8.24	0	21.1	10	10	10	0	0	0	0												-	-	-	-	-	-	0.79	-	-	-	-	-	-	-	-	-	-	-	-	3.58	1.46	0.85	-	0.67	0.5	0.3	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.37	-	-	-	-	-	-	0.79	-	-	-	-	-	-	-	-	-	-	-	-	3.58	1.46	0.85	-	0.67	0.5	0.3	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.37
H1032_089_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1609.06	30.33	1259.68	2939.27	406.14	22272.7	23030.9	418.06	300.85	2713.85	1130.27	0	59.94	676.67	12314.55	18380.13	423.56	536.98	6890.43	23800.93	474.85	1315.6	0	381	640.45	360.99	274.48	24.32	0	100	167.14											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0		Eff. copay 00 to 20 coins.	0	Eff. Copay 00 to 00		0	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	0											0	0	0	0	0	0	0.35	0	0	0	0	0	0	0	0	0	0	0	0	1.77	35.99	8.22	0	21.1	10	10	10	0	0	0	0											N/A	0	0	0	0	0	0	0.35	0	0	0	0	0	0	0	0	0	0	0	0	1.77	35.99	8.22	0	21.1	10	10	10	0	0	0	0												-	-	-	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	3.52	1.42	0.9	-	0.67	0.53	0.3	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.24	-	-	-	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	3.52	1.42	0.9	-	0.67	0.53	0.3	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.24
H1032_091_0	2006											4000											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1150.1	22.18	1014.42	1678.62	328.34	18126.82	18657.92	220.48	197.07	1685.03	659.16	0	39.05	441.51	6866.63	10217.11	181.42	230.96	4041.64	12196.17	309.38	764.56	0	381	362.65	260.41	155.42	17.49	0	100	26.92											0	0	50 days 8 to 100	10	100		Eff. copay 20 coins.	50	50	Eff. copay 0 to 20	Eff. copay 15 to 75	0		Eff. copay 0 to 25	Eff. Copay 0 to 25	Eff. copay 0 to 25	Eff. copay 10 to 20	25		Eff. copay 20 coins. 0 to 25 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10		0	0	Eff. copay 0 to 50											0	0	37.93	10	100	0	1.3	50	50	4.17	29.63	0	0	1.24	0.64	13.97	19	25	0	3.43	30.41	8.01	0	21.1	10	10	10	0	0	0	1.56											4000	0	0	36.61	9.65	96.5	0	1.25	48.25	48.25	4.03	28.59	0	0	1.2	0.61	13.49	18.34	24.13	0	3.31	29.35	7.73	0	20.36	9.65	9.65	9.65	0	0	0	1.51												-	-	3.09	1.35	2.64	-	1.95	0.89	0.79	0.57	1.57	-	-	0.04	0.35	11.48	0.28	0.46	-	3.37	0.76	0.49	-	0.65	0.29	0.21	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	31.36	-	-	3.09	1.35	2.64	-	1.95	0.89	0.79	0.57	1.57	-	-	0.04	0.35	11.48	0.28	0.46	-	3.37	0.76	0.49	-	0.65	0.29	0.21	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	31.36
H1032_092_0	2006											4000											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1135.6	22.06	975.22	1610.24	325.31	17984.02	18507.67	217.14	194.46	1665.61	650.67	0	38.41	434.68	6794.36	10118.36	179.54	228.26	4014.19	12123.4	304.32	753.64	0	381	357.24	255.69	153.1	17.16	0	100	26.41											0	0	50 days 8 to 100	10	100		Eff. copay 20 coins.	50	50	Eff. copay 0 to 20	Eff. copay 15 to 75			Eff. copay 0 to 25	Eff. Copay 0 to 25	Eff. copay 0 to 25	Eff. copay 10 to 20	25		Eff. copay 20 coins. 0 to 25 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10		0	0	Eff. copay 0 to 50											0	0	37.93	10	100	0	1.28	50	50	4.15	29.62	0	0	1.24	0.64	14.43	19	25	0	3.53	30.01	8.01	0	21.1	10	10	10	0	0	0	1.56											4000	0	0	36.65	9.66	96.62	0	1.24	48.31	48.31	4.01	28.62	0	0	1.2	0.61	13.95	18.36	24.16	0	3.41	28.99	7.74	0	20.39	9.66	9.66	9.66	0	0	0	1.51												-	-	2.98	1.3	2.62	-	1.9	0.87	0.78	0.56	1.55	-	-	0.04	0.35	11.76	0.27	0.46	-	3.44	0.74	0.49	-	0.65	0.29	0.21	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	31.38	-	-	2.98	1.3	2.62	-	1.9	0.87	0.78	0.56	1.55	-	-	0.04	0.35	11.76	0.27	0.46	-	3.44	0.74	0.49	-	0.65	0.29	0.21	0.12	-	-	-	0	-	-	-	-	-	-	-	-	-	-	31.38
H1032_093_0	2006											4000											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1153.31	22.12	1021.33	1697.46	329.79	18188.85	18724.5	222.62	198.7	1696.83	664.44	0	39.47	445.91	6903.19	10262.57	182.37	232.41	4052.18	12220.43	312.66	770.98	0	381	365.81	263.29	156.78	17.7	0	100	27.23											0	0	50 days 8 to 100	10	100		Eff. copay 20 coins.	50	50	Eff. copay 0 to 20	Eff. copay 15 to 75	0		Eff. copay 0 to 25	Eff. Copay 0 to 25	Eff. copay 0 to 25	Eff. copay 10 to 20	25		Eff. copay 20 coins. 0 to 25 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10		0	0	Eff. copay 0 to 50											0	0	37.93	10	100	0	1.31	50	50	4.19	29.64	0	0	1.24	0.64	14.57	19	25	0	3.59	30.71	8	0	21.1	10	10	10	0	0	0	1.56											4000	0	0	36.58	9.64	96.42	0	1.26	48.21	48.21	4.04	28.57	0	0	1.19	0.61	14.05	18.32	24.11	0	3.46	29.61	7.72	0	20.35	9.64	9.64	9.64	0	0	0	1.51												-	-	3.11	1.36	2.65	-	1.97	0.89	0.8	0.57	1.58	-	-	0.04	0.35	12.02	0.28	0.47	-	3.53	0.77	0.5	-	0.65	0.29	0.21	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	32.18	-	-	3.11	1.36	2.65	-	1.97	0.89	0.8	0.57	1.58	-	-	0.04	0.35	12.02	0.28	0.47	-	3.53	0.77	0.5	-	0.65	0.29	0.21	0.13	-	-	-	0	-	-	-	-	-	-	-	-	-	-	32.18
H1032_094_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	900.06	16.28	790.01	1382.87	265.68	14527.26	14972.74	195.76	164.61	1366.31	539.98	0	33.32	374.51	5459.6	8164.73	145.58	187.16	3137.6	9466.27	263.95	641.53	0	0	0	0	0	0	0	100	23.25											250 days 1 to 5	250 days 1 to 5	114 days 21 to 100	10	100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. Copay 150 to 200	Eff. copay 0 to 35	Eff. copay 15 to 75	0		Eff. copay 0 to 150	Eff. Copay 0 to 35	Eff. copay 0 to 40	Eff. copay 25 to 35	40		Eff. copay 20 coins. 0 to 40	Eff. copay 20 coins.	Eff. copay 0 to 10							0	0	Eff. copay 20 coins.											156.77	221.09	54.11	10	100	0	1.25	36.66	183.33	7.68	29.69	0	0	7.33	8.21	20.58	34	40	0	4.02	29.22	7.97	0	0	0	0	0	0	0	0	1.15											N/A	156.77	221.09	54.11	10	100	0	1.25	36.66	183.33	7.68	29.69	0	0	7.33	8.21	20.58	34	40	0	4.02	29.22	7.97	0	0	0	0	0	0	0	0	1.15												11.76	0.3	3.56	1.15	2.21	-	1.56	0.6	2.51	0.87	1.34	-	-	0.23	3.73	14	0.41	0.62	-	3.17	0.64	0.43	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	49.11	11.76	0.3	3.56	1.15	2.21	-	1.56	0.6	2.51	0.87	1.34	-	-	0.23	3.73	14	0.41	0.62	-	3.17	0.64	0.43	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	49.11
H1032_095_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	876.49	15.85	749.14	1316.47	260.43	14240.5	14677.3	192.26	161.43	1339.94	529.55	0	32.67	367.29	5351.93	8003.88	142.71	183.46	3075.66	9279.41	258.85	628.92	0	0	0	0	0	0	0	100	22.79											250 days 1 to 5	250 days 1 to 5	114 days 21 to 100	10	100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. Copay 150 to 200	Eff. copay 0 to 35	Eff. copay 15 to 75	0		Eff. copay 0 to 150	Eff. Copay 0 to 35	Eff. copay 0 to 40	Eff. copay 25 to 35	40		Eff. copay 20 coins. 0 to 40	Eff. copay 20 coins.	Eff. copay 0 to 10							0	0	Eff. copay 20 coins.											151.57	213.77	54.11	10	100	0	1.24	36.25	183.33	7.68	29.69	0	0	7.33	8.19	19.67	34	40	0	4.37	28.88	7.97	0	0	0	0	0	0	0	0	1.14											N/A	151.57	213.77	54.11	10	100	0	1.24	36.25	183.33	7.68	29.69	0	0	7.33	8.19	19.67	34	40	0	4.37	28.88	7.97	0	0	0	0	0	0	0	0	1.14												11.07	0.28	3.38	1.1	2.17	-	1.51	0.58	2.47	0.86	1.31	-	-	0.22	3.65	13.12	0.4	0.61	-	3.38	0.62	0.42	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	47.16	11.07	0.28	3.38	1.1	2.17	-	1.51	0.58	2.47	0.86	1.31	-	-	0.22	3.65	13.12	0.4	0.61	-	3.38	0.62	0.42	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	47.16
H1032_096_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	902.12	16.32	794.06	1389.91	266.19	14555.24	15001.69	196.1	165	1369.54	541.25	0	33.4	375.4	5470.06	8180.3	145.86	187.52	3143.64	9484.51	264.57	642.82	0	0	0	0	0	0	0	100	23.3											250 days 1 to 5	250 days 1 to 5	114 days 21 to 100	10	100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. Copay 150 to 200	Eff. copay 0 to 35	Eff. copay 15 to 75	0		Eff. copay 0 to 150	Eff. Copay 0 to 35	Eff. copay 0 to 40	Eff. copay 25 to 35	40		Eff. copay 20 coins. 0 to 40	Eff. copay 20 coins.	Eff. copay 0 to 10							0	0	Eff. copay 20 coins.											165.64	233.6	54.11	10	100	0	1.26	36.84	183.33	7.68	29.69	0	0	7.33	8.21	19.41	34	40	0	3.87	29.38	7.97	0	0	0	0	0	0	0	0	1.15											N/A	165.64	233.6	54.11	10	100	0	1.26	36.84	183.33	7.68	29.69	0	0	7.33	8.21	19.41	34	40	0	3.87	29.38	7.97	0	0	0	0	0	0	0	0	1.15												12.45	0.32	3.58	1.16	2.22	-	1.57	0.6	2.52	0.88	1.34	-	-	0.23	3.74	13.23	0.41	0.63	-	3.06	0.65	0.43	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	49.02	12.45	0.32	3.58	1.16	2.22	-	1.57	0.6	2.52	0.88	1.34	-	-	0.23	3.74	13.23	0.41	0.63	-	3.06	0.65	0.43	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	49.02
H1032_097_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	880.96	15.84	807.46	1374.83	261.04	14266.78	14718.78	203.57	170.25	1414.55	558.49	0	34.38	386.72	5742.57	9179.03	175.78	224.91	3432.52	10601.08	272.39	692.61	0	0	0	0	0	0	0	100	25.15											250 days 1 to 5	250 days 1 to 5	114 days 21 to 100	10	100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. Copay 150 to 200	Eff. copay 0 to 35	Eff. copay 15 to 75			Eff. copay 0 to 150	Eff. Copay 0 to	Eff. copay 0 to 40	Eff. copay 25 to 35	40		Eff. copay 20 coins. 0 to 40	Eff. copay 20 coins.	Eff. copay 0 to 10							0	0	Eff. copay 20 coins.											151.82	214.12	54.11	10	100	0	1.16	34.96	183.33	7.66	29.69	0	0	7.34	8.64	20.42	34	40	0	4.25	27.83	8.06	0	0	0	0	0	0	0	0	1.06											N/A	151.82	214.12	54.11	10	100	0	1.16	34.96	183.33	7.66	29.69	0	0	7.34	8.64	20.42	34	40	0	4.25	27.83	8.06	0	0	0	0	0	0	0	0	1.06												11.15	0.28	3.64	1.15	2.18	-	1.42	0.59	2.6	0.9	1.38	-	-	0.24	4.13	15.62	0.5	0.75	-	3.75	0.63	0.47	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	51.37	11.15	0.28	3.64	1.15	2.18	-	1.42	0.59	2.6	0.9	1.38	-	-	0.24	4.13	15.62	0.5	0.75	-	3.75	0.63	0.47	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	51.37
H1032_098_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	868.74	15.76	803.31	1407.82	267.34	14624.9	15017.3	150.69	131.74	1086.17	432.12	0	27.06	302.96	5200.67	7934.26	145.17	186.59	3145.55	9770.56	214.37	605.87	0	0	0	0	0	0	0	100	22.8											250 days 1 to 5	250 days 1 to 5	100 days 15 to 100		100		Eff. copay 20 coins.	50	Eff. Copay 100 to 150	Eff. copay 0 to 30	Eff. copay 15 to 75			Eff. copay 0 to 100	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 10 to 30	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.	Eff. copay 0 to 10							0	0	Eff. copay 0 to 50											211.38	210.61	58.72	0	100	0	1.21	50	133.33	6.73	29.72	0	0	4.83	7.54	30.05	28	35	0	9.36	33.75	8.26	0	0	0	0	0	0	0	0	1.63											N/A	211.38	210.61	58.72	0	100	0	1.21	50	133.33	6.73	29.72	0	0	4.83	7.54	30.05	28	35	0	9.36	33.75	8.26	0	0	0	0	0	0	0	0	1.63												15.3	0.28	3.93	-	2.23	-	1.51	0.63	1.46	0.61	1.07	-	-	0.12	3.27	19.87	0.34	0.54	-	7.62	0.6	0.42	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.8	15.3	0.28	3.93	-	2.23	-	1.51	0.63	1.46	0.61	1.07	-	-	0.12	3.27	19.87	0.34	0.54	-	7.62	0.6	0.42	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.8
H1032_100_0	2006											1500											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2013.57	40.26	1668.88	2598.8	445.96	24721.54	25529.36	358.65	323.7	2852.73	1151.34	0	63.14	716.95	10425.71	15257.56	275.83	349.21	6486.11	17980.55	500.19	1117.88	0	381	514.04	354.7	220.3	23.76	0	100	37.58											50 days 1 to 5	50 days 1 to 5	50 days 8 to 100				Eff. copay 20 coins.	50	Eff. Copay 25 to 50	Eff. copay 0 to 15	Eff. copay 0 to 50			Eff. copay 0 to 25	Eff. Copay 0 to 15	Eff. copay 0 to 15	Eff. copay 05 to 15	15		Eff. copay 20 coins. 0 to 15 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											32.49	32.37	37.93	0	0	0	1.26	50	41.67	2.99	11.74	0	0	1.25	0.31	8.12	14	15	0	2.61	27.61	7.8	0	21.1	10	10	10	0	0	0	0.36											1500	24.22	24.13	28.27	0	0	0	0.94	37.27	31.06	2.23	8.75	0	0	0.93	0.23	6.05	10.43	11.18	0	1.94	20.58	5.81	0	15.73	7.45	7.45	7.45	0	0	0	0.27												4.06	0.08	3.93	-	-	-	2	1.11	0.84	0.53	0.84	-	-	0.06	0.2	7.69	0.24	0.33	-	2.91	0.86	0.54	-	0.5	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	27.41	4.06	0.08	3.93	-	-	-	2	1.11	0.84	0.53	0.84	-	-	0.06	0.2	7.69	0.24	0.33	-	2.91	0.86	0.54	-	0.5	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	27.41
H1032_101_0	2006											1500											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1872.37	36.93	1505.84	2391.21	433.86	23978.15	24768.44	350.67	315.28	2767.22	1118.43	0	61.88	701.48	10122.17	14801.29	267.68	339.85	6238.95	17320.43	490.25	1095.36	0	381	504.94	351.53	216.4	23.59	0	100	37.23											50 days 1 to 5	50 days 1 to 5	50 days 8 to 100				Eff. copay 20 coins.	50	Eff. Copay 25 to 50	Eff. copay 0 to 15	Eff. copay 0 to 50			Eff. copay 0 to 25	Eff. Copay 0 to 15	Eff. copay 0 to 15	Eff. copay 05 to 15	15		Eff. copay 20 coins. 0 to 15 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											32.49	32.37	37.93	0	0	0	1.21	50	41.67	3.02	11.77	0	0	1.25	0.37	8.15	14	15	0	2.55	26.66	7.8	0	21.1	10	10	10	0	0	0	0.36											1500	24.65	24.56	28.78	0	0	0	0.92	37.93	31.61	2.29	8.93	0	0	0.95	0.28	6.18	10.62	11.38	0	1.93	20.23	5.91	0	16.01	7.59	7.59	7.59	0	0	0	0.27												3.85	0.08	3.61	-	-	-	1.9	1.11	0.83	0.53	0.83	-	-	0.06	0.24	7.62	0.24	0.32	-	2.79	0.83	0.54	-	0.51	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	26.54	3.85	0.08	3.61	-	-	-	1.9	1.11	0.83	0.53	0.83	-	-	0.06	0.24	7.62	0.24	0.32	-	2.79	0.83	0.54	-	0.51	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	26.54
H1032_102_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1883.95	37.42	2206.98	2353.47	438.19	24274.56	25020.88	320.59	288.56	2641.59	1072.75	0	56.54	641.18	10900.3	15931.78	325.07	411.1	6373.11	18901.47	447.88	1125.62	0	381	533.76	366.1	228.76	24.52	0	100	39.01																	Eff. copay 20 coins.	50			Eff. Copay 0 to 50									Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.22	50	0	0	11.6	0	0	0	0	0	0	0	0	1.74	26.88	8.04	0	21.1	10	10	10	0	0	0	0.37											N/A	0	0	0	0	0	0	1.22	50	0	0	11.6	0	0	0	0	0	0	0	0	1.74	26.88	8.04	0	21.1	10	10	10	0	0	0	0.37												-	-	-	-	-	-	2.53	1.34	-	-	1.04	-	-	-	-	-	-	-	-	2.75	1	0.75	-	0.67	0.44	0.31	0.19	-	-	-	0	-	-	-	-	-	-	-	-	-	-	11.02	-	-	-	-	-	-	2.53	1.34	-	-	1.04	-	-	-	-	-	-	-	-	2.75	1	0.75	-	0.67	0.44	0.31	0.19	-	-	-	0	-	-	-	-	-	-	-	-	-	-	11.02
H1032_104_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1935.15	38.39	2367.11	3204.03	463.48	25676.13	26570.84	409.15	369.57	3142.92	1220.73	0	71.99	817.78	11278.82	17950.96	379.38	479.02	7383.74	21220.58	570.32	1286.29	0	381	592.61	386.57	253.97	25.89	0	100	43.16											200 days 1 to 5	200 days 1 to 5	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	100	Eff. copay 0 to 25	Eff. copay 15 to 75			Eff. copay 0 to 50	Eff. Copay 0 to 25	Eff. copay 0 to 25	Eff. copay 15 to 25	25		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											129.98	129.5	75.87	0	100	0.9	1.22	50	100	5.15	29.59	0	0	2.51	4.09	13.91	24	25	0	3.61	26.3	7.82	0	21.1	10	10	10	0	0	0	0.38											N/A	129.98	129.5	75.87	0	100	0.9	1.22	50	100	5.15	29.59	0	0	2.51	4.09	13.91	24	25	0	3.61	26.3	7.82	0	21.1	10	10	10	0	0	0	0.38												20.96	0.41	14.97	-	3.86	1.93	2.71	1.7	3.08	1.35	3.01	-	-	0.17	3.84	20.81	0.76	1	-	6.39	1.25	0.84	-	0.67	0.49	0.32	0.21	-	-	-	0	-	-	-	-	-	-	-	-	-	-	90.74	20.96	0.41	14.97	-	3.86	1.93	2.71	1.7	3.08	1.35	3.01	-	-	0.17	3.84	20.81	0.76	1	-	6.39	1.25	0.84	-	0.67	0.49	0.32	0.21	-	-	-	0	-	-	-	-	-	-	-	-	-	-	90.74
H1032_106_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1696.09	33.34	1843.38	2901.18	501.35	27794.01	28463.86	244.68	218.4	1901.85	748.41	0	43.38	490.12	9971.32	15150.78	288.71	365.88	6353.47	19851.56	343.65	1058.55	0	381	525.12	396.83	225.05	26.58	0	100	38.64											25 days 1 to 5	25 days 1 to 5	50 days 15 to 100		50		Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 10	Eff. copay 15 to 75			Eff. copay 0 to 100	Eff. Copay 0 to 25	Eff. copay 0 to 10	Eff. copay 0 to 10	10		Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											16.25	16.19	29.36	0	50	0	1.25	50	116.67	2.05	29.6	0	0	4.95	0.38	5.9	9	10	0	2.32	36.17	8.4	0	21.1	10	10	10	0	0	0	0.4											N/A	16.25	16.19	29.36	0	50	0	1.25	50	116.67	2.05	29.6	0	0	4.95	0.38	5.9	9	10	0	2.32	36.17	8.4	0	21.1	10	10	10	0	0	0	0.4												2.3	0.04	4.51	-	2.09	-	2.98	1.02	2.12	0.33	1.85	-	-	0.2	0.31	7.45	0.22	0.3	-	3.83	1.04	0.74	-	0.67	0.44	0.33	0.19	-	-	-	0	-	-	-	-	-	-	-	-	-	-	32.95	2.3	0.04	4.51	-	2.09	-	2.98	1.02	2.12	0.33	1.85	-	-	0.2	0.31	7.45	0.22	0.3	-	3.83	1.04	0.74	-	0.67	0.44	0.33	0.19	-	-	-	0	-	-	-	-	-	-	-	-	-	-	32.95
H1032_107_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2522.19	50.83	1270.35	3352.08	531.91	29527.1	30363.68	435.8	309.83	2839.2	1180.65	0	60.63	687.86	13590.19	19964.6	490.25	617.81	7604.81	28291.87	480.32	1393.08	0	381	680.76	387.55	291.75	25.95	0	100	44.65																	Eff. copay 00 to 20 coins.													Eff. copay 20 coins.	Eff. copay 20 coins.																					0	0	0	0	0	0	0.44	0	0	0	0	0	0	0	0	0	0	0	0	1.89	48.73	0	0	0	0	0	0	0	0	0	0											N/A	0	0	0	0	0	0	0.44	0	0	0	0	0	0	0	0	0	0	0	0	1.89	48.73	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	1.12	-	-	-	-	-	-	-	-	-	-	-	-	4.45	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.53	-	-	-	-	-	-	1.12	-	-	-	-	-	-	-	-	-	-	-	-	4.45	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.53
H1032_111_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1275.77	24.79	929.38	1779.39	330.16	18222.78	18815.92	260.93	234.11	1980.74	772.95	0	46.11	522.16	7403.56	11658.1	211.84	269.06	4542.01	12619.87	365.26	875.26	0	381	411.25	270.72	176.25	18.18	0	100	30.29											50 days 1 to 5	50 days 1 to 5	50 days 8 to 25		100		Eff. copay 20 coins.	50	Eff. Copay 00 to 250	Eff. copay 0 to 30	Eff. copay 15 to 75	0		Eff. copay 00 coins.	Eff. Copay 0 to	Eff. copay 0 to 35	Eff. copay 20 to 30	35		Eff. copay 20 coins. 0 to 35 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10		0	0	Eff. copay 0 to 50											32.49	32.37	18.02	0	100	0	1.28	50	166.67	6.28	29.61	0	0	0	0.93	19.62	29	35	0	4.69	26.27	7.94	0	21.1	10	10	10	0	0	0	1.44											N/A	32.49	32.37	18.02	0	100	0	1.28	50	166.67	6.28	29.61	0	0	0	0.93	19.62	29	35	0	4.69	26.27	7.94	0	21.1	10	10	10	0	0	0	1.44												3.45	0.07	1.4	-	2.75	-	2	1.09	3.25	1.04	1.91	-	-	-	0.57	19.06	0.51	0.78	-	4.93	0.8	0.58	-	0.67	0.34	0.23	0.15	-	-	-	0	-	-	-	-	-	-	-	-	-	-	45.58	3.45	0.07	1.4	-	2.75	-	2	1.09	3.25	1.04	1.91	-	-	-	0.57	19.06	0.51	0.78	-	4.93	0.8	0.58	-	0.67	0.34	0.23	0.15	-	-	-	0	-	-	-	-	-	-	-	-	-	-	45.58
H1032_112_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	974.5	18.06	715.83	1411.57	260.76	14267.32	14743.08	208.89	185.38	1555.09	611.61	0	37.17	418.86	5837.1	9082.46	176.39	225.58	3480.04	9763.94	294.44	699.66	0	0	0	0	0	0	0	100	24.87											50 days 1 to 6	50 days 1 to 6	50 days 15 to 100		100		Eff. copay 20 coins.	50	Eff. Copay 50 to 100	Eff. copay 0 to 10	Eff. copay 15 to 75	0		Eff. copay 0 to 50	Eff. Copay 0 to	Eff. copay 0 to 35	Eff. copay 00 to 10	15		Eff. copay 20 coins. 0 to 15	Eff. copay 20 coins.	Eff. copay 0 to 10							0	0	Eff. copay 0 to 50											40.11	39.96	29.36	0	100	0	1.23	50	83.33	2.15	29.65	0	0	2.46	0.47	19.27	9	15	0	3.3	25.47	7.93	0	0	0	0	0	0	0	0	1.47											N/A	40.11	39.96	29.36	0	100	0	1.23	50	83.33	2.15	29.65	0	0	2.46	0.47	19.27	9	15	0	3.3	25.47	7.93	0	0	0	0	0	0	0	0	1.47												3.26	0.06	1.75	-	2.17	-	1.52	0.87	1.29	0.28	1.51	-	-	0.09	0.23	14.58	0.13	0.28	-	2.68	0.62	0.46	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	31.79	3.26	0.06	1.75	-	2.17	-	1.52	0.87	1.29	0.28	1.51	-	-	0.09	0.23	14.58	0.13	0.28	-	2.68	0.62	0.46	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	31.79
H1032_113_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1160.99	21.94	864.17	1656.64	305.56	16776.76	17330.89	243.49	217.03	1959.05	798.19	0	43.21	487.86	7411.56	11359.46	229.45	292.17	4519.55	12382.57	342.28	815.97	0	381	384.46	258.3	164.77	17.4	0	100	28.7																	Eff. copay 0 to 20 coins.	50	Eff. Copay 0 to 35		Eff. copay 0 to 50			Eff. Copay 0 to 35				10		Eff. copay 20 coins. 0 to 10	Eff. copay 20 coins.	Eff. copay 0 to 10		21.102362	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.26	50	27.63	0	11.67	0	0	13.82	0	0	0	10	0	4.31	26.08	7.93	0	21.1	10	10	10	0	0	0	1.46											N/A	0	0	0	0	0	0	1.26	50	27.63	0	11.67	0	0	13.82	0	0	0	10	0	4.31	26.08	7.93	0	21.1	10	10	10	0	0	0	1.46												-	-	-	-	-	-	1.83	1.01	0.5	-	0.78	-	-	0.56	-	-	-	0.24	-	4.44	0.74	0.54	-	0.67	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12	-	-	-	-	-	-	1.83	1.01	0.5	-	0.78	-	-	0.56	-	-	-	0.24	-	4.44	0.74	0.54	-	0.67	0.32	0.22	0.14	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12
H1032_114_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1809.93	35.46	1561.91	2855.06	453.72	25081.74	25897.36	359.58	323.27	2954.34	1200.23	0	63.46	719.32	11094.58	17136.68	348.7	441.52	6911.62	18852.54	502.73	1201.51	0	381	563.44	368.6	241.48	24.73	0	100	41.32																	Eff. copay 20 coins.	50			Eff. copay 0 to 50									Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10				Eff. copay 0 to 50											0	0	0	0	0	0	1.29	50	0	0	11.61	0	0	0	0	0	0	0	0	2	26.57	7.94	0	21.1	10	10	10	0	0	0	0.37											N/A	0	0	0	0	0	0	1.29	50	0	0	11.61	0	0	0	0	0	0	0	0	2	26.57	7.94	0	21.1	10	10	10	0	0	0	0.37												-	-	-	-	-	-	2.78	1.5	-	-	1.16	-	-	-	-	-	-	-	-	3.15	1.11	0.79	-	0.67	0.47	0.31	0.2	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.15	-	-	-	-	-	-	2.78	1.5	-	-	1.16	-	-	-	-	-	-	-	-	3.15	1.11	0.79	-	0.67	0.47	0.31	0.2	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.15
H1032_121_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1090.08	21.03	1055.19	1693.22	326.19	18023.44	18469.28	202.42	146.3	1312.33	546.86	0	29.33	330.57	6848.9	10335.25	207.68	263.76	4317.86	13402.5	232.38	701.04	0	381	347.41	263.57	148.89	17.69	0	100	25.81											0	0	0		0		Eff. copay 20 coins.	0	0		0	0		0	0		0			Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 10		21.1	10	10	10		0	0	0											0	0	0	0	0	0	1.24	0	0	0	0	0	0	0	0	0	0	0	0	1.47	35.32	8.37	0	21.1	10	10	10	0	0	0	0											N/A	0	0	0	0	0	0	1.24	0	0	0	0	0	0	0	0	0	0	0	0	1.47	35.32	8.37	0	21.1	10	10	10	0	0	0	0												-	-	-	-	-	-	1.91	-	-	-	-	-	-	-	-	-	-	-	-	1.65	0.68	0.49	-	0.67	0.29	0.22	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.03	-	-	-	-	-	-	1.91	-	-	-	-	-	-	-	-	-	-	-	-	1.65	0.68	0.49	-	0.67	0.29	0.22	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.03
H1034_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V	Coin	Coin	Coin	O	P	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	1292.42	82.49	628.69	1095.07	258.4	1.89	0.31	232.62	94.24	675.3	281.38	56.28	56.28	56.28	3963.08	3963.08	660.51	1321.03	660.51	0	0.09	0	0	653.11	1061.51	454.93	127.76	54.75	0	1051.13	0	109.86	37.7	264.21	396.31	1981.54						350 copay day 2-6	125 copay day 2+	75 for 9 to 100 days	20	75	20	20	50	300	11	13	50	22	0	0	40	40	40	13	0	20	0	0	0	0	0	0	0	0	0	0	22	150	10	10	11						199.34	98.14	37.26	20	75	0.2	0.2	50	300	10.68	12.5	50	22	0	0	40	40	40	12.5	0	0	0	0	0	0	0	0	0	0	0	0	22	150	10	10	10.68						N/A	199.34	98.14	37.26	20	75	0.2	0.2	50	300	10.68	12.5	50	22	0	0	40	40	40	12.5	0	0	0	0	0	0	0	0	0	0	0	0	22	150	10	10	10.68						0	21.47	0.67	1.95	1.83	1.62	0.38	0.06	0.97	2.36	0.6	0.29	0.23	0.1	-	-	13.21	2.2	4.4	0.69	-	-	-	-	-	-	-	-	-	-	-	-	0.2	0.47	0.22	0.33	1.76	-	-	-	-	-	56.02	21.47	0.67	1.95	1.83	1.62	0.38	0.06	0.97	2.36	0.6	0.29	0.23	0.1	-	-	13.21	2.2	4.4	0.69	-	-	-	-	-	-	-	-	-	-	-	-	0.2	0.47	0.22	0.33	1.76	-	-	-	-	-	56.02
H1034_003_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional	0	0	0	0	0	N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V	Coin	Coin	Coin	Coin	P	P	V	V	V	0	0	0	0	0	N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	1292.42	82.49	25.43	1365.57	5.61	1.93	0.32	342.33	64.12	760.9	317.04	63.41	63.41	63.41	4828.75	4828.75	804.79	29.29	804.79	0	0.09	0	0	667.28	1124.99	482.14	130.96	56.13	0	1051.13	0	112.25	42.75	321.92	482.87	2414.37	0	0	0	0	0	325 days 2-6	0 1; 100 2-190	50 for 8 to 100 days	10	50	12	20	50	200	5	20	20	22	0	0	35	30	20	25	0	20	0	0	0	0	0	0	0	0	0	0	22	100	10	10	5	0	0	0	0	0	173.7	78.51	26.28	10	50	0.12	0.2	50	200	5	20	20	22	0	0	35	30	20	25	0	0.2	0	0	0	0	0	0	0	0	0	0	22	100	10	10	5						N/A	173.7	78.51	26.28	10	50	0.12	0.2	50	200	5	20	20	22	0	0	35	30	20	25	0	0.2	0	0	0	0	0	0	0	0	0	0	22	100	10	10	5	0	0	0	0	0	0	18.71	0.54	0.06	1.14	0.02	0.23	0.06	1.43	1.07	0.32	0.53	0.11	0.12	-	-	14.08	2.01	0.05	1.68	-	0.02	-	-	-	-	-	-	-	-	-	-	0.21	0.36	0.27	0.4	1.01	-	-	-	-	-	44.4	18.71	0.54	0.06	1.14	0.02	0.23	0.06	1.43	1.07	0.32	0.53	0.11	0.12	-	-	14.08	2.01	0.05	1.68	-	0.02	-	-	-	-	-	-	-	-	-	-	0.21	0.36	0.27	0.4	1.01	-	-	-	-	-	44.4
H1034_004_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional	0	0	0	0	0	N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V	Coin	Coin	Coin	Coin	P	P	V	V	V	Coin	Coin	Coin	Coin	Coin	N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	1292.42	82.49	26.59	1386.23	6.62	2.16	0.36	346.61	7.67	651.04	271.27	54.25	54.25	54.25	4789.71	4789.71	798.28	31.87	798.28	0	0.1	0	0	681.56	1346.41	577.03	134.54	57.66	0	0	0	114.7	5.12	319.31	478.97	2394.85	0	0	0	0	0	225 Days 2-6	50 Days 2+	50 for 8 to 100 days	10	5000	5	20	50	10000	10	20	20	22	0	0	40	25	1500	2000	0	0.2	0.2	0	0	0	0	0	0	0	0	0	1200	0	0	10	10	0	0	0	0	0	120.26	39.26	26.28	10	50	0.05	0.2	50	100	10	20	20	22	0	0	40	25	15	20	0	0.2	0.2	0	0	0	0	0	0	0	0	0	12	0	0	10	10	0	0	0	0	0	N/A	120.26	39.26	26.28	10	50	0.05	0.2	50	100	10	20	20	22	0	0	40	25	15	20	0	0.2	0.2	0	0	0	0	0	0	0	0	0	12	0	0	10	10	0	0	0	0	0	0	12.95	0.27	0.06	1.16	0.03	0.11	0.07	1.44	0.06	0.54	0.45	0.09	0.1	-	-	15.97	1.66	0.04	1.33	-	0.02	-	-	-	-	-	-	-	-	-	-	0.11	-	-	0.4	2	-	-	-	-	-	38.86	12.95	0.27	0.06	1.16	0.03	0.11	0.07	1.44	0.06	0.54	0.45	0.09	0.1	-	-	15.97	1.66	0.04	1.33	-	0.02	-	-	-	-	-	-	-	-	-	-	0.11	-	-	0.4	2	-	-	-	-	-	38.86
H1034_005_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional	0	0	0	0	0	N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V	Coin	Coin	Coin	O	P	P	V	V	V	0	0	0	0	0	N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	1292.42	82.49	628.69	1095.07	258.4	1.89	0.31	232.62	94.24	675.3	281.38	56.28	56.28	56.28	3963.08	3963.08	660.51	1321.03	660.51	0	0.09	0	0	653.11	1061.51	454.93	127.76	54.75	0	1051.13	0	109.86	37.7	264.21	396.31	1981.54	0	0	0	0	0	150 2-7	175 1-90	0 1-4; 75 5-100	0	10000	5	20	35	40000	7	15	50	22	0	0	47	20	1500	1500	0	0.2	0.2	0	0	0	0	0	0	0	0	0	2200	20000	10	10	7.49123	0	0	0	0	0	86.73	175	52.66	0	100	0.05	0.2	35	400	7	15	50	22	0	0	47	20	15	15	0	0.2	0.2	0	0	0	0	0	0	0	0	0	22	200	10	10	7.49						N/A	86.73	175	52.66	0	100	0.05	0.2	35	400	7	15	50	22	0	0	47	20	15	15	0	0.2	0.2	0	0	0	0	0	0	0	0	0	22	200	10	10	7.49	0	0	0	0	0	0	9.34	1.2	2.76	-	2.15	0.09	0.06	0.68	3.14	0.39	0.35	0.23	0.1	-	-	15.52	1.1	1.65	0.83	-	0.02	-	-	-	-	-	-	-	-	-	-	0.2	0.63	0.22	0.33	1.24	-	-	-	-	-	42.25	9.34	1.2	2.76	-	2.15	0.09	0.06	0.68	3.14	0.39	0.35	0.23	0.1	-	-	15.52	1.1	1.65	0.83	-	0.02	-	-	-	-	-	-	-	-	-	-	0.2	0.63	0.22	0.33	1.24	-	-	-	-	-	42.25
H1034_006_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V	Coin	Coin	Coin	Coin	V	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	1292.42	82.49	1016.46	1365.57	204.27	1.93	0.32	342.33	64.12	760.9	317.04	63.41	63.41	63.41	4828.75	4828.75	804.79	1609.58	804.79	0	0.09	0	0	667.28	1124.99	482.14	130.96	56.13	0	1051.13	0	112.25	3.73	321.92	482.87	2414.37						125 2-6	175 1-90	50 for 5 to 100 days	0	7500	5	20	35	10000	7	20	20	22	0	0	20	20	2000	3500	0	0.2	0.2	0	0	0	0	0	0	0	0	0	2200	0	10	10	7						66.81	175	35.1	0	75	0.05	0.2	35	100	7	20	20	22	0	0	20	20	20	35	0	0.2	0.2	0	0	0	0	0	0	0	0	0	22	0	10	10	7						N/A	66.81	175	35.1	0	75	0.05	0.2	35	100	7	20	20	22	0	0	20	20	20	35	0	0.2	0.2	0	0	0	0	0	0	0	0	0	22	0	10	10	7						0	7.2	1.2	2.97	-	1.28	0.1	0.06	1	0.53	0.44	0.53	0.11	0.12	-	-	8.05	1.34	2.68	2.35	-	0.02	-	-	-	-	-	-	-	-	-	-	0.21	-	0.27	0.4	1.41	-	-	-	-	-	32.26	7.2	1.2	2.97	-	1.28	0.1	0.06	1	0.53	0.44	0.53	0.11	0.12	-	-	8.05	1.34	2.68	2.35	-	0.02	-	-	-	-	-	-	-	-	-	-	0.21	-	0.27	0.4	1.41	-	-	-	-	-	32.26
H1034_007_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional	0	0	0	0	0	N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab	0	0	0	0	0	D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V	Coin	Coin	Coin	Coin	P	P	V	V	V	Coin	Coin	Coin	Coin	Coin	N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	1292.42	82.49	1068.6	1386.23	219.69	2.16	0.36	346.61	88.34	651.04	271.27	54.25	54.25	54.25	4789.71	4789.71	798.28	1596.57	798.28	0	0.1	0	0	681.56	1346.41	577.03	134.54	57.66	0	0	0	114.7	5.12	319.31	478.97	2394.85	0	0	0	0	0	150 days 2-6	30 days 2+	50 for 8 to 100 days	0	35	5	20	50	100	7	20	20	22	0	0	12	20	20	20	0	20	0	0	0	0	0	0	0	0	0	0	12	0	0	10	7	0	0	0	0	0	76.05	23.55	26.28	0	35	0.05	0.2	50	100	7	20	20	22	0	0	12	20	20	20	0	0.2	0	0	0	0	0	0	0	0	0	0	12	0	0	10	7	0	0	0	0	0	N/A	76.05	23.55	26.28	0	35	0.05	0.2	50	100	7	20	20	22	0	0	12	20	20	20	0	0.2	0	0	0	0	0	0	0	0	0	0	12	0	0	10	7	0	0	0	0	0	0	8.19	0.16	2.34	-	0.64	0	0.07	1.44	0.74	0.38	0.45	0.09	0.1	-	-	4.79	1.33	2.66	1.33	-	0.02	-	-	-	-	-	-	-	-	-	-	0.11	-	-	0.4	1.4	-	-	-	-	-	26.65	8.19	0.16	2.34	-	0.64	0	0.07	1.44	0.74	0.38	0.45	0.09	0.1	-	-	4.79	1.33	2.66	1.33	-	0.02	-	-	-	-	-	-	-	-	-	-	0.11	-	-	0.4	1.4	-	-	-	-	-	26.65
H1035_002_0	2006											2960											D	D	D		T	Coin	coin	V	v		V	V			V	V	V	V	V	V	coin			V	V																	0																																										-	1501.81	32.61	651.21		146.96	1.43	0.48	569.82	397.63		218.18	22.85			3170.57	4491.38	138.39	690.3	206.28	779.49	4.15			249.89	355.86																																																										118.02	107.61	7.64		102.25	0.1	1.91	28.61	84.04		92.82	70.44			11.11	26.25	22.66	14.74	90.92	10.16	0.9			12.19	15.3																		116.27	106.02	7.53		100.74	0.1	1.88	28.19	82.8		91.44	69.4			10.95	25.86	22.33	14.52	89.57	10.01	0.89			12.01	15.08																		14.55	0.29	0.41	-	1.23	0.14	0.9	1.34	2.74	-	1.66	0.13	-	-	2.89	9.68	0.26	0.84	1.54	0.65	3.69	-	-	0.25	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.65	14.55	0.29	0.41	-	1.23	0.14	0.9	1.34	2.74	-	1.66	0.13	-	-	2.89	9.68	0.26	0.84	1.54	0.65	3.69	-	-	0.25	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.65
H1035_006_0	2006											2960											D	D	D		T	Coin	coin	V	v		V	V			V	V	V	V	V	V	coin			V	V																	0																																										-	1501.81	32.61	651.21		146.96	1.43	0.48	569.82	397.63		218.18	22.85			3170.57	4491.38	138.39	690.3	206.28	779.49	4.15			249.89	355.86																																																										118.02	107.61	7.64		102.25	0.1	1.91	28.61	84.04		92.82	70.44			11.11	26.25	22.66	14.74	90.92	10.16	0.9			12.19	15.3																		116.27	106.02	7.53		100.74	0.1	1.88	28.19	82.8		91.44	69.4			10.95	25.86	22.33	14.52	89.57	10.01	0.89			12.01	15.08																		14.55	0.29	0.41	-	1.23	0.14	0.9	1.34	2.74	-	1.66	0.13	-	-	2.89	9.68	0.26	0.84	1.54	0.65	3.69	-	-	0.25	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.65	14.55	0.29	0.41	-	1.23	0.14	0.9	1.34	2.74	-	1.66	0.13	-	-	2.89	9.68	0.26	0.84	1.54	0.65	3.69	-	-	0.25	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.65
H1035_007_0	2006											2960											D	D	D		T	Coin	coin	V	v		V	V			V	V	V	V	V	V	coin			V	V																	0																																										-	1501.81	32.61	651.21		146.96	1.43	0.48	569.82	397.63		218.18	22.85			3170.57	4491.38	138.39	690.3	206.28	779.49	4.15			249.89	355.86																																																										118.02	107.61	7.64		102.25	0.1	1.91	28.61	84.04		92.82	70.44			11.11	26.25	22.66	14.74	90.92	10.16	0.9			12.19	15.3																		116.27	106.02	7.53		100.74	0.1	1.88	28.19	82.8		91.44	69.4			10.95	25.86	22.33	14.52	89.57	10.01	0.89			12.01	15.08																		14.55	0.29	0.41	-	1.23	0.14	0.9	1.34	2.74	-	1.66	0.13	-	-	2.89	9.68	0.26	0.84	1.54	0.65	3.69	-	-	0.25	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.65	14.55	0.29	0.41	-	1.23	0.14	0.9	1.34	2.74	-	1.66	0.13	-	-	2.89	9.68	0.26	0.84	1.54	0.65	3.69	-	-	0.25	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.65
H1036_011_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2007.55	12.14	1002.2	2646.07	421.04	1.07	0.08	1317.83	993.65				0	958.72	10622.3	6936.26					4.45			1.95	356		230					22.81	0.18	18.72	0	0	0	0				100 per day (1-5)	100 per day (1-5)	0 per day (1-6) 50 per day (7-100)	0	50	0-20	0	20-50	50-150				0	0-150	0-25	20-25					0			0	25-Oct		0					1500 per admit	1500 per admit	0	0	0	0	0				60.55	68.02	26.94	0	50	0	0	44	83				0	18.45	0.49	19.38					0			0	5.36		0					1500	1500	0	0	0	0	0					60.55	68.02	26.94	0	50	0	0	44	83				0	18.45	0.49	19.38					0			0	5.36		0					1500	1500	0	0	0	0	0				0	10.13	0.07	2.25	-	1.75	0	-	4.83	6.87	-	-	-	-	1.47	0.43	11.2	-	-	-	-	-	-	-	-	0.16	-	-	-	-	-	-	2.85	0.02	-	-	-	-	-	-	-	-	42.06	10.13	0.07	2.25	-	1.75	0	-	4.83	6.87	-	-	-	-	1.47	0.43	11.2	-	-	-	-	-	-	-	-	0.16	-	-	-	-	-	-	2.85	0.02	-	-	-	-	-	-	-	-	42.06
H1036_025_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				2900	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1145.11	9.71	717.04	2106.5	199.57	0.92	129.86	1145.93	1073.86				38.1	334.9	7495.65	3536.66					4.45			1.95	356		230					60.27	0.51	7.22	0	0	0	0				50 per day (1-5)	50 per day (1-5)	0 per day (1-9) 50 per day (10-100)	0	100	0-20	0	20-50	100				0	0-100	0-75	20-75					10			0	Oct-59		0					50 per day (1-5)	50 per day (1-5)	10	0	0	0	0				15.51	34.01	13.72	0	83.58	0	0	36.65	70.51				0	15.08	1.23	17.58					0.1			0	36.13		0					28.33	34.01	0.08	0	0	0	0					15.51	34.01	13.72	0	83.58	0	0	36.65	70.51				0	15.08	1.23	17.58					10			0	36.13		0					28.33	34.01	0.08	0	0	0	0				0	1.48	0.03	0.82	-	1.39	0	-	3.5	6.31	-	-	-	-	0.42	0.77	5.18	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.14	0	0.6	-	-	-	-	-	-	-	22.16	1.48	0.03	0.82	-	1.39	0	-	3.5	6.31	-	-	-	-	0.42	0.77	5.18	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.14	0	0.6	-	-	-	-	-	-	-	22.16
H1036_034_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2245.1	12.84	1163.34	2857.09	471.01	0.75	0.06	1104.59	829.67				4.8	1148.17	11470.01	7489.42					4.45			1.95	356		230					24.57	0.14	9.53	0	0	0	0				50 per day (1-5)	50 per day (1-5)	0 per day (1-6) 25 per day (7-100)	0	50	0-20	0	20-50	25-75				0	0-50	0-25	0-25					0			0	0		0					1500 per admit	1500 per admit	0	0	0	0	0				34.01	34.01	14.55	0	50	0	0	44	41.5				0	15.2	0.49	0.49					0			0	0		0					1500	1500	0	0	0	0	0					29.94	34.01	3.09	0	29.55	0	0	44	41.5				0	15.32	0.49	0.49					0			0	0		0					1500	1500	0	0	0	0	0				0	5.6	0.04	0.3	-	1.16	0	-	4.05	2.87	-	-	-	-	1.47	0.47	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.07	0.02	-	-	-	-	-	-	-	-	19.35	5.6	0.04	0.3	-	1.16	0	-	4.05	2.87	-	-	-	-	1.47	0.47	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.07	0.02	-	-	-	-	-	-	-	-	19.35
H1036_035_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1576.8	11.3	1394.99	2464.18	338.27	0.52	0.04	1319.88	906.79				0	1167.52	9894.32	6458.83					4.45			1.95	356		230					21.48	0.17	10.38	0	0	0	0				100 per day (1-7)	100 per day (1-7)	0 per day (1-6) 75 per day (7-100)	0	100	0-20	0	20-50	100-200				0	0-150	0-10	25-Oct					0			0	20-25		0					1500 per admit	1500 per admit	0	0	0	0	0				54.66	77.96	43.61	0	100.04	0	0	44	133				0	17.89	0.2	16.87					0			0	6.89		0					1500	1500	0	0	0	0	0					54.66	77.96	43.61	0	100.04	0	0	44	133				0	17.89	0.2	16.87					0			0	6.89		0					1500	1500	0	0	0	0	0				0	7.18	0.07	5.07	-	2.82	0	-	4.84	10.05	-	-	-	-	1.74	0.16	9.08	-	-	-	-	-	-	-	-	0.2	-	-	-	-	-	-	2.68	0.02	-	-	-	-	-	-	-	-	43.93	7.18	0.07	5.07	-	2.82	0	-	4.84	10.05	-	-	-	-	1.74	0.16	9.08	-	-	-	-	-	-	-	-	0.2	-	-	-	-	-	-	2.68	0.02	-	-	-	-	-	-	-	-	43.93
H1036_037_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1589.84	11.4	1419.24	2125.86	381.38	0.76	0.06	1336.94	931.43				0	210.27	8155.77	5126.72					4.45			0	356		230					83.68	0.6	2.2	0	0	0	0				75 per day (1-5)	75 per day (1-5)	0 per day (1-6) 75 per day (7-100)	0	100	20	20	25-50	100				0	0-100	0	0-20					20				25-100		0					75 per day (1-5)	75 per day (1-5)	20	0	0	0	0				48.12	51.02	42.19	0	94.71	0.2	0.2	45	99.98				0	-25.25	0	19.61					0.2			0	42.34		0					51.02	51.02	0.2	0	0	0	0					48.12	51.02	42.19	0	94.71	0.2	0.2	45	99.98				0	-25.25	0	19.61					20			0	42.34		0					51.02	51.02	0.2	0	0	0	0				0	6.38	0.05	4.99	-	3.01	0.15	0.01	5.01	7.76	-	-	-	-	-0.44	-	8.38	-	-	-	-	0.89	-	-	-	1.26	-	-	-	-	-	-	0.36	0	0.44	-	-	-	-	-	-	-	38.24	6.38	0.05	4.99	-	3.01	0.15	0.01	5.01	7.76	-	-	-	-	-0.44	-	8.38	-	-	-	-	0.89	-	-	-	1.26	-	-	-	-	-	-	0.36	0	0.44	-	-	-	-	-	-	-	38.24
H1036_040_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				2900	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1158.32	9.82	725.32	2130.82	201.87	0.93	0.07	1159.16	1086.26				38.54	338.77	7582.18	3577.49					4.45			1.95	356		230					60.96	0.52	7.34	0	0	0	0				50 per day (1-5)	50 per day (1-5)	0 per day (1-9) 50 per day (10-100)	0	100	0-20	0	20-50	75-100				0	0-100	0-75	20-75					10			0	Oct-59		0					50 per day (1-5)	50 per day (1-5)	10	0	0	0	0				34.01	34.01	22.23	0	100	0	0	44	83.25				0	39.54	1.47	21.08					10			0	36.13		0					34.01	34.01	0.1	0	0	0	0					12.3	34.01	12.74	0	83.82	0	0	36.97	56.12				0	17.91	1.24	17.71					10			0	36.13		0					28.58	34.01	0.08	0	0	0	0				0	1.19	0.03	0.77	-	1.41	0	-	3.57	5.08	-	-	-	-	0.51	0.78	5.28	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.15	0	0.62	-	-	-	-	-	-	-	20.9	1.19	0.03	0.77	-	1.41	0	-	3.57	5.08	-	-	-	-	0.51	0.78	5.28	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.15	0	0.62	-	-	-	-	-	-	-	20.9
H1036_044_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1529.9	4.47	784.24	2015.97	158.46	0.22	0.02	1081.62	767.5				28.42	1241.49	5753.24	4625.07					4.45			0	356		230					80.52	0.24	3.56	0	0	0	0				100 per day (1-5)	100 per day (1-5)	0 per day (1-6) 75 per day (7-100)	0	100	20	20	25-50	75-100				0	0-100	May-50	25-50					20			0	May-39		0					100 per day (1-5)	100 per day (1-5)	20	0	0	0	0				57.4	68.02	34.73	0	100	0.2	0.2	45	78.33				0	1.4	5.88	25.49					0.2			0	17.49		0					68.02	68.02	0.2	0	0	0	0					57.4	68.02	34.73	0	100	0.2	0.2	45	78.33				0	1.4	5.88	25.49					20			0	17.49		0					68.02	68.02	0.2	0	0	0	0				0	7.32	0.03	2.27	-	1.32	0.04	0	4.06	5.01	-	-	-	-	0.14	2.82	9.82	-	-	-	-	0.89	-	-	-	0.52	-	-	-	-	-	-	0.46	0	0.71	-	-	-	-	-	-	-	35.42	7.32	0.03	2.27	-	1.32	0.04	0	4.06	5.01	-	-	-	-	0.14	2.82	9.82	-	-	-	-	0.89	-	-	-	0.52	-	-	-	-	-	-	0.46	0	0.71	-	-	-	-	-	-	-	35.42
H1036_047_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1401.6	7.18	744.54	2108.16	205.82	0.24	0.02	1134.96	903.56				166.64	725.06	5481.98	5059.48					4.45			1.95	356		230					73.77	0.38	11.63	0	0	0	0				100 per day (1-5)	100 per day (1-5)	0 per day (1-7) 50 per day (8-100)	0	100	0-20	0	40-50	150				0	0-150	0-50	20-50					20			0	Oct-50		0					100 per day (1-5)	100 per day (1-5)	20	0	0	0	0				42.9	68.02	26.56	0	100	0	0	48	138.39				0	44.72	0.98	20.59					0.2			0	21.56		0					68.02	68.02	0.2	0	0	0	0					42.9	68.02	26.56	0	100	0	0	48	138.39				0	44.72	0.98	20.59					20			0	21.56		0					68.02	68.02	0.2	0	0	0	0				0	5.01	0.04	1.65	-	1.72	0	-	4.54	10.42	-	-	-	-	2.7	0.45	8.68	-	-	-	-	0.89	-	-	-	0.64	-	-	-	-	-	-	0.42	0	2.33	-	-	-	-	-	-	-	39.48	5.01	0.04	1.65	-	1.72	0	-	4.54	10.42	-	-	-	-	2.7	0.45	8.68	-	-	-	-	0.89	-	-	-	0.64	-	-	-	-	-	-	0.42	0	2.33	-	-	-	-	-	-	-	39.48
H1036_052_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				2900	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1168	9.9	731.38	2148.61	203.56	0.9	132.46	1168.83	1095.33				38.87	341.6	7645.49	3607.35					4.45			1.95	356		230					61.47	0.52	7.12	0	0	0	0				50 per day (1-5)	50 per day (1-5)	0 per day (1-9) 50 per day (10-100)	0	100	0-20	0	15-50	50				0	0-50	0-50	15-50					10			0	Oct-59		0					50 per day (1-5)	50 per day (1-5)	10	0	0	0	0				34.01	34.01	22.23	0	100	0	0	43	50				0	13.47	0.98	15.69					10			0	36.13		0					34.01	34.01	0.1	0	0	0	0					29.8	34.01	19.48	0	87.63	0	0	37.68	43.82				0	11.8	0.86	13.75					10			0	36.13		0					29.8	34.01	0.09	0	0	0	0				0	2.9	0.03	1.19	-	1.49	0	-	3.67	4	-	-	-	-	0.34	0.55	4.13	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.15	0	0.62	-	-	-	-	-	-	-	20.59	2.9	0.03	1.19	-	1.49	0	-	3.67	4	-	-	-	-	0.34	0.55	4.13	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.15	0	0.62	-	-	-	-	-	-	-	20.59
H1036_053_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1901.42	11.5	1898.43	2506.18	398.78	0.96	0.07	1248.16	941.12				0	908.04	10060.74	6569.57					4.45			1.95	356		230					21.61	0.17	16.8	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0-20	0	0-25	0				0	0	0	0					0			0 - 0	0		0					1500 per admit (0-0)	1500 per admit (0-0)	0	0	0	0	0				0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	1500	0	0	0	0	0					0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	1500	0	0	0	0	0				0	-	-	-	-	-	0	-	2.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.7	0.02	-	-	-	-	-	-	-	-	4.81	-	-	-	-	-	0	-	2.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.7	0.02	-	-	-	-	-	-	-	-	4.81
H1036_054_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2265.13	12.96	1173.72	2882.58	475.21	0.76	0.06	1114.44	837.07				4.85	1158.42	11572.34	7556.24					4.45			1.95	356		230					24.79	0.14	9.7	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1-6) 25 per day (7-100)	0	0	0-20	0	20-50	25-50				0	0-25	0	0					0			0	0		0					1500 per admit	1500 per admit	0	0	0	0	0				0	0	14.55	0	0	0	0	44	33.25				0	9.95	0	0					0			0	0		0					1500	1500	0	0	0	0	0					0	0	14.55	0	0	0	0	44	33.25				0	9.95	0	0					0			0	0		0					1500	1500	0	0	0	0	0				0	-	-	1.42	-	-	0	-	4.09	2.32	-	-	-	-	0.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.1	0.02	-	-	-	-	-	-	-	-	11.91	-	-	1.42	-	-	0	-	4.09	2.32	-	-	-	-	0.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.1	0.02	-	-	-	-	-	-	-	-	11.91
H1036_056_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1410.84	4.12	1446.42	1858.34	142.87	0.19	0.01	975.24	692.01				26.2	1119.38	5303.38	4263.43					4.45			0	356		230					74.25	0.22	3.19	0	0	0	0				50 per day (1-5)	50 per day (1-5)	0 per day (1-6) 50 per day (7-100)	0	100	20	20	30-50	50-75				0	0-50	May-50	20-50					0.2				May-39		0					50 per day (1-5)	50 per day (1-5)	20	0	0	0	0				34.01	34.01	14.55	0	100	0.2	0.2	46	66.75				0	-1.49	5.88	20.59					0.2			0	17.49		0					34.01	34.01	0.2	0	0	0	0					34.01	34.01	14.55	0	100	0.2	0.2	46	66.75				0	-1.49	5.88	20.59					0.2			0	17.49		0					34.01	34.01	0.2	0	0	0	0				0	4	0.01	1.75	-	1.19	0.04	0	3.74	3.85	-	-	-	-	-0.14	2.6	7.31	-	-	-	-	0.89	-	-	-	0.52	-	-	-	-	-	-	0.21	0	0.64	-	-	-	-	-	-	-	26.62	4	0.01	1.75	-	1.19	0.04	0	3.74	3.85	-	-	-	-	-0.14	2.6	7.31	-	-	-	-	0.89	-	-	-	0.52	-	-	-	-	-	-	0.21	0	0.64	-	-	-	-	-	-	-	26.62
H1036_061_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2159.41	12.35	2237.88	2671.57	451.56	0.82	0.06	1058.98	795.41				4.49	1100.76	10725.24	7003.12					4.45			1.95	356		230					23.64	0.13	10.49	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0-20	0	0-25	0				0	0	0	0					0			0 - 0	0		0					1500 per admit (0-0)	1500 per admit (0-0)	0	0	0	0	0				0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	1500	0	0	0	0	0					0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	1500	0	0	0	0	0				0	-	-	-	-	-	0	-	1.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.95	0.02	-	-	-	-	-	-	-	-	4.74	-	-	-	-	-	0	-	1.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.95	0.02	-	-	-	-	-	-	-	-	4.74
H1036_062_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1533.2	10.99	1356.42	2396.05	328.92	0.49	0.04	1283.38	881.72				0	1135.24	9620.75	6280.25					4.45			1.95	356		230					20.88	0.16	9.82	0	0	0	0				25 per day (1-7)	25 per day (1-7)	0 per day (1-6) 25 per day (7-100)	0	50	0-20	0	20-50	50-150				0	0-50	0	0-10					0			0	0-10		0					1500 per admit	1500 per admit	0	0	0	0	0				9.72	19.49	7.25	0	50	0	0	44	83				0	11.9	0	2.45					0			0	1.53		0					1500	1500	0	0	0	0	0					9.72	19.49	7.25	0	50	0	0	44	83				0	11.9	0	2.45					0			0	1.53		0					1500	1500	0	0	0	0	0				0	1.24	0.02	0.82	-	1.37	0	-	4.71	6.1	-	-	-	-	1.13	-	1.28	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	2.61	0.02	-	-	-	-	-	-	-	-	19.34	1.24	0.02	0.82	-	1.37	0	-	4.71	6.1	-	-	-	-	1.13	-	1.28	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	2.61	0.02	-	-	-	-	-	-	-	-	19.34
H1036_063_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1487.72	10.66	2632.37	2324.97	319.16	0.46	0.03	1245.31	855.56				0	1101.56	9335.36	6093.95					4.45			1.95	356		230					20.26	0	9.24	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0-20	0	0-25	0				0	0	0	0					0			0 - 0	0		0					1500 per admit (0-0)	0 per day (0-0)	0	0	0	0	0				0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	0	0	0	0	0	0					0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	0	0	0	0	0	0				0	-	-	-	-	-	0	-	2.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.53	-	-	-	-	-	-	-	-	-	4.61	-	-	-	-	-	0	-	2.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.53	-	-	-	-	-	-	-	-	-	4.61
H1036_065_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1923.74	11.63	960.36	2535.6	403.46	0.98	0.07	1262.81	952.17				0	918.7	10178.83	6646.68					4.45			1.95	356		230					21.86	0.17	17.19	0	0	0	0				0 per day (1-7)	0 per day (1-7)	0 per day (1-6) 25 per day (7-100)	0	50	0-20	0	20-50	25-75				0	0-50	0-25	25-May					0			0	0-10		0					1500 per admit	1500 per admit	0	0	0	0	0				0	0	7.25	0	50	0	0	44	41.5				0	11.9	0.49	2.94					0			0	1.53		0					1500	1500	0	0	0	0	0					0	0	7.25	0	50	0	0	44	41.5				0	11.9	0.49	2.94					0			0	1.53		0					1500	1500	0	0	0	0	0				0	-	-	0.58	-	1.68	0	-	4.63	3.29	-	-	-	-	0.91	0.42	1.63	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	2.73	0.02	-	-	-	-	-	-	-	-	15.94	-	-	0.58	-	1.68	0	-	4.63	3.29	-	-	-	-	0.91	0.42	1.63	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	2.73	0.02	-	-	-	-	-	-	-	-	15.94
H1036_067_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				2900	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1081.01	9.17	676.91	1907.18	190	0.86	0.06	1090.96	1022.35				34.5	318.84	6786.4	3202.02					4.45			1.95	356		230					56.9	0.48	6.81	0	0	0	0				50 per day (1-5)	50 per day (1-5)	0 per day (1-9) 50 per day (10-100)	0	100	0-20	0	Oct-50	50				0	0-50	0-50	Oct-50					10			0	Oct-59		0					50 per day (1-5)	50 per day (1-5)	10	0	0	0	0				34.01	34.01	22.23	0	100	0	0	42	50				0	11.65	0.98	10.78					10			0	36.13		0					34.01	34.01	0.1	0	0	0	0					30.55	34.01	19.97	0	89.83	0	0	37.73	44.92				0	10.47	0.88	9.69					10			0	36.13		0					30.55	34.01	0.09	0	0	0	0				0	2.75	0.03	1.13	-	1.42	0	-	3.43	3.83	-	-	-	-	0.28	0.5	2.59	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.14	0	0.61	-	-	-	-	-	-	-	18.22	2.75	0.03	1.13	-	1.42	0	-	3.43	3.83	-	-	-	-	0.28	0.5	2.59	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.14	0	0.61	-	-	-	-	-	-	-	18.22
H1036_068_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1414.77	4.14	725.22	1862.09	137.15	0.21	0.02	936.18	664.29				26.25	1074.55	5314.09	4272.04					4.45			1.95	356		230					74.46	0.22	3.41	0	0	0	0				100 per day (1-5)	100 per day (1-5)	0 per day (1-6) 75 per day (7-100)	0	100	20	0	35-50	100				0	0-100	May-50	35-50					20			0	25-100		0					100 per day (1-5)	100 per day (1-5)	20	0	0	0	0				68.02	68.02	43.64	0	100	0.2	0	46.3	100				0	47.46	5.88	35.29					0.2			0	43.88		0					68.02	68.02	0.2	0	0	0	0					68.02	68.02	43.64	0	100	0.2	0	46.3	100				0	47.46	5.88	35.29					20			0	43.88		0					68.02	68.02	0.2	0	0	0	0				0	8.02	0.02	2.64	-	1.14	0.04	-	3.61	5.54	-	-	-	-	4.25	2.61	12.56	-	-	-	-	0.89	-	-	-	1.3	-	-	-	-	-	-	0.42	0	0.68	-	-	-	-	-	-	-	43.73	8.02	0.02	2.64	-	1.14	0.04	-	3.61	5.54	-	-	-	-	4.25	2.61	12.56	-	-	-	-	0.89	-	-	-	1.3	-	-	-	-	-	-	0.42	0	0.68	-	-	-	-	-	-	-	43.73
H1036_071_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1553.01	9.39	775.28	1896.82	323.91	0.91	0.07	1013.81	764.42				0	737.55	7614.54	4972.23					4.45			1.95	356		230					17.65	0.14	15.96	0	0	0	0				50 per day (1-5)	50 per day (1-5)	0 per day (1-6) 25 per day (7-100)	0	50	0-20	0	20-50	50-100				0	0-100	0-25	15-25					0			0	20-Oct		0					1500 per admit	1500 per admit	0	0	0	0	0				11.8	34.01	0	0	50	0	0	44	66.5				0	16.6	0.49	12.74					0			0	4.59		0					1500	1500	0	0	0	0	0					11.8	34.01	0	0	50	0	0	44	66.5				0	16.6	0.49	12.74					0			0	4.59		0					1500	1500	0	0	0	0	0				0	1.53	0.03	-	-	1.35	0	-	3.72	4.24	-	-	-	-	1.02	0.31	5.28	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	2.21	0.02	-	-	-	-	-	-	-	-	19.83	1.53	0.03	-	-	1.35	0	-	3.72	4.24	-	-	-	-	1.02	0.31	5.28	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	2.21	0.02	-	-	-	-	-	-	-	-	19.83
H1036_072_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1627.36	9.31	843.24	1896.79	338.06	0.63	0.05	792.79	595.48				3.19	824.08	7614.83	4972.16					4.45			1.95	356		230					17.81	0.1	8.04	0	0	0	0				25 per day (1-5)	25 per day (1-5)	0 per day (1-6) 25 per day (7-100)	0	25	0-20	0	20-50	25-75				0	0-50	0-25	0-25					0			0	0		0					1500 per admit	1500 per admit	0	0	0	0	0				17.01	17.01	14.55	0	11.71	0	0	44	41.5				0	14.7	0.49	0.49					0			0	0		0					1500	1500	0	0	0	0	0					17.01	17.01	14.55	0	11.71	0	0	44	41.5				0	14.7	0.49	0.49					0			0	0		0					1500	1500	0	0	0	0	0				0	2.31	0.01	1.02	-	0.33	0	-	2.91	2.06	-	-	-	-	1.01	0.31	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.23	0.01	-	-	-	-	-	-	-	-	12.4	2.31	0.01	1.02	-	0.33	0	-	2.91	2.06	-	-	-	-	1.01	0.31	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.23	0.01	-	-	-	-	-	-	-	-	12.4
H1036_073_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1316.75	9.44	1164.94	1920.86	280.56	0.47	0.04	1094.69	752.08				0	968.33	7712.77	5034.75					4.45			1.95	356		230					17.93	0.14	9.46	0	0	0	0				50 per day (1-7)	50 per day (1-7)	0 per day (1-6) 50 per day (7-100)	0	100	0-20	0	20-50	100-200				0	0-100	0-10	25-Oct					0			0	15-20		0					1500 per admit	1500 per admit	0	0	0	0	0				23.58	38.98	29.09	0	100	0	0	44	133				0	16.9	0.2	12.94					0			0	5.36		0					1500	1500	0	0	0	0	0					23.58	38.98	29.09	0	100	0	0	44	133				0	16.9	0.2	12.94					0			0	5.36		0					1500	1500	0	0	0	0	0				0	2.59	0.03	2.82	-	2.34	0	-	4.01	8.34	-	-	-	-	1.36	0.13	5.43	-	-	-	-	-	-	-	-	0.16	-	-	-	-	-	-	2.24	0.02	-	-	-	-	-	-	-	-	29.47	2.59	0.03	2.82	-	2.34	0	-	4.01	8.34	-	-	-	-	1.36	0.13	5.43	-	-	-	-	-	-	-	-	0.16	-	-	-	-	-	-	2.24	0.02	-	-	-	-	-	-	-	-	29.47
H1036_074_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				2900	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1043.53	8.85	653.44	1797.5	184.26	0.86	0.06	1058.03	991.5				32.51	309.22	6396.09	3017.86					4.45			1.95	356		230					54.92	0.47	6.8	0	0	0	0				50 per day (1-5)	50 per day (1-5)	0 per day (1-9) 50 per day (10-100)	0	100	0-20	0	20-50	100				0	0-100	0-75	20-75					10			0	Oct-59		0					50 per day (1-5)	50 per day (1-5)	10	0	0	0	0				34.01	34.01	22.23	0	100	0	0	44	100				0	38.03	1.47	21.08					10			0	36.13		0					34.01	34.01	0.1	0	0	0	0					12.1	34.01	13.77	0	85	0	0	37.4	69.71				0	57.44	1.25	13.4					10			0	36.13		0					28.91	34.01	0.08	0	0	0	0				0	1.05	0.03	0.75	-	1.31	0	-	3.3	5.76	-	-	-	-	1.48	0.67	3.37	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.13	0	0.58	-	-	-	-	-	-	-	19.94	1.05	0.03	0.75	-	1.31	0	-	3.3	5.76	-	-	-	-	1.48	0.67	3.37	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.13	0	0.58	-	-	-	-	-	-	-	19.94
H1036_077_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1665.1	9.52	862.8	1940.79	345.9	0.66	38.76	811.18	609.29				3.26	843.19	7791.45	5087.48					4.45			4.85	356		230					18.23	0	12589.42	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0-20	0	0-25	0				0	0	0	0					0			0-50	0		0					1500 per admit	0 per day (0-0)	0	0	0	0	0				0	0	0	0	0	0	0	20	0				0	0	0	0					0			0.1	0		0					1500	0	0	0	0	0	0					0	0	0	0	0	0	0	20	0				0	0	0	0					0			0.1	0		0					1500	0	0	0	0	0	0				0	-	-	-	-	-	0	-	1.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.5	-	-	-	-	-	-	-	2.28	-	-	-	-	-	-	-	-	-	4.13	-	-	-	-	-	0	-	1.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.5	-	-	-	-	-	-	-	2.28	-	-	-	-	-	-	-	-	-	4.13
H1036_078_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1626.75	9.3	842.93	1896.08	337.93	0.63	0.05	792.5	595.25				3.19	823.77	7611.98	4970.29					4.45			1.95	356		230					17.81	0.1	8.03	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0-20	0	20-50	25-50				0	0-25	0	0					0			0	0		0					1500 per admit	1500 per admit	0	0	0	0	0				0	0	0	0	0	0	0	44	33.25				0	9.95	0	0					0			0	0		0					1500	1500	0	0	0	0	0					0	0	0	0	0	0	0	44	33.25				0	9.95	0	0					0			0	0		0					1500	1500	0	0	0	0	0				0	-	-	-	-	-	0	-	2.91	1.65	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.23	0.01	-	-	-	-	-	-	-	-	7.48	-	-	-	-	-	0	-	2.91	1.65	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.23	0.01	-	-	-	-	-	-	-	-	7.48
H1036_080_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1383.42	9.92	1234.97	1775.62	298.14	0.75	0.06	1045.13	728.13				0	164.37	6812.09	4282.08					4.45			0	356		230					72.81	0.52	2.15	0	0	0	0				100 per day (1-7)	100 per day (1-7)	0 per day (1-6) 100 per day (7-100)	0	150	20	0	25-50	50				0	0-100	0	0					20				25-100		0					100 per day (1-7)	100 per day (1-7)	20	0	0	0	0				77.96	77.96	58.18	0	150	0.2	0	45	50				0	-39.62	0	0					0.2			0	42.34		0					77.96	77.96	0.2	0	0	0	0					77.96	77.96	58.18	0	150	0.2	0	45	50				0	-39.62	0	0					20			0	42.34		0					77.96	77.96	0.2	0	0	0	0				0	8.99	0.06	5.99	-	3.73	0.15	-	3.92	3.03	-	-	-	-	-0.54	-	-	-	-	-	-	0.89	-	-	-	1.26	-	-	-	-	-	-	0.47	0	0.43	-	-	-	-	-	-	-	28.38	8.99	0.06	5.99	-	3.73	0.15	-	3.92	3.03	-	-	-	-	-0.54	-	-	-	-	-	-	0.89	-	-	-	1.26	-	-	-	-	-	-	0.47	0	0.43	-	-	-	-	-	-	-	28.38
H1036_081_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1437.75	10.31	1283.47	1845.34	309.84	0.81	0.06	1086.17	756.72				0	170.83	7079.59	4450.23					4.45			0	356		230					75.67	0.54	2.33	0	0	0	0				150 per day (1-5)	150 per day (1-5)	0 per day (1-6) 125 per day (7-100)	0	100	20	20	30-50	100-150				0	0-150	0-5	0-25					0				25-100		0					150 per day (1-5)	150 per day (1-5)	20	0	0	0	0				102.03	102.03	72.73	0	100	0.2	0.2	46	116.5				0	41.25	4.9	24.51					0			0	42.34		0					102.03	102.03	0.2	0	0	0	0					102.03	102.03	72.73	0	100	0.2	0.2	46	116.5				0	41.25	4.9	24.51					0			0	42.34		0					102.03	102.03	0.2	0	0	0	0				0	12.22	0.09	7.78	-	2.58	0.16	0.01	4.16	7.35	-	-	-	-	0.59	2.89	9.09	-	-	-	-	-	-	-	-	1.26	-	-	-	-	-	-	0.64	0	0.47	-	-	-	-	-	-	-	49.29	12.22	0.09	7.78	-	2.58	0.16	0.01	4.16	7.35	-	-	-	-	0.59	2.89	9.09	-	-	-	-	-	-	-	-	1.26	-	-	-	-	-	-	0.64	0	0.47	-	-	-	-	-	-	-	49.29
H1036_082_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1440.9	10.34	1286.28	1849.39	310.52	0.81	0.06	1088.55	758.38				0	171.2	7095.13	4460					4.45			0	356		230					75.84	0.54	2.34	0	0	0	0				100 per day (1-7)	100 per day (1-7)	0 per day (1-6) 100 per day (7-100)	0	150	20	0	30-50	100				0	0-100	0-5	0-15					0				25-100		0					100 per day (1-7)	100 per day (1-7)	20	0	0	0	0				77.96	77.96	58.18	0	150	0.2	0	46	100				0	39.15	4.9	14.71					0			0	42.34		0					77.96	77.96	0.2	0	0	0	0					77.96	77.96	58.18	0	150	0.2	0	46	100				0	39.15	4.9	14.71					0			0	42.34		0					77.96	77.96	0.2	0	0	0	0				0	9.36	0.07	6.24	-	3.88	0.16	-	4.17	6.32	-	-	-	-	0.56	2.9	5.47	-	-	-	-	-	-	-	-	1.26	-	-	-	-	-	-	0.49	0	0.47	-	-	-	-	-	-	-	41.34	9.36	0.07	6.24	-	3.88	0.16	-	4.17	6.32	-	-	-	-	0.56	2.9	5.47	-	-	-	-	-	-	-	-	1.26	-	-	-	-	-	-	0.49	0	0.47	-	-	-	-	-	-	-	41.34
H1036_083_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1418.7	4.15	1454.47	1866.73	135.25	0.22	0.02	923.23	655.1				26.32	1059.68	5327.32	4282.68					4.45			0	356		230					74.67	0.22	3.63	0	0	0	0				200 per day (1-7)	200 per day (1-7)	0 per day (1-6) 125 per day (7-100)	20	100	20	20	30-50	100-200				0	0-200	5-100	30-100					0.2				May-39		0					200 per day (1-7)	200 per day (1-7)	20	0	0	0	0				155.92	155.92	36.36	20	100	0.2	0.2	46	133				0	10.12	6.86	31.37					0.2			0	17.49		0					155.92	155.92	0.2	0	0	0	0					155.92	155.92	36.36	20	100	0.2	0.2	46	133				0	10.12	6.86	31.37					0.2			0	17.49		0					155.92	155.92	0.2	0	0	0	0				0	18.43	0.05	4.41	3.11	1.13	0.04	0	3.54	7.26	-	-	-	-	0.89	3.05	11.2	-	-	-	-	0.89	-	-	-	0.52	-	-	-	-	-	-	0.97	0	0.73	-	-	-	-	-	-	-	56.23	18.43	0.05	4.41	3.11	1.13	0.04	0	3.54	7.26	-	-	-	-	0.89	3.05	11.2	-	-	-	-	0.89	-	-	-	0.52	-	-	-	-	-	-	0.97	0	0.73	-	-	-	-	-	-	-	56.23
H1036_085_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1330.91	6.82	1413.97	1872.73	204.86	0.25	0.02	1129.7	899.37				148.03	721.71	4869.76	4494.45					4.45			1.95	356		230					70.05	0.36	12.15	0	0	0	0				100 per day (1-7)	100 per day (1-7)	0 per day (1-7) 50 per day (8-100)	0	100	0-20	0	Oct-50	150-200				0	0-200	0-50	Oct-50					0.2			0 - 0	Oct-50		0					100 per day (1-7)	100 per day (1-7)	20	0	0	0	0				77.96	77.96	13.28	0	100	0	0	42	166.5				0	43.1	0.98	10.78					0.2			0	21.56		0					77.96	77.96	0.2	0	0	0	0					77.96	77.96	13.28	0	100	0	0	42	166.5				0	43.1	0.98	10.78					0.2			0	21.56		0					77.96	77.96	0.2	0	0	0	0				0	8.65	0.04	1.56	-	1.71	0	-	3.95	12.48	-	-	-	-	2.59	0.4	4.04	-	-	-	-	0.89	-	-	-	0.64	-	-	-	-	-	-	0.46	0	2.43	-	-	-	-	-	-	-	39.84	8.65	0.04	1.56	-	1.71	0	-	3.95	12.48	-	-	-	-	2.59	0.4	4.04	-	-	-	-	0.89	-	-	-	0.64	-	-	-	-	-	-	0.46	0	2.43	-	-	-	-	-	-	-	39.84
H1036_086_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1335.29	6.84	1418.62	1878.9	205.54	0.25	0.02	1133.42	902.34				148.51	724.08	4885.8	4509.26					4.45			1.95	356		230					70.28	0.36	12.23	0	0	0	0				250 per day (1-7)	250 per day (1-7)	0 per day (1-9) 100 per day (10-100)	20	100	0-20	0	30-50	100-200				0	0-200	5-100	25-100					0.2			0 - 0	Oct-50		0					250 per day (1-7)	250 per day (1-7)	20	0	0	0	0				194.9	194.9	22.23	20	100	0	0	46	133				0	48.35	6.86	26.47					0.2			0	21.56		0					194.9	194.9	0.2	0	0	0	0					194.9	194.9	22.23	20	100	0	0	46	133				0	48.35	6.86	26.47					0.2			0	21.56		0					194.9	194.9	0.2	0	0	0	0				0	21.69	0.11	2.63	3.13	1.71	0	-	4.34	10	-	-	-	-	2.92	2.79	9.95	-	-	-	-	0.89	-	-	-	0.64	-	-	-	-	-	-	1.14	0.01	2.45	-	-	-	-	-	-	-	64.4	21.69	0.11	2.63	3.13	1.71	0	-	4.34	10	-	-	-	-	2.92	2.79	9.95	-	-	-	-	0.89	-	-	-	0.64	-	-	-	-	-	-	1.14	0.01	2.45	-	-	-	-	-	-	-	64.4
H1036_087_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1934.41	11.7	965.68	2549.66	405.7	0.99	0.07	1269.81	957.45				0	923.79	10235.29	6683.55					4.45			1.95	356		230					21.98	0.18	17.39	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0-20	0	0-25	0				0	0	0	0					0			0	0		0					1500 per admit	1500 per admit	0	0	0	0	0				0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	1500	0	0	0	0	0					0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	1500	0	0	0	0	0				0	-	-	-	-	-	0	-	2.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.75	0.02	-	-	-	-	-	-	-	-	4.89	-	-	-	-	-	0	-	2.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.75	0.02	-	-	-	-	-	-	-	-	4.89
H1036_088_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1553.01	9.39	1550.56	1896.82	323.91	0.91	0.07	1013.81	764.42				0	737.55	7614.54	4972.23					4.45			1.95	356		230					17.65	0.14	26906.35	0	0	0	0				200 per day (1-7)	200 per day (1-7)	0 per day (1-6) 125 per day (7-100)	0	50	0-20	0	20-50	50-200				0	0-200	0-25	25					0			0 - 0	0		0					1500 per admit (0-0)	1500 per admit (0-0)	0	0	0	0	0				155.92	155.92	36.36	0	50	0	0	44	99.5				0	18.7	0.49	25					0			0	0		0					1500	1500	0	0	0	0	0					155.92	155.92	36.36	0	50	0	0	44	99.5				0	18.7	0.49	25					0			0	0		0					1500	1500	0	0	0	0	0				0	20.18	0.12	4.7	-	1.35	0	-	3.72	6.34	-	-	-	-	1.15	0.31	10.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.21	0.02	-	-	-	-	-	-	-	-	50.45	20.18	0.12	4.7	-	1.35	0	-	3.72	6.34	-	-	-	-	1.15	0.31	10.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.21	0.02	-	-	-	-	-	-	-	-	50.45
H1036_089_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1553.01	9.39	775.28	1896.82	323.91	0.91	0.07	1013.81	764.42				0	737.55	7614.54	4972.23					4.45			1.95	356		230					17.65	0.14	26906.35	0	0	0	0				200 per day (1-7)	200 per day (1-7)	0 per day (1-6) 125 per day (7-100)	0	50	0-20	0	20-50	50-200				0	0-200	0-25	25					0			0	0		0					1500 per admit	1500 per admit	0	0	0	0	0				155.92	155.92	72.73	0	50	0	0	44	99.5				0	18.7	0.49	25					0			0	0		0					1500	1500	0	0	0	0	0					155.92	155.92	72.73	0	50	0	0	44	99.5				0	18.7	0.49	25					0			0	0		0					1500	1500	0	0	0	0	0				0	20.18	0.12	4.7	-	1.35	0	-	3.72	6.34	-	-	-	-	1.15	0.31	10.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.21	0.02	-	-	-	-	-	-	-	-	50.45	20.18	0.12	4.7	-	1.35	0	-	3.72	6.34	-	-	-	-	1.15	0.31	10.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.21	0.02	-	-	-	-	-	-	-	-	50.45
H1036_090_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1410.41	10.11	2495.59	2096.88	301.07	0.51	0.04	1174.72	807.06				0	1039.12	8419.51	5496.1					4.45			1.95	356		230					19.21	0.15	10.14	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0-20	0	0-25	0				0	0	0	0					0			0 - 0	0		0					1500 per admit (0-0)	1500 per admit (0-0)	0	0	0	0	0				0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	1500	0	0	0	0	0					0	0	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					1500	1500	0	0	0	0	0				0	-	-	-	-	-	0	-	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.4	0.02	-	-	-	-	-	-	-	-	4.38	-	-	-	-	-	0	-	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.4	0.02	-	-	-	-	-	-	-	-	4.38
H1036_091_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1315.9	9.43	1164.18	1907.28	280.2	0.48	0.04	1093.3	751.13				0	967.1	7658.24	4999.16					4.45			1.95	356		230					17.92	0.14	12100.72	0	0	0	0				200 per day (1-7)	200 per day (1-7)	0 per day (1-6) 50 per day (7-100)	0	100	0-20	0	20-50	100-200				0	0-200	0-10	25-Oct					0			0	20-25		0					1500 per admit	1500 per admit	0	0	0	0	0				155.92	155.92	29.09	0	100	0	0	44	133				0	19	0.2	24.71					0			0	6.89		0					1500	1500	0	0	0	0	0					155.92	155.92	29.09	0	100	0	0	44	133				0	19	0.2	24.71					0			0	6.89		0					1500	1500	0	0	0	0	0				0	17.1	0.12	2.82	-	2.34	0	-	4.01	8.33	-	-	-	-	1.53	0.13	10.29	-	-	-	-	-	-	-	-	0.2	-	-	-	-	-	-	2.24	0.02	-	-	-	-	-	-	-	-	49.12	17.1	0.12	2.82	-	2.34	0	-	4.01	8.33	-	-	-	-	1.53	0.13	10.29	-	-	-	-	-	-	-	-	0.2	-	-	-	-	-	-	2.24	0.02	-	-	-	-	-	-	-	-	49.12
H1036_092_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1114.4	9.45	1395.64	1919.58	196.78	0.98	118.34	1129.9	1058.84				34.72	330.22	6830.52	3222.83					4.45			1.9	356		230					58.65	0	7.76	0	0	0	0				0 per day (1-5)	0 per day (1-5)	0 per day (1-9) 50 per day (10-100)	0	50	0-20	0	20-50	0				0	0-20	0	0-20					0.1			25 - 75	Oct-59		0					0 per day (1-5)	0 per day (0-0)	10	0	0	0	0				0	0	11.12	0	50	0	0	44	0				0	-13.37	0	19.61					0.1			0.35	36.13		0					0	0	0.1	0	0	0	0					0	0	11.12	0	50	0	0	44	0				0	-13.37	0	19.61					0.1			0.35	36.13		0					0	0	0.1	0	0	0	0				0	-	-	1.29	-	0.82	0	-	4.14	-	-	-	-	-	-0.37	-	5.27	-	-	-	-	0.45	-	-	0.67	1.07	-	-	-	-	-	-	-	-	0.78	-	-	-	-	-	-	-	14.12	-	-	1.29	-	0.82	0	-	4.14	-	-	-	-	-	-0.37	-	5.27	-	-	-	-	0.45	-	-	0.67	1.07	-	-	-	-	-	-	-	-	0.78	-	-	-	-	-	-	-	14.12
H1036_093_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1068.79	9.06	669.26	1841.01	188.72	0.9	113.5	1083.65	1015.5				33.3	316.7	6550.92	3090.91					4.45			1.95	356		230					56.25	0.48	7.14	0	0	0	0				200 per day (1-7)	200 per day (1-7)	0 per day (1-9) 100 per day (10-100)	20	100	0-20	0	25-50	100-200				0	0-200	0-100	25-100					10			0	Oct-59		0					200 per day (1-7)	200 per day (1-7)	10	0	0	0	0				155.92	155.92	44.46	20	100	0	0	45	133				0	45.64	1.96	26.47					10			0	36.13		0					155.92	155.92	0.1	0	0	0	0					155.92	155.92	44.46	20	100	0	0	45	133				0	45.64	1.96	26.47					10			0	36.13		0					155.92	155.92	0.1	0	0	0	0				0	13.89	0.12	2.48	3.07	1.57	0	-	4.06	11.26	-	-	-	-	1.2	1.07	6.82	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.73	0.01	0.71	-	-	-	-	-	-	-	48.51	13.89	0.12	2.48	3.07	1.57	0	-	4.06	11.26	-	-	-	-	1.2	1.07	6.82	-	-	-	-	0.45	-	-	-	1.07	-	-	-	-	-	-	0.73	0.01	0.71	-	-	-	-	-	-	-	48.51
H1036_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1274.36	10.8	797.98	2344.28	222.1	1.07	0.08	1275.28	1195.08				42.41	372.71	8341.75	3935.87					4.45			0	0		0					67.07	0.57	0	0	0	0	0				295 per day (1-5)	295 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					295 per day (1-5)	295 per day (1-5)	0	0	0	0	0				200.66	200.66	22.01	0	100	0.2	0.2	46.3	200				0	31.44	22.55	37.26					20			0	0		0					200.66	200.66	0	0	0	0	0					200.66	200.66	22.01	0	100	0.2	0.2	46.3	200				0	31.44	22.55	37.26					20			0	0		0					200.66	200.66	0	0	0	0	0				0	21.31	0.18	1.46	-	1.85	0.21	0.02	4.92	19.92	-	-	-	-	0.98	15.68	12.22	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.12	0.01	-	-	-	-	-	-	-	-	80.77	21.31	0.18	1.46	-	1.85	0.21	0.02	4.92	19.92	-	-	-	-	0.98	15.68	12.22	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.12	0.01	-	-	-	-	-	-	-	-	80.77
H1036_806_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1268.35	10.75	1588.44	2333.22	221.05	1.07	0.08	1269.26	1189.44				42.21	370.95	8302.4	3917.3					4.45			0	0		0					66.76	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	31.31	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	31.31	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	21.57	0.18	1.46	-	1.84	0.21	0.02	4.9	19.82	-	-	-	-	0.97	15.6	12.16	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.14	0.01	-	-	-	-	-	-	-	-	80.77	21.57	0.18	1.46	-	1.84	0.21	0.02	4.9	19.82	-	-	-	-	0.97	15.6	12.16	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.14	0.01	-	-	-	-	-	-	-	-	80.77
H1036_807_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1274.36	10.8	797.98	2344.28	222.1	1.07	0.08	1275.28	1195.08				42.41	372.71	8341.75	3935.87					4.45			0	0		0					67.07	0.57	0	0	0	0	0				295 per day (1-5)	295 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					295 per day (1-5)	295 per day (1-5)	0	0	0	0	0				200.66	200.66	22.01	0	100	0.2	0.2	46.3	200				0	31.44	22.55	37.26					20			0	0		0					200.66	200.66	0	0	0	0	0					200.66	200.66	22.01	0	100	0.2	0.2	46.3	200				0	31.44	22.55	37.26					20			0	0		0					200.66	200.66	0	0	0	0	0				0	21.31	0.18	1.46	-	1.85	0.21	0.02	4.92	19.92	-	-	-	-	0.98	15.68	12.22	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.12	0.01	-	-	-	-	-	-	-	-	80.77	21.31	0.18	1.46	-	1.85	0.21	0.02	4.92	19.92	-	-	-	-	0.98	15.68	12.22	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.12	0.01	-	-	-	-	-	-	-	-	80.77
H1036_808_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1268.35	10.75	1588.44	2333.22	221.05	1.07	0.08	1269.26	1189.44				42.21	370.95	8302.4	3917.3					4.45			0	0		0					66.76	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	31.31	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	31.31	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	21.57	0.18	1.46	-	1.84	0.21	0.02	4.9	19.82	-	-	-	-	0.97	15.6	12.16	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.14	0.01	-	-	-	-	-	-	-	-	80.77	21.57	0.18	1.46	-	1.84	0.21	0.02	4.9	19.82	-	-	-	-	0.97	15.6	12.16	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.14	0.01	-	-	-	-	-	-	-	-	80.77
H1045_001_0	2006																													V																V																																																												-								38.25																551.71																									50 per ER visit; waived if admitted																12 copay																									50																12																										50																12																			-	-	-	-	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.71	-	-	-	-	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.71
H1045_002_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H1045_005_0	2006																						D	D						V	V							V								V																																																												-	735.9	38.73						38.39	46.7							2446.05								553.44																		50 Days 1-5; 0 after	50 Days 1-5; 0 after						50 per ER visit; waived if admitted	100							10 Office Visit Copay								12 Copay																		50	50						50	100							10								12																			50	50						50	100							10								12																			3.07	0.16	-	-	-	-	-	0.16	0.39	-	-	-	-	-	-	2.04	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.37	3.07	0.16	-	-	-	-	-	0.16	0.39	-	-	-	-	-	-	2.04	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.37
H1045_006_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H1045_008_0	2006																						Coin															Coin					S			P		P																																																										-	0.01															0.01					435.13			3.94		1.26																30 Gastr Bypass															30 Gastr Bypass					0 Gen; 10 Brand			Various Copays		150 Copay																0.3															0.3					5.39			94.5		150																	0.3															0.3					5.39			94.5		150																	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	0.2	-	-	0.03	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.25	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	0.2	-	-	0.03	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.25
H1045_009_0	2006																						D	D	D					V	V	V						V	V	V								P																	0	0	0					0	0	0						0	0	0								0																-	880.92	37.11	350.89					51	46.54	132.94						3501.33	332.41	760.05								6.91																150 per day for days 1-5 Medicare Limits Apply.	150 per day for days 1-5 Medicare Limits Apply.	50 per days for days 7-100 Medicare Limits Apply.	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	50 per visit	125 per visit	50 MRI MRA CT; 150 PET; 0 Therapeutic Radiology	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	35 per Specialist Visit 15 for Routine Foot Care	35 per visit	35 per visit	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	150 copay for Contact Lenses Only.	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing											150	150	50					50	125	50.18						34.95	35	35								150																	150	150	50					50	125	50.18						34.95	35	35								150																	11.01	0.46	1.46	-	-	-	-	0.21	0.48	0.56	-	-	-	-	-	10.2	0.97	2.22	-	-	-	-	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.66	11.01	0.46	1.46	-	-	-	-	0.21	0.48	0.56	-	-	-	-	-	10.2	0.97	2.22	-	-	-	-	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.66
H1076_003_0	2006																								D			Coin	Coin	V	V		V			V							S			V							V																																																					-			894.81			0.39	4.03	225.41	61.44		103.81			148.45							241.91			2281.46							10													25/d (days 8-25)			non-std items	non-std items		Hospital only		Hospital only			Hospital only							20 coinsurance			Copays vary by service category							Travel benefit													10.83			0.2	0.2	50	100		50			25							14.42			52.36							20														10.83			0.2	0.2	50	100		50			25							14.42			52.36							20												-	-	0.81	-	-	0.08	0.81	0.94	0.51	-	0.43	-	-	0.31	-	-	-	-	-	-	0.29	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.15	-	-	0.81	-	-	0.08	0.81	0.94	0.51	-	0.43	-	-	0.31	-	-	-	-	-	-	0.29	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.15
H1076_010_0	2006																																																																																																									-																									2281.46																																																																																		15.59																																										15.59																		-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.96
H1076_011_0	2006																																													V																																																												-																								2284.93																																																																																		15.59																																										15.59																			-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.97
H1076_016_0	2006																						D		D			Coin	Coin	V	V				V	V		V					S			V							V																																																					-	1597.07		953.22			0.39	4.03	195.09	77.48		46.26		29.37	317.22		9816.93					663.73			2281.46							10											50/day (days 1-5)		25/day (days 8-25)			non-std items only	non-std items only		Hospital only		Hospital only		Hospital only	Hospital only							20 coinsurance			Copays vary by service type																		33.6		10.83			0.2	0.2	50	100		50		25	25		15					13.61			52.36							20												33.6		10.83			0.2	0.2	50	100		50		25	25		15					13.61			52.36							20												4.47	-	0.86	-	-	0.08	0.81	0.81	0.65	-	0.19	-	0.06	0.66	-	12.27	-	-	-	-	0.75	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	31.58	4.47	-	0.86	-	-	0.08	0.81	0.81	0.65	-	0.19	-	0.06	0.66	-	12.27	-	-	-	-	0.75	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	31.58
H1076_020_0	2006																								D			Coin	Coin	V	V		V			V	V	V					S			V					Coin																																																							-			597.99			3.22	0.31	165.69	49.78		61.91			103.61	3467.39	6576.31					363.99			1825.17					164.94															25/day (days 8-25)			non-std items	non-std items	Hospital only	hospital only		Hospital only			Hospital only							20 Coinsurance			Copays vary by service category					100 OON Deductible; 30 Coinsurance															10.83			0.2	0.2	50	100		50			25	5	20					14.08			52.36					0.3																10.83			0.2	0.2	50	100		50			25	5	20					14.08			52.36					0.3														-	-	0.54	-	-	0.64	0.06	0.69	0.41	-	0.26	-	-	0.22	1.44	10.96	-	-	-	-	0.43	-	-	7.96	-	-	-	-	49.48	-	-	-	-	-	-	-	-	-	-	-	-	73.1	-	-	0.54	-	-	0.64	0.06	0.69	0.41	-	0.26	-	-	0.22	1.44	10.96	-	-	-	-	0.43	-	-	7.96	-	-	-	-	49.48	-	-	-	-	-	-	-	-	-	-	-	-	73.1
H1076_022_0	2006																								D			Coin	Coin	V	V		V		V	V	V	V					S			V					Coin																																																							-			795.23			3.36	0.33	162.76	64.64		38.07		24.5	264.64	5548.57	8053.13					553.72			1903.32					196.62															25/day (days 8-25)			non-std items only	non-std items only		Hospital only		Hospital only		Hospital only	Hospital only							20 Coinsurance			Copays vary by service category					350 deductible; 30 Coinsurance															10.83			0.2	0.2	50	100		50		25	25	5	35					14.65			52.36					0.3																10.83			0.2	0.2	50	100		50		25	25	5	35					14.65			52.36					0.3														-	-	0.72	-	-	0.67	0.07	0.68	0.54	-	0.16	-	0.05	0.55	2.31	23.49	-	-	-	-	0.68	-	-	8.3	-	-	-	-	58.99	-	-	-	-	-	-	-	-	-	-	-	-	97.2	-	-	0.72	-	-	0.67	0.07	0.68	0.54	-	0.16	-	0.05	0.55	2.31	23.49	-	-	-	-	0.68	-	-	8.3	-	-	-	-	58.99	-	-	-	-	-	-	-	-	-	-	-	-	97.2
H1076_024_0	2006																								D			Coin	Coin	V	V		V			V							S			V							V																																																					-			766.48			4.03	0.39	203.04	67.9		60.8			117.76							769.51			2281.46							10													25/day (days 8-25)			non-std items only	non-std items only		Hospital only		Hospital only			Hospital only							20 Coinsurance			Copays vary by service category							Travel benefit													10.83			0.2	0.2	50	100		50			25							11.3			52.36							20														10.83			0.2	0.2	50	100		50			25							11.3			52.36							20												-	-	0.69	-	-	0.81	0.08	0.85	0.57	-	0.25	-	-	0.25	-	-	-	-	-	-	0.72	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.18	-	-	0.69	-	-	0.81	0.08	0.85	0.57	-	0.25	-	-	0.25	-	-	-	-	-	-	0.72	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.18
H1080_004_0	2006											3600											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2023.85	124.68	1050.18	0	111.12	14.11	4.75	294.41	64	13540.32	51.77	0	0.68	24.29	6612.25	3344.53	452.78	3.26	0	0	22.89	1895.88	0	0.43	63.03	0	234.32	0	0	0	0											250	17500	150	0	150	0	0	25/50	15/25	15	15/15/25	15/25 (incl in g)	0.3	40/30 / 15/25	Oct-00	20	40 / 30	15/25	0	0	0.3	20 /0		0	20		20			0												250	175	150	0	150	0.3	0.3	43.68	0.23	6	0.13	0	0.3	0.23	10	20	37.5	0.19	0	0	0.3	20	0	0	20	0	20	0	0	0	0												141.65	99.15	84.99	0	84.99	0.17	0.17	24.75	0.13	3.4	0.07	0	0.17	0.13	10	20	37.5	0.11	0	0	0.17	20	0	0	20	0	20	0	0	0	0												23.89	1.03	7.44	-	0.79	2.4	0.82	0.61	8.4	3.84	3.71	-	0.11	3.14	5.51	5.57	1.41	0.35	-	-	3.89	3.16	-	-	0.11	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.57	23.89	1.03	7.44	-	0.79	2.4	0.82	0.61	8.4	3.84	3.71	-	0.11	3.14	5.51	5.57	1.41	0.35	-	-	3.89	3.16	-	-	0.11	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.57
H1080_011_0	2006											3800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin																																																							-	1376.9	127.56	512.68	0	74.55	10.43	4.2	233.27	51.6	9663.65	43.76	0	0.02	2.73	5021.21	2315.21	474.33	2.84	0	0	14.53	1155.62	0	0.43	19.9	0	201.93	0	39.65	0	0											265/295	17500	125	0	150	0	0	25/50	15/25	15	15/15/25	15/25 (incl in g)	0.3	40 / 30 / 15/25	15/0	25	40 / 30	15/25	0	0	0.3	25 /0		0	25		25		See PBP	0												265	175	125	0	150	0.3	0.3	48.35	0.2	6	0.13	0	0.3	0.02	15	25	37.5	0.19	0	0	0.3	25	0	0	25	0	25	0	0.02	0	0												170.75	112.76	80.54	0	96.65	0.19	0.2	31.16	0.13	3.87	0.08	0	0.19	0.01	15	25	37.5	0.12	0	0	0.19	25	0	0	25	0	25	0	0.02	0	0												19.59	1.2	3.44	-	0.6	2.02	0.82	0.61	6.77	3.11	3.57	-	0	0.04	6.28	4.82	1.48	0.35	-	-	2.81	2.41	-	-	0.04	-	0.42	-	0.75	-	-	-	-	-	-	-	-	-	-	-	-	61.13	19.59	1.2	3.44	-	0.6	2.02	0.82	0.61	6.77	3.11	3.57	-	0	0.04	6.28	4.82	1.48	0.35	-	-	2.81	2.41	-	-	0.04	-	0.42	-	0.75	-	-	-	-	-	-	-	-	-	-	-	-	61.13
H1080_013_0	2006											3600											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1874.73	123.96	966.94	0	112.76	13.54	4.26	324.86	69.1	13848.55	42.38	0	0.45	9	6236.22	3614.7	452.38	3.83	0	0	22.03	1586.51	0	0.43	24.47	0	234.5	0	0	0	0											295	17500	150	0	150	0	0	25/50	15/25	15	15/15/25	15/25 (incl in g)	0.3	40 / 30 / 15/25	Oct-00	20	40 / 30	15/25	0	0	0.3	20 /0		0	20		20			0												295	175	150	0	150	0.3	0.3	45.39	0.22	6	0.13	0	0.3	0.19	10	20	37.5	0.19	0	0	0.3	20	0	0	20	0	20	0	0	0	0												165.73	98.31	84.27	0	84.27	0.17	0.17	25.5	0.12	3.37	0.07	0	0.17	0.11	10	20	37.5	0.11	0	0	0.17	20	0	0	20	0	20	0	0	0	0												25.89	1.02	6.79	-	0.79	2.28	0.73	0.69	8.63	3.89	3.01	-	0.08	0.97	5.2	6.02	1.41	0.41	-	-	3.71	2.64	-	-	0.04	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.61	25.89	1.02	6.79	-	0.79	2.28	0.73	0.69	8.63	3.89	3.01	-	0.08	0.97	5.2	6.02	1.41	0.41	-	-	3.71	2.64	-	-	0.04	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.61
H1080_031_0	2006											3800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin																																																							-	1322.03	122.44	851.08	0	96.13	12.12	4.14	204.35	42.57	9039.25	32.98	0	0.43	2.46	1328.59	-118.18	439.46	2.22	0	0	18.95	1169.54	0	0.4	35.98	0	160.31	0	72.81	0	0											265/295	17500	125	0	150	0	0	25/50	15/25	15	15/15/25	15/25 (incl in g)	0.3	40 / 30 / 15/25	Oct-00	25	40 / 30	15/25	0	0	0.3	25 /0		0	25		25		See PBP	0												265	175	125	0	150	0.3	0.3	45.08	0.21	6	0.13	0	0.3	0.04	10	25	37.5	0.19	0	0	0.3	25	0	0	25	0	25	0	0.03	0	0												170	112.26	80.19	0	96.23	0.19	0.2	28.92	0.13	3.85	0.08	0	0.19	0.03	10	25	37.5	0.12	0	0	0.19	25	0	0	25	0	25	0	0.03	0	0												18.73	1.15	5.69	-	0.77	2.33	0.81	0.49	5.73	2.9	2.68	-	0.08	0.07	1.11	-0.25	1.37	0.27	-	-	3.65	2.44	-	-	0.07	-	0.33	-	2.2	-	-	-	-	-	-	-	-	-	-	-	-	52.61	18.73	1.15	5.69	-	0.77	2.33	0.81	0.49	5.73	2.9	2.68	-	0.08	0.07	1.11	-0.25	1.37	0.27	-	-	3.65	2.44	-	-	0.07	-	0.33	-	2.2	-	-	-	-	-	-	-	-	-	-	-	-	52.61
H1080_034_0	2006											3800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin																																																							-	992.57	121.21	381.97	0	43.29	10.89	3.78	192.67	39.26	7924.15	32.58	0	0.03	2.44	3702.88	1767.35	456.12	2.45	0	0	14.64	970.6	0	0.43	110.99	0	168.86	0	74.23	0	0											265/295	17500	150	0	150	0	0	25/50	15/25	15	15/15/25	15/25 (incl in g)	0.3	40 / 30 / 15/25	Oct-00	25	40 / 30	15/25	0	0	0.3	25 /0		0	25		25		See PBP	0												265	175	150	0	150	0.3	0.3	46.71	0.21	6	0.13	0	0.3	0.04	10	25	37.5	0.19	0	0	0.3	25	0	0	25	0	25	0	0.03	0	0												174.77	115.42	98.93	0	98.93	0.2	0.2	30.81	0.14	3.96	0.08	0	0.2	0.02	10	25	37.5	0.13	0	0	0.2	25	0	0	25	0	25	0	0.03	0	0												14.46	1.17	3.15	-	0.36	2.15	0.76	0.49	5.43	2.61	2.72	-	0.01	0.06	3.09	3.68	1.43	0.31	-	-	2.9	2.02	-	-	0.23	-	0.35	-	2.55	-	-	-	-	-	-	-	-	-	-	-	-	49.91	14.46	1.17	3.15	-	0.36	2.15	0.76	0.49	5.43	2.61	2.72	-	0.01	0.06	3.09	3.68	1.43	0.31	-	-	2.9	2.02	-	-	0.23	-	0.35	-	2.55	-	-	-	-	-	-	-	-	-	-	-	-	49.91
H1080_036_0	2006											1800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	V	V	V	V	Coin	V	V	Coin	V	T	V	V	Coin	V	P		O																																																						-	2251.92	150.69	1068.31	0	152.62	20.01	6.83	449.05	0	0	0	0	0.7	0.2	0	0	0	0	0	0	31.3	2403.55	0	0.62	329.99	0	0	0	0	0	0											25	2500	15	0	100	0	0	20/40	0	0	0	0	0.3	15 /0	0	0	0	0	0	0	0.3	May-00	0	0	May-00	0	0	0		0												25	25	15	0	100	0.3	0.3	36.07	0	0	0	0	0.3	15	0	0	0	0	0	0	0.3	2.5	0	0	2.5	0	0	0	0	0	0												18.01	18.01	10.81	0	72.04	0.22	0.22	25.99	0	0	0	0	0.22	10.81	0	0	0	0	0	0	0.22	2.5	0	0	2.5	0	0	0	0	0	0												3.38	0.23	0.96	-	0.92	4.32	1.49	0.97	-	-	-	-	0.15	0	-	-	-	-	-	-	6.76	0.5	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.76	3.38	0.23	0.96	-	0.92	4.32	1.49	0.97	-	-	-	-	0.15	0	-	-	-	-	-	-	6.76	0.5	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.76
H1080_037_0	2006											2900											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2023.85	124.68	1050.18	0	111.12	14.11	4.75	294.41	64	17.18	51.77	0	0.68	24.29	6612.25	3344.53	452.78	3.26	0	0	22.89	1895.88	0	0.43	63.03	0	234.32	0	0	0	0											195	17500	125	0	150	0	0	25/50	20-Oct	0	0/10/20	10/20 (incl in g)	0.2	40 / 30 / 10/20	Mar-00	10	40 / 30	20-Oct	0	0	0.2	Oct-00		0	10		10			0												195	175	125	0	150	0.2	0.2	43.68	0.18	0	0.11	0	0.2	0.18	3	10	37.5	0.14	0	0	0.2	10	0	0	10	0	10	0	0	0	0												115.02	103.23	73.73	0	88.48	0.12	0.12	25.77	0.11	0	0.06	0	0.12	0.11	3	10	37.5	0.08	0	0	0.12	10	0	0	10	0	10	0	0	0	0												19.4	1.07	6.45	-	0.82	1.66	0.57	0.63	6.85	-	3.32	-	0.08	2.62	1.65	2.79	1.41	0.27	-	-	2.7	1.58	-	-	0.05	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.13	19.4	1.07	6.45	-	0.82	1.66	0.57	0.63	6.85	-	3.32	-	0.08	2.62	1.65	2.79	1.41	0.27	-	-	2.7	1.58	-	-	0.05	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.13
H1080_038_0	2006											3000											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin																																																							-	1376.9	127.56	512.68	0	74.55	10.43	4.2	233.27	51.6	12.68	43.76	0	0.02	2.73	5021.21	2315.21	474.33	2.84	0	0	14.53	1155.62	0	0.43	19.9	0	201.93	0	39.65	0	0											200/275	17500	100	0	150	0	0	25/50	15-May	0	0/5/15	5/15 (incl in g)	0.2	40 / 30 / 5/15	Oct-00	20	40 / 30	15-May	0	0	0.2	20 /0		0	20		20		See PBP	0												200	175	100	0	150	0.2	0.2	48.35	0.13	0	0.11	0	0.2	0.01	10	20	37.5	0.09	0	0	0.2	20	0	0	20	0	20	0	0.02	0	0												135.1	118.21	67.55	0	101.32	0.14	0.14	32.66	0.09	0	0.07	0	0.14	0.01	10	20	37.5	0.06	0	0	0.14	20	0	0	20	0	20	0	0.02	0	0												15.5	1.26	2.89	-	0.63	1.41	0.57	0.63	4.57	-	3.21	-	0	0.02	4.18	3.86	1.48	0.17	-	-	1.96	1.93	-	-	0.03	-	0.34	-	0.73	-	-	-	-	-	-	-	-	-	-	-	-	45.39	15.5	1.26	2.89	-	0.63	1.41	0.57	0.63	4.57	-	3.21	-	0	0.02	4.18	3.86	1.48	0.17	-	-	1.96	1.93	-	-	0.03	-	0.34	-	0.73	-	-	-	-	-	-	-	-	-	-	-	-	45.39
H1080_039_0	2006											2900											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1874.73	123.96	966.94	0	112.76	13.54	4.26	324.86	69.1	19.25	42.38	0	0.45	9	6236.22	3614.7	452.38	3.83	0	0	22.03	1586.51	0	0.43	24.47	0	234.5	0	0	0	0											265	17500	150	0	150	0	0	25/50	20-Oct	0	0/10/20	10/20 (incl in g)	0.2	40 / 30 / 10/20	Mar-00	10	40 / 30	20-Oct	0	0	0.2	Oct-00		0	10		10			0												265	175	150	0	150	0.2	0.2	45.39	0.17	0	0.11	0	0.2	0.15	3	10	37.5	0.14	0	0	0.2	10	0	0	10	0	10	0	0	0	0												148.92	98.34	84.29	0	84.29	0.11	0.11	25.51	0.1	0	0.06	0	0.11	0.09	3	10	37.5	0.08	0	0	0.11	10	0	0	10	0	10	0	0	0	0												23.26	1.02	6.79	-	0.79	1.52	0.49	0.69	6.69	-	2.59	-	0.05	0.78	1.56	3.01	1.41	0.3	-	-	2.48	1.32	-	-	0.02	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.97	23.26	1.02	6.79	-	0.79	1.52	0.49	0.69	6.69	-	2.59	-	0.05	0.78	1.56	3.01	1.41	0.3	-	-	2.48	1.32	-	-	0.02	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.97
H1080_040_0	2006											2900											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin																																																							-	1322.03	122.44	851.08	0	96.13	12.12	4.14	204.35	42.57	11.35	32.98	0	0.43	2.46	1328.59	-118.18	439.46	2.22	0	0	18.95	1169.53	0	0.4	35.98	0	160.31	0	72.79	0	0											195/250	17500	95	0	150	0	0	25/50	20-Oct	0	0/10/20	10/20 (incl in g)	0.2	40 / 30 / 10/20	May-00	20	40 / 30	20-Oct	0	0	0.2	20 /0		0	20		20		See PBP	0												195	175	95	0	150	0.2	0.2	45.08	0.18	0	0.11	0	0.2	0.03	5	20	37.5	0.14	0	0	0.2	20	0	0	20	0	20	0	0.03	0	0												122.06	109.54	59.46	0	93.89	0.13	0.13	28.22	0.11	0	0.07	0	0.13	0.02	5	20	37.5	0.09	0	0	0.13	20	0	0	20	0	20	0	0.03	0	0												13.45	1.12	4.22	-	0.75	1.52	0.53	0.48	4.72	-	2.24	-	0.05	0.05	0.55	-0.2	1.37	0.19	-	-	2.37	1.95	-	-	0.06	-	0.27	-	2.04	-	-	-	-	-	-	-	-	-	-	-	-	37.74	13.45	1.12	4.22	-	0.75	1.52	0.53	0.48	4.72	-	2.24	-	0.05	0.05	0.55	-0.2	1.37	0.19	-	-	2.37	1.95	-	-	0.06	-	0.27	-	2.04	-	-	-	-	-	-	-	-	-	-	-	-	37.74
H1080_041_0	2006											2500											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin																																																							-	992.57	121.21	381.97	0	43.29	10.89	3.78	192.67	39.26	10.62	32.58	0	0.03	2.4	3702.88	1767.35	456.12	2.45	0	0	14.64	970.6	0	0.43	110.99	0	168.86	0	74.21	0	0											250/295	17500	95	0	150	0	0	25/50	20-Oct	0	0/10/20	10/20 (incl in g)	0.2	40 / 30 / 10/20	May-00	20	40 / 30	20-Oct	0	0	0.2	20 /0		0	20		20		See PBP	0												250	175	95	0	150	0.2	0.2	46.71	0.18	0	0.11	0	0.2	0.03	5	20	37.5	0.14	0	0	0.2	20	0	0	20	0	20	0	0.03	0	0												153.54	107.48	58.35	0	92.13	0.12	0.13	28.69	0.11	0	0.07	0	0.12	0.02	5	20	37.5	0.09	0	0	0.12	20	0	0	20	0	20	0	0.03	0	0												12.7	1.09	1.86	-	0.33	1.34	0.47	0.46	4.28	-	2.18	-	0	0.05	1.54	2.95	1.43	0.21	-	-	1.8	1.62	-	-	0.18	-	0.28	-	2.55	-	-	-	-	-	-	-	-	-	-	-	-	37.31	12.7	1.09	1.86	-	0.33	1.34	0.47	0.46	4.28	-	2.18	-	0	0.05	1.54	2.95	1.43	0.21	-	-	1.8	1.62	-	-	0.18	-	0.28	-	2.55	-	-	-	-	-	-	-	-	-	-	-	-	37.31
H1080_801_0	2006											3600											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V																																																														-	1866.32	124.89	885.39	0	100	13.77	4.7	294.24	66.91	17.85	51.83	0	0.48	2.82	6385.19	3455.06	457.17	3.56	0	0	21.53	1683.99	0	0	51.8	0	0.12	0	0	0	0											250	17500	150	0	150	0	0	50	0	10	25-Oct	25 (incl in g)	0.3	40 / 30 / 25	25/0	25	40 / 30	0	0	0	0.3	25 /0			25		25															250	175	150	0	150	0.3	0.3	50	0.25	0	0.22	0	0.3	0.06	25	25	37.5	0.25	0	0	0.3	25	0	0	25	0	25	0	0	0	0												145.48	101.84	87.29	0	87.29	0.17	0.18	29.1	0.15	0	0.13	0	0.17	0.04	25	25	37.5	0.15	0	0	0.17	25	0	0	25	0	25	0	0	0	0												22.63	1.06	6.44	-	0.73	2.4	0.84	0.71	9.73	-	6.66	-	0.08	0.1	13.3	7.2	1.43	0.52	-	-	3.76	3.51	-	-	0.11	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.21	22.63	1.06	6.44	-	0.73	2.4	0.84	0.71	9.73	-	6.66	-	0.08	0.1	13.3	7.2	1.43	0.52	-	-	3.76	3.51	-	-	0.11	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.21
H1099_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						none	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	0	0	V	V	0	V	0	0	0	0	Coin	V	V	V	V						none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1631.07	104.11	871.73	2179.33	93.4	0.19	0.03	155.67	130.76	3735.99	1556.66	311.33	311.33	311.33	3735.99	3735.99	622.67	1245.33	622.67	0	7.89	0	0	19.36	3051.06	1307.6	0	0	0	6849.32	0	0.09	87.17	249.07	373.6	1868						100 for 1st 5 days	100 for 1st 5 days	75 for 1st 14 days	0	10000	10	10	80x50+20x5	10000	0	0	0	0	0	5	75x20+25x15	15	1500	0	0	0.2	0	0	0	0	0	15	0	0	0	0	0	10000	15	15	0						69.44	69.44	54	0	100	0.1	0.1	41	100	0	0	0	0	0	5	18.75	15	15	0	0	0	0	0	0	0	0	15	0	0	0	0	0	100	15	15	0						none	69.44	69.44	54	0	100	0.1	0.1	41	100	0	0	0	0	0	5	18.75	15	15	0	0	0	0	0	0	0	0	15	0	0	0	0	0	100	15	15	0						0	9.44	0.6	3.92	-	0.78	0.02	0	0.53	1.09	-	-	-	-	-	1.56	5.84	0.78	1.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.73	0.31	0.47	-	-	-	-	-	-	27.62	9.44	0.6	3.92	-	0.78	0.02	0	0.53	1.09	-	-	-	-	-	1.56	5.84	0.78	1.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.73	0.31	0.47	-	-	-	-	-	-	27.62
H1099_006_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3250	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	V	Coin	O	T	V	V	P	V					Coin	Coin	V	V	V						none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	259.36	16.55	18.84	34.76	4.56	0.19	0.03	155.67	8.22	3735.99	1556.66	4.7	311.33	311.33	3735.99	3735.99	622.67	16.81	622.67	0	7.89	0	0	19.36	3051.06	1307.6	0	0	0	6849.32	0	0.09	5.48	249.07	373.6	1868						15	15	15	0	15	15	15	80x50+20x10	15	0	0	0	0	0	5	20	20	15	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	15	20	20	0						0.15	0.15	0.15	0	0.15	0.15	0.15	42	0.15	0	0	0.15	0	0	5	20	20	0.15	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0.15	20	20	0						none	0.14	0.14	0.14	0	0.14	0.14	0.14	40.57	0.14	0	0	0.14	0	0	4.83	19.32	19.32	0.14	0	0	0.19	0	0	0	0	0	0	0	0	0	0	0	0.14	19.32	19.32	0						0	37.58	2.4	2.73	-	0.66	0.03	0	0.53	1.19	-	-	0.68	-	-	1.5	6.02	1	2.44	-	-	1.52	-	-	-	-	-	-	-	-	-	-	-	0.79	0.4	0.6	-	-	-	-	-	-	60.08	37.58	2.4	2.73	-	0.66	0.03	0	0.53	1.19	-	-	0.68	-	-	1.5	6.02	1	2.44	-	-	1.52	-	-	-	-	-	-	-	-	-	-	-	0.79	0.4	0.6	-	-	-	-	-	-	60.08
H1099_008_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						none	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	0	0	V	V	0	V					Coin	V	V	V	V						none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	2120.59	135.36	1133.35	2698.46	115.65	0.23	0.04	202.38	170	4857.23	2023.85	404.77	404.77	404.77	4857.23	4857.23	809.54	1619.08	809.54	0	9.77	0	0	1.2	3777.85	1619.08	0	0	0	8480.88	0	0.12	113.34	323.82	485.72	2428.62						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H1099_802_0	2006											none											Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					none																																										-	339.01	21.64	18.9	20.69	4.48	0.25	0.06	5.47	13.49	16.62	6.92	1.38	1.38	1.38	61.66	61.66	7.71	15.42	7.71	0	7.66																					FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																					7.6	7.6	16.5	20	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4																					none	7.6	7.6	16.5	20	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4																					40	25.89	1.65	3.13	4.14	0.96	0.05	0.01	1.17	2.88	3.55	1.48	0.3	0.3	0.3	13.17	13.17	1.65	3.29	1.65	-	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.36	25.89	1.65	3.13	4.14	0.96	0.05	0.01	1.17	2.88	3.55	1.48	0.3	0.3	0.3	13.17	13.17	1.65	3.29	1.65	-	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.36
H1099_803_0	2006											none											Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					none																																										-	339.01	21.64	18.9	20.69	4.48	0.25	0.06	5.47	13.49	16.62	6.92	1.38	1.38	1.38	61.66	61.66	7.71	15.42	7.71	0	7.66																					FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																					7.6	7.6	16.5	20	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4																					none	7.6	7.6	16.5	20	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4	21.4																					40	25.89	1.65	3.13	4.14	0.96	0.05	0.01	1.17	2.88	3.55	1.48	0.3	0.3	0.3	13.17	13.17	1.65	3.29	1.65	-	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.36	25.89	1.65	3.13	4.14	0.96	0.05	0.01	1.17	2.88	3.55	1.48	0.3	0.3	0.3	13.17	13.17	1.65	3.29	1.65	-	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.36
H1108_001_0	2006											2900											D	D	D	P	P	P	P	V	V	P	P	V	P	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	1696.38	86.1			3284.4																																					175 first 17 days	175 first 17 days			75 per trip																																					175	175			25																																						127.07	127.07			18.15																																						17.96	0.91	-	-	4.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.84	17.96	0.91	-	-	4.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.84
H1108_002_0	2006											525	Routine Physical Exams	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		P					V	P						V																																																				-	2204.66	506.29	868.71		303.92	29.4	25.88	847.92	340.04	1722.66	847.65	58.06	2.87	2205.83	120.59	3294.22	947.23	626.85		741.11																						75/day	75/day	114/day		100	20	20	35	25	10	10	50	20	50		25	35 indiv/25 group	10		25												10										75	75	60.08		100	0.2	0.2	35	25	10	10	50	0.2	46.38	25	25	32.5	13.43		25																							25.46	25.46	20.39		33.94	0.07	0.07	11.88	8.49	3.39	3.39	16.97	0.07	15.74	25	8.49	11.03	4.56		8.49																							4.68	1.07	1.48	-	0.86	2	1.76	0.84	0.24	0.49	0.24	0.08	0.2	2.89	0.25	2.33	0.87	0.24	-	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.03	4.68	1.07	1.48	-	0.86	2	1.76	0.84	0.24	0.49	0.24	0.08	0.2	2.89	0.25	2.33	0.87	0.24	-	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.03
H1109_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1647.19	16.81	1395.38	907.5	186.87	2.76	0.03	164.65	34.45	302.34	239.48	0.37	250.13	20.11	3605.17	7830.02	3.66	926.73	492.05		272.99	805.71																				200/d 7	200/d 7	0/d 1-8 75/d 9-15 125/d 16-100																																							143.69	143.69	77.39	0	100	0.2	0.2	48	100	35	40.13	35	35	35	25	35	35	35	35		45	35			0		0			0													143.69	143.69	77.39	0	100	0.2	0.2	48	100	35	40.13	35	35	35	25	35	35	35	35		45	35			0		0			0													19.72	0.2	9	-	1.56	0.55	0.01	0.66	0.29	0.88	0.8	0	0.73	0.06	7.51	22.84	0.01	2.7	1.44	-	1.02	2.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.33	19.72	0.2	9	-	1.56	0.55	0.01	0.66	0.29	0.88	0.8	0	0.73	0.06	7.51	22.84	0.01	2.7	1.44	-	1.02	2.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.33
H1109_002_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1660.85	16.95	1406.94	915.02	188.42	2.79	0.03	166.02	34.74	304.85	241.47	0.37	252.2	20.27	3635.05	7894.92	3.69	934.41	496.13		275.25	812.39																				150/d 7	150/d 7	0/d 1-10 75 11-100																																							107.77	107.77	77.39	0	100	0.2	0.2	48	100	35	40.13	35	35	35	25	35	35	35	35		45	35			0		0			0													107.77	107.77	77.39	0	100	0.2	0.2	48	100	35	40.13	35	35	35	25	35	35	35	35		45	35			0		0			0													14.92	0.15	9.07	-	1.57	0.56	0.01	0.66	0.29	0.89	0.81	0	0.74	0.06	7.57	23.03	0.01	2.73	1.45	-	1.03	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.91	14.92	0.15	9.07	-	1.57	0.56	0.01	0.66	0.29	0.89	0.81	0	0.74	0.06	7.57	23.03	0.01	2.73	1.45	-	1.03	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.91
H1109_003_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1743.2	17.79	1476.7	960.39	197.76	2.93	0.03	174.25	36.46	319.96	253.44	0.39	264.71	21.28	3815.29	8286.38	3.88	980.74	520.73		288.9	852.67																				50/d 7	50/d 7	0/d 1-10 75 11-100																																							35.92	35.92	77.39	0	100	0.2	0.2	46.75	100	25	33.55	25	25	25	15	25	25	25	25		45	25			0		0			0													35.92	35.92	77.39	0	100	0.2	0.2	46.75	100	25	33.55	25	25	25	15	25	25	25	25		45	25			0		0			0													5.22	0.05	9.52	-	1.65	0.59	0.01	0.68	0.3	0.67	0.71	0	0.55	0.04	4.77	17.26	0.01	2.04	1.08	-	1.08	1.78	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.02	5.22	0.05	9.52	-	1.65	0.59	0.01	0.68	0.3	0.67	0.71	0	0.55	0.04	4.77	17.26	0.01	2.04	1.08	-	1.08	1.78	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.02
H1109_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1559.49	15.75	1199.67	1171.31	210.72	1.95	0.02	219.98	44.62	822.58	252.89		60.71	38.37	2427.52	9208.9	0.37	626.51	559.06		269	667.27																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													18.67	0.19	10	3.42	2.63	0.58	0.01	0.92	0.56	0.56	2.07	-	0.18	0.11	7.08	26.86	0	1.83	1.63	-	1.51	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.75	18.67	0.19	10	3.42	2.63	0.58	0.01	0.92	0.56	0.56	2.07	-	0.18	0.11	7.08	26.86	0	1.83	1.63	-	1.51	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.75
H1109_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1559.49	15.75	1199.67	1171.31	210.72	1.95	0.02	219.98	44.62	822.58	252.89		60.71	38.37	2427.52	9208.9	0.37	626.51	559.06		269	667.27																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													18.67	0.19	10	3.42	2.63	0.58	0.01	0.92	0.56	0.56	2.07	-	0.18	0.11	7.08	26.86	0	1.83	1.63	-	1.51	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.75	18.67	0.19	10	3.42	2.63	0.58	0.01	0.92	0.56	0.56	2.07	-	0.18	0.11	7.08	26.86	0	1.83	1.63	-	1.51	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.75
H1109_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1559.49	15.75	1199.67	1171.31	210.72	1.95	0.02	219.98	44.62	822.58	252.89		60.71	38.37	2427.52	9208.9	0.37	626.51	559.06		269	667.27																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													18.67	0.19	10	3.42	2.63	0.58	0.01	0.92	0.56	0.56	2.07	-	0.18	0.11	7.08	26.86	0	1.83	1.63	-	1.51	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.75	18.67	0.19	10	3.42	2.63	0.58	0.01	0.92	0.56	0.56	2.07	-	0.18	0.11	7.08	26.86	0	1.83	1.63	-	1.51	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.75
H1110_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												5000	0	0							0																																	-	1436.7	14.51	1217.06	791.53	162.99	16.42	1.23	143.61	30.05	263.71	208.88	0.32	218.17	17.54	3144.46	6829.41	3.19	808.3	429.17		238.1	702.75																				150/d 7	150/d 7	0/d 1-10 75 11-100																																							107.77	107.77	77.39	0	100	0.2	0.2	48	200	35	40.13	35	35	35	25	35	35	35	35		45	35			0		0			0													107.77	107.77	77.39	0	100	0.2	0.2	48	200	35	40.13	35	35	35	25	35	35	35	35		45	35			0		0			0												0	12.9	0.13	7.85	-	1.36	3.28	0.25	0.57	0.5	0.77	0.7	0	0.64	0.05	6.55	19.92	0.01	2.36	1.25	-	0.89	2.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.03	12.9	0.13	7.85	-	1.36	3.28	0.25	0.57	0.5	0.77	0.7	0	0.64	0.05	6.55	19.92	0.01	2.36	1.25	-	0.89	2.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.03
H1110_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1372.4	13.86	1055.75	1030.8	185.44	1.71	0.02	193.59	39.27	723.9	222.56		53.43	33.77	2136.3	8104.15	0.33	551.36	492		236.73	587.22																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													16.43	0.17	8.8	3.01	2.32	0.51	0.01	0.81	0.49	0.49	1.82	-	0.16	0.1	6.23	23.64	0	1.61	1.43	-	1.33	1.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.06	16.43	0.17	8.8	3.01	2.32	0.51	0.01	0.81	0.49	0.49	1.82	-	0.16	0.1	6.23	23.64	0	1.61	1.43	-	1.33	1.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.06
H1110_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1372.4	13.86	1055.75	1030.8	185.44	1.71	0.02	193.59	39.27	723.9	222.56		53.43	33.77	2136.3	8104.15	0.33	551.36	492		236.73	587.22																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													16.43	0.17	8.8	3.01	2.32	0.51	0.01	0.81	0.49	0.49	1.82	-	0.16	0.1	6.23	23.64	0	1.61	1.43	-	1.33	1.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.06	16.43	0.17	8.8	3.01	2.32	0.51	0.01	0.81	0.49	0.49	1.82	-	0.16	0.1	6.23	23.64	0	1.61	1.43	-	1.33	1.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.06
H1110_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1372.4	13.86	1055.75	1030.8	185.44	1.71	0.02	193.59	39.27	723.9	222.56		53.43	33.77	2136.3	8104.15	0.33	551.36	492		236.73	587.22																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													16.43	0.17	8.8	3.01	2.32	0.51	0.01	0.81	0.49	0.49	1.82	-	0.16	0.1	6.23	23.64	0	1.61	1.43	-	1.33	1.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.06	16.43	0.17	8.8	3.01	2.32	0.51	0.01	0.81	0.49	0.49	1.82	-	0.16	0.1	6.23	23.64	0	1.61	1.43	-	1.33	1.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.06
H1111_002_0	2006											2650											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V	V		V		V			V																																																						-	1416.5	74.4	484.9	0	94.7	14.46	14.19	317.8	36.7	972.8	16.9	2.09	0.13	14.6	3940	5457.1	149.9	2.3	22.14	400	22.1	0	0		124		222			0												295	175	150	0	150	30	30	50	30	10	30 / 10	30	30	30 / 40 / 30	15 / 0	30	40 / 30	30	30 / 10	0 / 30	30	0	0		30		30			0												295	175	150	0	150	0.3	0.3	50	0.3	10	0.23	0.3	0.3	0.29	15	28.25	37.5	0.3	0.22	0.3	0.3	0	0		30		30			0													157.8	93.61	80.24	0	80.24	0.16	0.16	26.75	0.16	5.35	0.12	0.16	0.16	0.16	15	28.25	37.5	0.16	0.12	0.3	0.16	0	0		30		30			0													18.63	0.58	3.24	-	0.63	2.32	2.28	0.71	5.89	0.43	2.1	0.33	0.02	2.27	4.93	12.85	0.47	0.36	2.66	0.01	3.55	-	-	-	0.31	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.13	18.63	0.58	3.24	-	0.63	2.32	2.28	0.71	5.89	0.43	2.1	0.33	0.02	2.27	4.93	12.85	0.47	0.36	2.66	0.01	3.55	-	-	-	0.31	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.13
H1111_003_0	2006											2200											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V	V		V		V			V																																																						-	1416.6	74.4	484.9	0	94.7	14.46	14.19	317.8	36.71	972.8	16.9	2.09	0.13	14.56	3940.1	5457.2	149.9	2.27	22.14	400.1	22.1	0	0		124		222			0												265	175	125	0	150	20	20	50	20	10	20 / 10	20	20	20 / 40 / 30	Oct-00	20	40 / 30	20	20 / 10	0 / 20	20	0	0		20		20			0												265	175	125	0	150	0.2	0.2	50	0.2	10	0.16	0.2	0.2	0.2	10	18.83	37.5	0.2	0.17	0.29	0.2	0	0		20		20			0													144.78	95.61	68.29	0	81.95	0.11	0.11	27.32	0.11	5.46	0.09	0.11	0.11	0.11	10	18.83	37.5	0.11	0.09	0.29	0.11	0	0		20		20			0													17.09	0.59	2.76	-	0.65	1.58	1.55	0.72	4.01	0.44	1.46	0.23	0.01	1.55	3.28	8.56	0.47	0.25	2.07	0.01	2.42	-	-	-	0.21	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.29	17.09	0.59	2.76	-	0.65	1.58	1.55	0.72	4.01	0.44	1.46	0.23	0.01	1.55	3.28	8.56	0.47	0.25	2.07	0.01	2.42	-	-	-	0.21	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.29
H1111_004_0	2006											600											D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	V	V		V																																																						-	1660.25	89.17	505.02		108.13	16.51	16.21	531.76	598.51		765.72	55.51	0.22	1177.45	8655.19	5964.52	181.2	271.28	4418.9	435.22	24.11				124		322.01															25	25	15		100	20	20	40	15		0 / 10	15	20	15 / 10 / 8 / 4	Feb-00	4	04-Aug	10	0 / 10	0 / 4	20				05-Apr		4															25	25	15		100	0.2	0.2	40	15		9.56	15	0.2	13.9	1.25	3.77	7	10	5.36	0.25	0.2				4.95		4																16.56	16.56	9.94		66.23	0.13	0.13	26.49	9.94		6.33	9.94	0.13	9.21	1.25	3.77	7	6.62	3.55	0.25	0.13				4.95		4																2.29	0.12	0.42	-	0.6	2.19	2.15	1.17	0.5	-	0.4	0.05	0.03	0.9	0.9	1.87	0.11	0.15	1.31	0.01	3.19	-	-	-	0.05	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.51	2.29	0.12	0.42	-	0.6	2.19	2.15	1.17	0.5	-	0.4	0.05	0.03	0.9	0.9	1.87	0.11	0.15	1.31	0.01	3.19	-	-	-	0.05	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.51
H1111_801_0	2006											2250											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V			V		V			V																																																						-	1487.33	74.38	487.95	0	98.05	14.77	14.83	325.69	39.6	1032.8	18.16	2.22	0.12	15.29	4208.82	5893.43	154.11	2.46	23.87	434.98	23.62	0			133.3		238.65			0												265	17500	150	0	150	0	0	50	0	10	30 / 10	0.3	0.3	30 / 40 / 30	35 / 0	35	40 / 30	0	30 / 10	0 / 35	0.3	0			35		35			0												265	175	150	0	150	0.3	0.3	50	0.3	10	0.23	0.3	0.3	0.29	35	32.98	37.5	0.3	0.22	0.35	0.3	0			35		35			0													130.71	86.32	73.99	0	73.99	0.15	0.15	24.66	0.15	4.93	0.11	0.15	0.15	0.14	35	32.98	37.5	0.15	0.11	0.35	0.15	0			35		35			0													16.2	0.54	3.01	-	0.6	2.19	2.19	0.67	5.86	0.42	2.07	0.33	0.02	2.21	12.28	16.2	0.48	0.36	2.65	0.01	3.5	-	-	-	0.39	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.87	16.2	0.54	3.01	-	0.6	2.19	2.19	0.67	5.86	0.42	2.07	0.33	0.02	2.21	12.28	16.2	0.48	0.36	2.65	0.01	3.5	-	-	-	0.39	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.87
H1112_001_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1382.63	27.46	873.05	1760.75	360.02	19963.99	20567.81	257.47	232	1954.9	761.14	0	45.37	514.84	6499.01	9765.7	172.08	218.52	3963.65	12114.74	359.45	747.25	0	0	337.06	279.68	144.46	18.73	0	100	26.23											175 days 1 to 8	175 days 1 to 8	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 30	Eff. copay 15 to 75	0		Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 35	Eff. copay 30 to 30	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.	Eff. copay 0 to 20			20	20	20		0	0	Eff. copay 0 to 50											139.67	139.35	75.87	0	100	0.95	1.24	50	116.67	6.27	29.62	0	0	5.01	7.18	19.16	30	35	0	3.71	26.87	15.26	0	0	20	20	20	0	0	0	1.71											N/A	139.67	139.35	75.87	0	100	0.95	1.24	50	116.67	6.27	29.62	0	0	5.01	7.18	19.16	30	35	0	3.71	26.87	15.26	0	0	20	20	20	0	0	0	1.71												16.09	0.32	5.52	-	3	1.58	2.13	1.07	2.26	1.02	1.88	-	-	0.21	3.89	15.59	0.43	0.64	-	3.75	0.8	0.95	-	-	0.56	0.47	0.24	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.4	16.09	0.32	5.52	-	3	1.58	2.13	1.07	2.26	1.02	1.88	-	-	0.21	3.89	15.59	0.43	0.64	-	3.75	0.8	0.95	-	-	0.56	0.47	0.24	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.4
H1112_002_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1456.76	29.01	958.03	1913.79	374.09	20755.06	21381.4	266.98	240.74	2029.6	789.83	0	47.03	533.78	6741.51	10134.27	178.51	226.56	4118.99	12594.7	372.55	774.11	0	0	348.95	289.61	149.55	19.39	0	100	27.12											175 days 1 to 7	175 days 1 to 7	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 30	Eff. copay 15 to 75	0		Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 30	Eff. copay 30 to 30	35		Eff. copay 20 coins. 0 to 30 coins.	Eff. copay 20 coins.	Eff. copay 0 to 20			20	20	20		0	0	Eff. copay 0 to 50											137.73	137.42	75.87	0	100	0.97	1.26	50	116.67	6.26	29.62	0	0	5.01	7.17	19.19	30	35	0	3.78	27.34	15.26	0	0	20	20	20	0	0	0	1.72											N/A	137.73	137.42	75.87	0	100	0.97	1.26	50	116.67	6.26	29.62	0	0	5.01	7.17	19.19	30	35	0	3.78	27.34	15.26	0	0	20	20	20	0	0	0	1.72												16.72	0.33	6.06	-	3.12	1.67	2.25	1.11	2.34	1.06	1.95	-	-	0.22	4.03	16.21	0.45	0.66	-	3.97	0.85	0.98	-	-	0.58	0.48	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	65.3	16.72	0.33	6.06	-	3.12	1.67	2.25	1.11	2.34	1.06	1.95	-	-	0.22	4.03	16.21	0.45	0.66	-	3.97	0.85	0.98	-	-	0.58	0.48	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	65.3
H1112_003_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1401.57	27.85	879.21	1773.17	362.56	20104.77	20712.86	259.28	233.63	2012.08	782.65	0	45.69	518.47	6756.52	10016.11	176.63	224.26	4103.09	12461.39	361.98	752.52	0	0	339.44	281.66	145.47	18.86	0	100	26.42											100 days 1 to 7	100 days 1 to 7	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 20	Eff. copay 15 to 75	0		Eff. copay 0 to 100	Eff. copay 0 to 05	Eff. copay 0 to 20	Eff. copay 20 to 20	20		Eff. copay 20 coins. 0 to 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 20			20	20	20		0	0	Eff. copay 0 to 50											75.33	75.17	75.87	0	100	0.95	1.24	50	116.67	4.09	29.6	0	0	5.01	3.85	11.2	20	20	0	2.67	26.93	15.26	0	0	20	20	20	0	0	0	1.71											N/A	75.33	75.17	75.87	0	100	0.95	1.24	50	116.67	4.09	29.6	0	0	5.01	3.85	11.2	20	20	0	2.67	26.93	15.26	0	0	20	20	20	0	0	0	1.71												8.8	0.17	5.56	-	3.02	1.59	2.15	1.08	2.27	0.69	1.93	-	-	0.22	2.17	9.35	0.29	0.37	-	2.78	0.81	0.96	-	-	0.57	0.47	0.24	-	-	-	0	-	-	-	-	-	-	-	-	-	-	45.49	8.8	0.17	5.56	-	3.02	1.59	2.15	1.08	2.27	0.69	1.93	-	-	0.22	2.17	9.35	0.29	0.37	-	2.78	0.81	0.96	-	-	0.57	0.47	0.24	-	-	-	0	-	-	-	-	-	-	-	-	-	-	45.49
H1112_004_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1472.02	29.37	959.88	1916.28	375.08	20817.05	21444.4	267.37	241.21	2079.59	808.24	0	47.08	534.53	6972.23	10341.45	182.26	231.18	4246.59	12905.26	372.99	774.62	0	0	349	289.7	149.57	19.39	0	100	27.11											100 days 1 to 7	100 days 1 to 7	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 20	Eff. copay 15 to 75	0		Eff. copay 0 to 100	Eff. copay 0 to 05	Eff. copay 0 to 20	Eff. copay 20 to 20	20		Eff. copay 20 coins. 0 to 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 20			20	20	20		0	0	Eff. copay 0 to 50											75.33	75.17	75.87	0	100	0.97	1.26	50	116.67	4.08	29.6	0	0	5.01	3.84	11.18	20	20	0	2.7	27.33	15.26	0	0	20	20	20	0	0	0	1.72											N/A	75.33	75.17	75.87	0	100	0.97	1.26	50	116.67	4.08	29.6	0	0	5.01	3.84	11.18	20	20	0	2.7	27.33	15.26	0	0	20	20	20	0	0	0	1.72												9.24	0.18	6.07	-	3.13	1.68	2.26	1.11	2.35	0.71	1.99	-	-	0.22	2.23	9.63	0.3	0.39	-	2.9	0.85	0.98	-	-	0.58	0.48	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	47.54	9.24	0.18	6.07	-	3.13	1.68	2.26	1.11	2.35	0.71	1.99	-	-	0.22	2.23	9.63	0.3	0.39	-	2.9	0.85	0.98	-	-	0.58	0.48	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	47.54
H1112_005_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1807.69	35.49	1273.66	2480.07	471.61	26089.92	26888.88	341.6	306.8	2689.7	1087.53	0	60.32	683.48	9030.32	13262.12	237.72	302.52	5472.01	16506.19	477.9	993.23	0	0	449.01	372.17	192.43	24.96	0	100	35.13											50 days 1 to 7	50 days 1 to 7	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 00 to 50	Eff. copay 0 to 15	Eff. copay 0 to 50	0		Eff. copay 0 to 50	Eff. copay 0 to 25	Eff. copay 0 to 15	Eff. copay 15 to 15	15		Eff. copay 20 coins. 0 to 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 20			20	20	20		0	0	Eff. copay 0 to 50											37.67	37.58	37.93	0	100	0.93	1.22	50	33.33	3.03	11.77	0	0	2.49	0.52	8.67	15	15	0	2.39	26.7	15.26	0	0	20	20	20	0	0	0	0.39											N/A	37.67	37.58	37.93	0	100	0.93	1.22	50	33.33	3.03	11.77	0	0	2.49	0.52	8.67	15	15	0	2.39	26.7	15.26	0	0	20	20	20	0	0	0	0.39												5.67	0.11	4.03	-	3.93	2.03	2.74	1.42	0.85	0.68	1.07	-	-	0.14	0.39	9.58	0.3	0.38	-	3.29	1.06	1.26	-	-	0.75	0.62	0.32	-	-	-	0	-	-	-	-	-	-	-	-	-	-	40.62	5.67	0.11	4.03	-	3.93	2.03	2.74	1.42	0.85	0.68	1.07	-	-	0.14	0.39	9.58	0.3	0.38	-	3.29	1.06	1.26	-	-	0.75	0.62	0.32	-	-	-	0	-	-	-	-	-	-	-	-	-	-	40.62
H1112_006_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1839.62	35.39	1327.09	2631.99	1480.7	27203.24	28048.35	387.69	323.34	2929.68	1111.56	0	64.1	724.62	9970.86	14575.64	251.18	360.87	5992.18	17971.86	507.81	1181.97	0	0	0	0	0	0	0	0	284.27											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.11	175.1	54.11	0	12.76	0	0	33.16	169.73	0	53.71	0	2.9	33.42	0	0	17.39	0	0	1.46	26.42	0	0	0	0	0	0	0	0	0	0.15											N/A	180.11	175.1	54.11	0	12.76	0	0	33.16	169.73	0	53.71	0	2.9	33.42	0	0	17.39	0	0	1.46	26.42	0	0	0	0	0	0	0	0	0	0.15												27.61	0.52	5.98	-	1.57	-	-	1.07	4.57	-	4.98	-	0.02	2.02	-	-	0.36	-	-	2.18	1.12	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	52.01	27.61	0.52	5.98	-	1.57	-	-	1.07	4.57	-	4.98	-	0.02	2.02	-	-	0.36	-	-	2.18	1.12	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	52.01
H1112_007_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1942.6	37.37	1455.11	2860.41	1549	28457.87	29341.64	404.2	338.06	3063.01	1162.15	0	67.02	757.6	10430.24	15246.41	256.07	377.52	6268.55	18800.73	530.92	1236.33	0	0	0	0	0	0	0	0	291.85											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.11	175.1	54.11	0	13.07	0	0	33.88	173.68	0	54.96	0	2.97	34.2	0	0	17.81	0	0	1.49	27.03	0	0	0	0	0	0	0	0	0	0.16											N/A	180.11	175.1	54.11	0	13.07	0	0	33.88	173.68	0	54.96	0	2.97	34.2	0	0	17.81	0	0	1.49	27.03	0	0	0	0	0	0	0	0	0	0.16												29.16	0.55	6.56	-	1.69	-	-	1.14	4.89	-	5.32	-	0.02	2.16	-	-	0.38	-	-	2.34	1.2	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.4	29.16	0.55	6.56	-	1.69	-	-	1.14	4.89	-	5.32	-	0.02	2.16	-	-	0.38	-	-	2.34	1.2	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.4
H1112_008_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1911.19	37.92	1383.3	2658.1	490.43	27187.67	28013.19	352.61	317.6	2792.9	1128.05	0	62.15	705.13	9338.99	13729.99	245.87	312.18	5699.58	17216.65	492.4	1020.67	0	0	460.11	381.73	197.19	25.57	0	100	35.83											50 days 1 to 7	50 days 1 to 7	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 00 to 50	Eff. copay 0 to 15	Eff. copay 0 to 50	0		Eff. copay 0 to 50	Eff. copay 0 to 25	Eff. copay 0 to 15	Eff. copay 15 to 15	15		Eff. copay 20 coins. 0 to 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 20			20	20	20		0	0	Eff. copay 0 to 50											37.67	37.58	37.93	0	100	0.94	1.24	50	33.33	3	11.75	0	0	2.5	0.52	8.61	15	15	0	2.4	26.98	15.25	0	0	20	20	20	0	0	0	0.39											N/A	37.67	37.58	37.93	0	100	0.94	1.24	50	33.33	3	11.75	0	0	2.5	0.52	8.61	15	15	0	2.4	26.98	15.25	0	0	20	20	20	0	0	0	0.39												6	0.12	4.37	-	4.09	2.14	2.89	1.47	0.88	0.7	1.1	-	-	0.15	0.4	9.86	0.31	0.39	-	3.44	1.11	1.3	-	-	0.77	0.64	0.33	-	-	-	0	-	-	-	-	-	-	-	-	-	-	42.45	6	0.12	4.37	-	4.09	2.14	2.89	1.47	0.88	0.7	1.1	-	-	0.15	0.4	9.86	0.31	0.39	-	3.44	1.11	1.3	-	-	0.77	0.64	0.33	-	-	-	0	-	-	-	-	-	-	-	-	-	-	42.45
H1112_009_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1295.83	24.94	855.57	1719.78	1030.94	18940.22	19526.8	267.81	224.01	1876.59	717.68	0	44.41	502.02	6356.59	9550.95	170.43	214.09	3778.88	11506.59	351.81	822.08	0	0	0	0	0	0	0	0	26.46											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.										Eff. copay 20 coins.											125.48	124.85	54.11	0	13.17	0.95	1.25	33.9	173.81	0	55	0	0	34.22	6.46	17.42	17.95	35	0	3.55	27.05	0	0	0	0	0	0	0	0	0	1.15											N/A	125.48	124.85	54.11	0	13.17	0.95	1.25	33.9	173.81	0	55	0	0	34.22	6.46	17.42	17.95	35	0	3.55	27.05	0	0	0	0	0	0	0	0	0	1.15												13.55	0.26	3.86	-	1.13	1.5	2.03	0.76	3.24	-	3.29	-	-	1.43	3.42	13.86	0.25	0.62	-	3.4	0.79	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	53.41	13.55	0.26	3.86	-	1.13	1.5	2.03	0.76	3.24	-	3.29	-	-	1.43	3.42	13.86	0.25	0.62	-	3.4	0.79	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	53.41
H1112_010_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1369.25	26.44	941.04	1873.12	1073.86	19741.28	20351.04	277.85	232.98	1952.87	746.26	0	46.12	521.58	6607.71	9933.09	177.2	222.4	3936.68	11993.22	365.38	854.12	0	0	0	0	0	0	0	0	27.41											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											118.9	118.3	54.11	0	13.44	0.97	1.27	34.44	176.88	0	55.99	0	0	34.85	6.45	17.47	18.32	35	0	3.62	27.54	0	0	0	0	0	0	0	0	0	1.17											N/A	118.9	118.3	54.11	0	13.44	0.97	1.27	34.44	176.88	0	55.99	0	0	34.85	6.45	17.47	18.32	35	0	3.62	27.54	0	0	0	0	0	0	0	0	0	1.17												13.57	0.26	4.24	-	1.2	1.59	2.16	0.8	3.43	-	3.48	-	-	1.51	3.55	14.46	0.27	0.65	-	3.62	0.84	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.64	13.57	0.26	4.24	-	1.2	1.59	2.16	0.8	3.43	-	3.48	-	-	1.51	3.55	14.46	0.27	0.65	-	3.62	0.84	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.64
H1170_002_0	2006											2700											A	A	A		T	Coin	Coin	V	Coin		Coin			V	V	V	V	V			S				V		V			V	V											NA																																										-	287.96	9.25	434.18		368.18	8.93	0.99	468.86	45.36		39.27			224.06	3987.18	3247.58	145.66	204.18			1289				4		36.85			185.47	41.98											750 / admit	750 / admit	100/day for days 11-100		150 per trip	20 coinsurance	20 coinsurance	50 / visit	15 coinsurance		15 coinsurance			10 / visit	25 / visit	40 / visit	blended	40 / visit			35 brand / 15 generic				40 / visit		40 / visit			blended	40 / visit											750	750	100		150	0.2	0.2	50	0.15		0.15			10	25	40	30.7	40			20				40		40			0.3	40											2700	746	746	100		150	0.2	0.2	50	0.15		0.15			10	25	40	30.7	40			20				40		40			0.3	40												17.9	0.58	3.62	-	4.6	1.79	0.2	1.95	6.8	-	5.89	-	-	0.19	8.31	10.83	0.37	0.68	-	-	2.15	-	-	-	0.01	-	0.12	-	-	0	0.14	-	-	-	-	-	-	-	-	-	-	66.13	17.9	0.58	3.62	-	4.6	1.79	0.2	1.95	6.8	-	5.89	-	-	0.19	8.31	10.83	0.37	0.68	-	-	2.15	-	-	-	0.01	-	0.12	-	-	0	0.14	-	-	-	-	-	-	-	-	-	-	66.13
H1170_005_0	2006											2700											A	A	A		T	Coin	Coin	V	Coin		Coin			V	V	V	V	V			S				V		V			V	V											NA																																										-	287.96	9.25	434.18		368.18	8.93	0.99	468.86	45.36		39.27			224.06	3908.71	3183.66	142.79	200.16			1289				4		36.85			185.47	41.98											750 / admit	750 / admit	100/day for days 11-100		150 per trip	20 coinsurance	20 coinsurance	50 / visit	15 coinsurance		15 coinsurance			10 / visit	25 / visit	40 / visit	blended	40 / visit			35 brand / 15 generic				40 / visit		40 / visit			blended	40 / visit											750	750	100		150	0.2	0.2	50	0.15		0.15			10	25	40	30.7	40			20				40		40			0.3	40											2700	746	746	100		150	0.2	0.2	50	0.15		0.15			10	25	40	30.7	40			20				40		40			0.3	40												17.9	0.58	3.62	-	4.6	1.79	0.2	1.95	6.8	-	5.89	-	-	0.19	8.14	10.61	0.37	0.67	-	-	2.15	-	-	-	0.01	-	0.12	-	-	0	0.14	-	-	-	-	-	-	-	-	-	-	65.73	17.9	0.58	3.62	-	4.6	1.79	0.2	1.95	6.8	-	5.89	-	-	0.19	8.14	10.61	0.37	0.67	-	-	2.15	-	-	-	0.01	-	0.12	-	-	0	0.14	-	-	-	-	-	-	-	-	-	-	65.73
H1170_801_0	2006											3000											Ded	Ded	Ded		T	Ded	Ded	V	Ded	Ded	Ded			Ded	V	V	V			V	Ded	Ded																				NA	48.31	0.52	3.66			1.5	0.19		5.09	5.39	6.12			0.22							1.78	0.02																				72.8					435.2			339.9						171.5	4154.4	3864.5	188.8			155.9																										125 per trip			50 / visit						30/visit	20 / visit	30 / visit	blended			40/visit																										125			50						30	20	30	23			40																						NA					125			50						30	20	30	23			40																						500	-	-	-	-	4.53	-	-	1.42	-	-	-	-	-	0.43	6.92	9.66	0.36	-	-	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.85	48.31	0.52	3.66	-	4.53	1.5	0.19	1.42	5.09	5.39	6.12	-	-	0.65	6.92	9.66	0.36	-	-	0.52	1.78	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.65
H1170_802_0	2006											3000											Ded	Ded	Ded		T	Ded	Ded	V	Ded	Ded	Ded			Ded	V	V	V			V	Ded	Ded																				NA	48.31	0.52	3.66			1.5	0.19		5.09	5.39	6.12			0.22							1.78	0.02																				72.8					435.2			339.9						171.5	4154.4	3864.5	188.8			155.9																										125 per trip			50 / visit						30/visit	20 / visit	30 / visit	blended			40/visit																										125			50						30	20	30	23			40																						NA					125			50						30	20	30	23			40																						500	-	-	-	-	4.53	-	-	1.42	-	-	-	-	-	0.43	6.92	9.66	0.36	-	-	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.85	48.31	0.52	3.66	-	4.53	1.5	0.19	1.42	5.09	5.39	6.12	-	-	0.65	6.92	9.66	0.36	-	-	0.52	1.78	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.65
H1170_803_0	2006											3000											Ded	Ded	Ded		T	Ded	Ded	V	Ded	Ded	Ded			Ded	V	V	V			V	Ded	Ded																				NA	48.31	0.52	3.66			1.5	0.19		5.09	5.39	6.12			0.22							1.78	0.02																				72.8					435.2			339.9						171.5	4154.4	3864.5	188.8			155.9																										125 per trip			50 / visit						30/visit	20 / visit	30 / visit	blended			40/visit																										125			50						30	20	30	23			40																						NA					125			50						30	20	30	23			40																						500	-	-	-	-	4.53	-	-	1.42	-	-	-	-	-	0.43	6.92	9.66	0.36	-	-	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.85	48.31	0.52	3.66	-	4.53	1.5	0.19	1.42	5.09	5.39	6.12	-	-	0.65	6.92	9.66	0.36	-	-	0.52	1.78	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.65
H1170_804_0	2006											3000											Ded	Ded	Ded		T	Ded	Ded	V	Ded	Ded	Ded			Ded	V	V	V			V	Ded	Ded																				NA	48.31	0.52	3.66			1.5	0.19		5.09	5.39	6.12			0.22							1.78	0.02																				72.8					435.2			339.9						171.5	4154.4	3864.5	188.8			155.9																										125 per trip			50 / visit						30/visit	20 / visit	30 / visit	blended			40/visit																										125			50						30	20	30	23			40																						NA					125			50						30	20	30	23			40																						500	-	-	-	-	4.53	-	-	1.42	-	-	-	-	-	0.43	6.92	9.66	0.36	-	-	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.85	48.31	0.52	3.66	-	4.53	1.5	0.19	1.42	5.09	5.39	6.12	-	-	0.65	6.92	9.66	0.36	-	-	0.52	1.78	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.65
H1230_001_0	2006											1500															T	P	P	V	V						V	V	V	V	V	V	O						V			V												none																																										-					129.88	201.22	27.44	259.78	116.58						7745.28	91.12	273.36	820.09	91.12	91.12	557.23						5.04			8.65																Twenty percent	Twenty percent	Twenty percent	25/visit	14						14/visit	14/visit	20 for 1st 20 visit & 50 for visit 21+	14	14	14	10/generic & 40 brand						14/visit			14/visit																60.62	35.12	35.12	25	14.06						14.06	14.06	19.35	14.06	14.06	14.06	21.1						172.12			14.06												1500					60.62	35.12	35.12	25	14.06						14.06	14.06	19.35	14.06	14.06	14.06	21.1						172.12			14.06													-	-	-	-	0.66	0.59	0.08	0.54	0.14	-	-	-	-	-	9.07	0.11	0.44	0.96	0.11	0.11	0.98	-	-	-	-	-	0.07	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	13.86	-	-	-	-	0.66	0.59	0.08	0.54	0.14	-	-	-	-	-	9.07	0.11	0.44	0.96	0.11	0.11	0.98	-	-	-	-	-	0.07	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	13.86
H1230_002_0	2006											1500															T	P	P	V	V						V	V	V	V	V	V	O						V			V												none																																										-					129.88	201.22	27.44	259.78	116.58						7745.28	91.12	273.36	820.09	91.12	91.12	557.23						5.04			8.65																Twenty percent	Twenty percent	Twenty percent	25/visit	14						14/visit	14/visit	20 for 1st 20 visit & 50 for visit 21+	14	14	14	10/generic & 40 brand						14/visit			14/visit																60.62	35.12	35.12	25	14.06						14.06	14.06	19.35	14.06	14.06	14.06	21.1						172.12			14.06												1500					60.62	35.12	35.12	25	14.06						14.06	14.06	19.35	14.06	14.06	14.06	21.1						172.12			14.06													-	-	-	-	0.66	0.59	0.08	0.54	0.14	-	-	-	-	-	9.07	0.11	0.44	0.96	0.11	0.11	0.98	-	-	-	-	-	0.07	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	13.86	-	-	-	-	0.66	0.59	0.08	0.54	0.14	-	-	-	-	-	9.07	0.11	0.44	0.96	0.11	0.11	0.98	-	-	-	-	-	0.07	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	13.86
H1230_801_0	2006											1500											D				T	P	P	V	V	P	P				V	V	V	V	V	V	O	P					V			V												none																																										-	562.95				129.88	201.22	27.44	259.78	116.58	26307	2044				7745.35	273.37	273.37	820.1	718.72	8302.67	557.23						5.04			8.65												20Room & Board				Twenty percent	Twenty percent	Twenty percent	50/visit	30	Twenty percent	Twenty percent				30/visit	30/visit	20 for 1st 20 visit & 50 for visit 21+	30	20 IP Radiology	20 IP Lab	10/generic & 40 brand						30/visit			30/visit												308.54				60.62	35.12	35.12	50	30.02	5.3	56.32				30.02	30.02	19.35	30.02	56.32	5.3	20.8	4.68					30.02			30.02												1500	308.54				60.62	35.12	35.12	50	30.02	5.3	56.32				30.02	30.02	19.35	30.02	56.32	5.3	20.8	4.68					30.02			30.02													14.47	-	-	-	0.66	0.59	0.08	1.08	0.29	11.62	9.59	-	-	-	19.38	0.68	0.44	2.05	3.37	3.67	0.97	-	-	-	-	-	0.01	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	68.98	14.47	-	-	-	0.66	0.59	0.08	1.08	0.29	11.62	9.59	-	-	-	19.38	0.68	0.44	2.05	3.37	3.67	0.97	-	-	-	-	-	0.01	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	68.98
H1230_802_0	2006											1500															T	P	P	V	V						V	V	V	V	V	V	O						V			V												none																																										-	562.95				129.88	201.22	27.44	259.78	116.58	26307	2044				7745.35	273.37	273.37	820.1	718.72	8302.67	557.23						5.04			8.65												20Room & Board				Twenty percent	Twenty percent	Twenty percent	50/visit	30	Twenty percent	Twenty percent				30/visit	30/visit	20 for 1st 20 visit & 50 for visit 21+	30	20 IP Radiology	20 IP Lab	10/generic & 40 brand						30/visit			30/visit												308.54				60.62	35.12	35.12	50	30.02	5.3	56.32				30.02	30.02	19.35	30.02	56.32	5.3	20.8	4.68					30.02			30.02												1500	308.54				60.62	35.12	35.12	50	30.02	5.3	56.32				30.02	30.02	19.35	30.02	56.32	5.3	20.8	4.68					30.02			30.02													14.47	-	-	-	0.66	0.59	0.08	1.08	0.29	11.62	9.59	-	-	-	19.38	0.68	0.44	2.05	3.37	3.67	0.97	-	-	-	-	-	0.01	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	68.98	14.47	-	-	-	0.66	0.59	0.08	1.08	0.29	11.62	9.59	-	-	-	19.38	0.68	0.44	2.05	3.37	3.67	0.97	-	-	-	-	-	0.01	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	68.98
H1230_803_0	2006											1500											D				T	P	P	V	V	P	P				V	V	V	V	V	V	O	P					V			V												none																																										-	562.95				129.88	201.22	27.44	259.78	116.58	26307	2044				7745.35	273.37	273.37	820.1	718.72	8302.67	557.23						5.04			8.65												20Room & Board				Twenty percent	Twenty percent	Twenty percent	50/visit	30	Twenty percent	Twenty percent				30/visit	30/visit	20 for 1st 20 visit & 50 for visit 21+	30	20 IP Radiology	20 IP Lab	10/generic & 40 brand						30/visit			30/visit												308.54				60.62	35.12	35.12	50	30.02	5.3	56.32				30.02	30.02	19.35	30.02	56.32	5.3	20.8	4.68					30.02			30.02												1500	308.54				60.62	35.12	35.12	50	30.02	5.3	56.32				30.02	30.02	19.35	30.02	56.32	5.3	20.8	4.68					30.02			30.02													14.47	-	-	-	0.66	0.59	0.08	1.08	0.29	11.62	9.59	-	-	-	19.38	0.68	0.44	2.05	3.37	3.67	0.97	-	-	-	-	-	0.01	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	68.98	14.47	-	-	-	0.66	0.59	0.08	1.08	0.29	11.62	9.59	-	-	-	19.38	0.68	0.44	2.05	3.37	3.67	0.97	-	-	-	-	-	0.01	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	68.98
H1230_804_0	2006											1500															T	P	P	V	V						V	V	V	V	V	V	O						V			V												none																																										-	562.95				129.88	201.22	27.44	259.78	116.58	26307	2044				7745.35	273.37	273.37	820.1	718.72	8302.67	557.23						5.04			8.65												20Room & Board				Twenty percent	Twenty percent	Twenty percent	50/visit	30	Twenty percent	Twenty percent				30/visit	30/visit	20 for 1st 20 visit & 50 for visit 21+	30	20 IP Radiology	20 IP Lab	10/generic & 40 brand						30/visit			30/visit												308.54				60.62	35.12	35.12	50	30.02	5.3	56.32				30.02	30.02	19.35	30.02	56.32	5.3	20.8	4.68					30.02			30.02												1500	308.54				60.62	35.12	35.12	50	30.02	5.3	56.32				30.02	30.02	19.35	30.02	56.32	5.3	20.8	4.68					30.02			30.02													14.47	-	-	-	0.66	0.59	0.08	1.08	0.29	11.62	9.59	-	-	-	19.38	0.68	0.44	2.05	3.37	3.67	0.97	-	-	-	-	-	0.01	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	68.98	14.47	-	-	-	0.66	0.59	0.08	1.08	0.29	11.62	9.59	-	-	-	19.38	0.68	0.44	2.05	3.37	3.67	0.97	-	-	-	-	-	0.01	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	68.98
H1302_001_0	2006											1500											A	A			T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	Coin	V			V		V				V											3000																																										-	249.48	3.6	225.36	1385.1	205.2	9	5.85	465.3	320.4	0	1055.7	0	20.88	291.6	3485.1	3125.4	167.4	630	3638.7	7871.4	6	508.5	0	0	297.9	0	0	0	0	0	0														10 coinsurance = 17.07	10 coinsurance = 30.15	10 coinsurance	10 coinsurance	50 ER/20 Urgent Care	10 coinsurance		10 coinsurance		10 coinsurance					20 CORF/20 OT/20 PT (37c7i)	10 coinsurance	10 coinsurance																																																																500	500	25	17.07	30.15	0.1	0.1	40.31	77.98	0	24.88	0	14.26	20	20	20	20	20	5.55	3.99	0.1	20	0	0	20	0	0	0	0	0	0												10.4	0.15	0.47	1.97	0.52	0.9	0.59	1.56	2.08	-	2.19	-	0.02	0.49	5.81	5.21	0.28	1.05	1.68	2.62	0.6	0.85	-	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.93	10.4	0.15	0.47	1.97	0.52	0.9	0.59	1.56	2.08	-	2.19	-	0.02	0.49	5.81	5.21	0.28	1.05	1.68	2.62	0.6	0.85	-	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.93
H1302_002_0	2006											1500											A	A			T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	Coin	V			V		V				V											3000																																										-	235.08	3.24	207.72	1298.7	199.8	9.1	5.95	397.8	238.5	0	779.4	0	19.83	220.5	3699.11	3284.89	183.6	696.6	3494.7	8547.3	6.03	540	0	0	319.5	0	0	0	0	0	0														10 coinsurance = 17.07	10 coinsurance = 30.15	10 coinsurance	10 coinsurance	50 ER/20 Urgent Care	10 coinsurance		10 coinsurance		10 coinsurance					20 CORF/20 OT/20 PT (37c7i)	10 coinsurance	10 coinsurance																																																																500	500	25	18.27	31.64	0.1	0.1	37.99	103.53	0	32.93	0	15.46	20	20	20	20	20	6.28	3.84	0.1	20	0	0	20	0	0	0	0	0	0												9.8	0.14	0.43	1.98	0.53	0.91	0.59	1.26	2.06	-	2.14	-	0.03	0.37	6.17	5.47	0.31	1.16	1.83	2.74	0.6	0.9	-	-	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.93	9.8	0.14	0.43	1.98	0.53	0.91	0.59	1.26	2.06	-	2.14	-	0.03	0.37	6.17	5.47	0.31	1.16	1.83	2.74	0.6	0.9	-	-	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.93
H1302_004_0	2006											1500											A	A			T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	Coin	V			V		V				V											3000																																										-	249.48	3.6	225.36	1385.1	205.2	9	5.85	465.3	320.4	0	1055.7	0	20.88	291.6	3485.1	3125.4	167.4	630	3638.7	7870.5	6	508.5	0	0	297.9	0	0	0	0	0	0														10 coinsurance = 17.07	10 coinsurance = 30.15	10 coinsurance	10 coinsurance	50 ER/20 Urgent Care	10 coinsurance		10 coinsurance		10 coinsurance					20 CORF/20 OT/20 PT (37c7i)	10 coinsurance	10 coinsurance																																																																500	500	25	17.07	30.15	0.1	0.1	40.31	77.98	0	24.88	0	14.26	20	20	20	20	20	5.55	3.99	0.1	20	0	0	20	0	0	0	0	0	0												10.4	0.15	0.47	1.97	0.52	0.9	0.59	1.56	2.08	-	2.19	-	0.02	0.49	5.81	5.21	0.28	1.05	1.68	2.62	0.6	0.85	-	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.93	10.4	0.15	0.47	1.97	0.52	0.9	0.59	1.56	2.08	-	2.19	-	0.02	0.49	5.81	5.21	0.28	1.05	1.68	2.62	0.6	0.85	-	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.93
H1302_005_0	2006											1500											A	A			T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	Coin	V			V		V				V											3000																																										-	235.44	3.24	207.72	1299.6	199.8	9.12	5.96	399.6	240.3	0	783.9	0	19.87	221.4	3698.09	3284.11	182.7	695.7	3496.5	8532	6.05	540	0	0	319.5	0	0	0	0	0	0														10 coinsurance = 17.07	10 coinsurance = 30.15	10 coinsurance	10 coinsurance	50 ER/20 Urgent Care	10 coinsurance		10 coinsurance		10 coinsurance					20 CORF/20 OT/20 PT (37c7i)	10 coinsurance	10 coinsurance																																																																500	500	25	18.25	31.61	0.1	0.1	38.04	103.11	0	32.79	0	15.47	20	20	20	20	20	6.27	3.84	0.1	20	0	0	20	0	0	0	0	0	0												9.81	0.14	0.43	1.98	0.53	0.91	0.6	1.27	2.06	-	2.14	-	0.03	0.37	6.16	5.47	0.3	1.16	1.83	2.73	0.6	0.9	-	-	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.96	9.81	0.14	0.43	1.98	0.53	0.91	0.6	1.27	2.06	-	2.14	-	0.03	0.37	6.16	5.47	0.3	1.16	1.83	2.73	0.6	0.9	-	-	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.96
H1302_801_0	2006											1500											A	A	D		T	Coin	Coin	V	V		V		V	V	V	V	V	V	V	V	Coin	V																				3000																																										-	246.24	3.42	229.5	1388.7	206.1	9.05	5.88	460.8	309.6	2002.5	1020.6	0	21.12	282.6	3608.83	3233.87	174.6	660.6	3689.1	8390.7	6.32	526.5	0	0	0	0	0	0	0	0	0															10 Coinsurance	10 Coinsurance	10 Coinsurance	50 ER / 20 Urgent Care	10 Coinsurance		10 Coinsurance		10 Coinsurance						10 Coinsurance	10 Coinsurance																																																																500	500	25	17.38	30.34	0.1	0.1	39.86	85.02	5.08	27.12	0	14.88	20	20	20	20	20	5.76	3.93	0.1	20	0	0	0	0	0	0	0	0	0												10.26	0.14	0.48	2.01	0.52	0.91	0.59	1.53	2.19	0.85	2.31	-	0.03	0.47	6.01	5.39	0.29	1.1	1.77	2.75	0.63	0.88	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.11	10.26	0.14	0.48	2.01	0.52	0.91	0.59	1.53	2.19	0.85	2.31	-	0.03	0.47	6.01	5.39	0.29	1.1	1.77	2.75	0.63	0.88	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.11
H1303_001_0	2006											2700											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	983.65	57.12	758.29		68.53	8.98	16.21	309.82	40.84		21.72	4.17		22.87	2935.78	3894.52	91.91	5.11	16.95	243.49	13.96				117.8		210.9															275	275	150		150	30	30	50	30		0/30	30	30	30/40/30	10.00/0	25	40/30	30	0/30	0/25	30				25		25															275	275	150		150	0.3	0.3	50	0.3		0.24	0.3		0.3	10	23.5	37.5	0.3	0.16	0.49	0.3				25		25																159.26	153.39	83.67		83.67	0.17	0.17	27.89	0.17		0.14	0.17		0.17	10	23.5	37.5	0.17	0.09	0.49	0.17				25		25																13.05	0.73	5.29	-	0.48	1.5	2.71	0.72	6.83	-	2.97	0.7	-	3.81	2.45	7.63	0.29	0.87	1.52	0.01	2.34	-	-	-	0.25	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.58	13.05	0.73	5.29	-	0.48	1.5	2.71	0.72	6.83	-	2.97	0.7	-	3.81	2.45	7.63	0.29	0.87	1.52	0.01	2.34	-	-	-	0.25	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.58
H1303_003_0	2006											2400											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	983.66	57.12	758.29	0	68.54	8.98	16.21	309.82	40.84	0	21.72	4.17	0	22.87	2935.81	3894.56	91.91	5.11	16.95	243.49	13.96	0	0	0	117.8	0	210.9	0	0	0	0											265	265	100	0	150	20	20	50	20	0	0/20	20	20	20/40/30	8.00/0	20	40/30	20	0/20	0/20	20	0			20		20															265	265	100	0	150	0.2	0.2	50	0.2	0	0.16	0.2	0	0.2	8	19	37.5	0.2	0.11	0.49	0.2	0	0	0	20	0	20	0	0	0	0												163.03	157.86	59.57	0	89.36	0.12	0.12	29.79	0.12	0	0.1	0.12	0	0.12	8	19	37.5	0.12	0.06	0.49	0.12	0	0	0	20	0	20	0	0	0	0												13.36	0.75	3.76	-	0.51	1.07	1.93	0.77	4.87	-	2.11	0.5	-	2.71	1.96	6.17	0.29	0.62	1.08	0.01	1.66	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.68	13.36	0.75	3.76	-	0.51	1.07	1.93	0.77	4.87	-	2.11	0.5	-	2.71	1.96	6.17	0.29	0.62	1.08	0.01	1.66	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.68
H1303_004_0	2006											600											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1205.65	73.12	751.54		95.84	12.56	22.67	505.16	66.63		37.26	6.81		37.33	8190.19	5190.26	135.81	6.78	24.92	323.83	18.57				117.8		311.65															25	25	15		100	20	20	40	15		0/10	15	20	15/10/8/4	Feb-00	4	04-Aug	10	0/10	0/4	20				4.00/5.00		4															25	25	15		100	0.2	0.2	40	0.01		0.02	0.01		0.07	1.01	3.8	7	0.09	0.08	0.2	0.2				4		4																16.65	16.23	9.74		64.92	0.13	0.13	25.97	0.01		0.01	0.01		0.05	1.01	3.8	7	0.06	0.05	0.2	0.13				4		4																1.67	0.1	0.61	-	0.52	1.63	2.94	1.09	0.51	-	0.38	0.06	-	1.7	0.69	1.64	0.08	0.41	1.25	0.01	2.41	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.87	1.67	0.1	0.61	-	0.52	1.63	2.94	1.09	0.51	-	0.38	0.06	-	1.7	0.69	1.64	0.08	0.41	1.25	0.01	2.41	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.87
H1303_801_0	2006											3600											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1029.69	50.31	765.75		70.58	9.14	16.95	319	44.18		27.55	4.36		23.88	3140.31	4209.16	78.57	5.37	18.3	263.2	15.27				126.64		226.72															265	175	150		150	30	30	50	30	20	20/30	30	30	30/40/30	35/0	35	40/30	30	20/30	0/35	30				35		35															265	175	150		150	0.3	0.3	50	0.3		0.23	0.3		0.3	35	33.27	10.5	0.3	0.29	0.6	0.3				35		35																167.32	107.17	91.86		91.86	0.18	0.18	30.62	0.18		0.14	0.18		0.18	35	33.27	10.5	0.19	0.18	0.6	0.18				35		35																14.36	0.45	5.86	-	0.54	1.68	3.11	0.81	8.12	-	3.84	0.8	-	4.37	9.16	11.67	0.07	1	3.24	0.01	2.81	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.92	14.36	0.45	5.86	-	0.54	1.68	3.11	0.81	8.12	-	3.84	0.8	-	4.37	9.16	11.67	0.07	1	3.24	0.01	2.81	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.92
H1304_001_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	557.55	9	0	0	231.3	10.12	6.59	513	0	0	0	0	0	0	4418.3	3913	213.3	881.1	0	1427.4	6.99	646.2	0	0	379.8	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	33.26	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												4.65	0.08	-	-	0.96	1.12	-	1.42	-	-	-	-	-	-	1.84	1.63	0.09	0.33	-	0.59	0.78	0.27	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.92	4.65	0.08	-	-	0.96	1.12	-	1.42	-	-	-	-	-	-	1.84	1.63	0.09	0.33	-	0.59	0.78	0.27	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.92
H1304_002_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	557.55	9	0	0	231.3	10.12	6.59	513	0	0	0	0	0	0	4418.3	3913	213.3	881.1	0	1427.4	6.99	646.2	0	0	379.8	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	33.26	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												4.65	0.08	-	-	0.96	1.12	-	1.42	-	-	-	-	-	-	1.84	1.63	0.09	0.33	-	0.59	0.78	0.27	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.92	4.65	0.08	-	-	0.96	1.12	-	1.42	-	-	-	-	-	-	1.84	1.63	0.09	0.33	-	0.59	0.78	0.27	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.92
H1350_001_0	2006																								D					V						V	V	V	V	V		V		V			V		V																																																									-	0	0	22.14	0	0	0	0	382.98	0	0	0	0	0	857.43	4272.47	3561.58	248.76	567.53	0	0	0	0	0	0	0	0	0.74	0	0	0	0																		50 ER/20 Urgent										10 CORF/10 OT/10 PT (37c7i)																																																																		0	0	25	0	0	0	0	41.01	0	0	0	0	0	10	10	20	20	10	0	20	0	20	0	0	20	0	10	0	0	0	0												-	-	0.05	-	-	-	-	1.31	-	-	-	-	-	0.71	3.56	5.94	0.41	0.47	-	-	-	0	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.45	-	-	0.05	-	-	-	-	1.31	-	-	-	-	-	0.71	3.56	5.94	0.41	0.47	-	-	-	0	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.45
H1350_002_0	2006																						A	A			T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	Coin	V			V		V				V																																																					-	0	0	244.8	0	0	10.6	6.88	449	0	0	0	0	0	251	4266.72	3801.28	211	847	0	1416	6.77	603	0	0	354	0	0	0	0	0	0																		50 ER/20 Urgent Care										10 CORF/10 OT/10 PT (37c7i)																																																																		0	0	25	0	0	0	0	38.11	0	0	0	0	0	10	10	20	20	10	0	20	0	20	0	0	20	0	0	0	0	0	0												-	-	0.51	-	-	-	-	1.43	-	-	-	-	-	0.21	3.56	6.34	0.35	0.71	-	2.36	-	1.01	-	-	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.05	-	-	0.51	-	-	-	-	1.43	-	-	-	-	-	0.21	3.56	6.34	0.35	0.71	-	2.36	-	1.01	-	-	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.05
H1350_005_0	2006																						A	A			T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	Coin	V			V		V				V																																																					-	0	0	239.8	0	0	10.26	6.72	480	0	0	0	0	0	288	4033.05	3567.95	188	755	0	1222	5.9	572	0	0	338	0	0	0	0	0	0																		50 ER/20 Urgent Care										10 CORF/10 OT/10 PT (37c7i)																																																																		0	0	25	0	0	0	0	39.44	0	0	0	0	0	10	10	20	20	10	0	20	0	20	0	0	20	0	0	0	0	0	0												-	-	0.5	-	-	-	-	1.58	-	-	-	-	-	0.24	3.36	5.95	0.31	0.63	-	2.04	-	0.95	-	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.12	-	-	0.5	-	-	-	-	1.58	-	-	-	-	-	0.24	3.36	5.95	0.31	0.63	-	2.04	-	0.95	-	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.12
H1350_006_0	2006																								D					V						V	V	V	V	V		V		V			V		V																																																									-	0	0	22.14	0	0	0	0	382.98	0	0	0	0	0	857.43	4272.47	3561.58	248.76	567.53	0	0	0	0	0	0	0	0	0.74	0	0	0	0																		50 ER/20 Urgent										10 CORF/10 OT/10 PT (37c7i)																																																																		0	0	25	0	0	0	0	41.01	0	0	0	0	0	10	10	20	20	10	0	20	0	20	0	0	20	0	10	0	0	0	0												-	-	0.05	-	-	-	-	1.31	-	-	-	-	-	0.71	3.56	5.94	0.41	0.47	-	0	-	0	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.45	-	-	0.05	-	-	-	-	1.31	-	-	-	-	-	0.71	3.56	5.94	0.41	0.47	-	0	-	0	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.45
H1350_007_0	2006																						A	A			T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	Coin	V			V		V				V																																																					-	0	0	244.8	0	0	10.6	6.88	449	0	0	0	0	0	251	4266.72	3801.28	211	847	0	1416	6.77	603	0	0	354	0	0	0	0	0	0																		50 ER/20 Urgent Care																																																																												0	0	25	0	0	0	0	38.11	0	0	0	0	0	10	10	20	20	10	0	20	0	20	0	0	20	0	0	0	0	0	0												-	-	0.51	-	-	-	-	1.43	-	-	-	-	-	0.21	3.56	6.34	0.35	0.71	-	2.36	-	1.01	-	-	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.05	-	-	0.51	-	-	-	-	1.43	-	-	-	-	-	0.21	3.56	6.34	0.35	0.71	-	2.36	-	1.01	-	-	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.05
H1350_008_0	2006																						A	A			T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	Coin	V			V		V				V																																																					-	0	0	239.8	0	0	10.26	6.72	480	0	0	0	0	0	288	4032.49	3567.51	188	755	0	1222	5.9	572	0	0	338	0	0	0	0	0	0																		50 ER/20 Urgent Care										10 CORF/10 OT/10 PT (37c7i)																																																																		0	0	25	0	0	0	0	39.44	0	0	0	0	0	10	10	20	20	10	0	20	0	20	0	0	20	0	0	0	0	0	0												-	-	0.5	-	-	-	-	1.58	-	-	-	-	-	0.24	3.36	5.95	0.31	0.63	-	2.04	-	0.95	-	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.12	-	-	0.5	-	-	-	-	1.58	-	-	-	-	-	0.24	3.36	5.95	0.31	0.63	-	2.04	-	0.95	-	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.12
H1350_802_0	2006																								D					V						V	V	V	V	V		V		V																																																														-	0	0	237.6	0	0	9.5	6.21	497	0	0	0	0	0	299	4121.47	3643.53	188	755	0	1219	6.83	585	0	0	0	0	0	0	0	0	0																		50 ER/20 Urgent										20 CORF/10 OT/10 PT (37c7i)																																																																		0	0	25	0	0	0	0	39.56	0	0	0	0	0	10	10	20	20	11	0	20	0	20	0	0	0	0	0	0	0	0	0												-	-	0.5	-	-	-	-	1.64	-	-	-	-	-	0.25	3.43	6.07	0.31	0.69	-	2.03	-	0.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.9	-	-	0.5	-	-	-	-	1.64	-	-	-	-	-	0.25	3.43	6.07	0.31	0.69	-	2.03	-	0.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.9
H1406_006_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2213.89	11.92	1946.3	2189.45	273.41	0.31	0.02	1109.17	773.33				0	526.09	7525.73	5264.33					4.45			7.56	0		0					116.52	0.63	2.43	0	0	0	0				175 per day (1-7)	175 per day (1-7)	0 per day (1-6) 100 per day (7-100)	0	100	20	20	30-50	0-200				0	0-200	15-30	30					0.2			0 - 0	0		0					500 per day (1-7)	175 per day (1-7)	20	0	0	0	0				136.43	136.43	29.09	0	100	0.2	0.2	45.4	66				0	28.1	15.29	30					0.2			0	0		0					389.8	136.43	0.2	0	0	0	0					136.43	136.43	29.09	0	100	0.2	0.2	45.4	66				0	28.1	15.29	30					0.2			0	0		0					389.8	136.43	0.2	0	0	0	0				0	25.17	0.14	4.72	-	2.28	0.06	0	4.2	4.25	-	-	-	-	1.23	9.59	13.16	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	3.78	0.01	0.49	-	-	-	-	-	-	-	69.97	25.17	0.14	4.72	-	2.28	0.06	0	4.2	4.25	-	-	-	-	1.23	9.59	13.16	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	3.78	0.01	0.49	-	-	-	-	-	-	-	69.97
H1406_013_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1978.56	10.66	869.71	1956.71	244.35	0.25	0.02	991.27	691.13				0	470.17	6725.77	4704.75					4.45			0	0		0					104.13	0.56	1.94	0	0	0	0				100 per day (1-7)	100 per day (1-7)	0 per day (1-6) 75 per day (7-100)	0	100	20	20	30-50	0-200				0	0-200	0-30	30					20			0	0		0					500 per day (1-7)	100 per day (1-7)	20	0	0	0	0				77.96	77.96	43.64	0	100	0.2	0.2	45.4	66				0	37.18	0.59	30					20			0	0		0					389.8	77.96	0.2	0	0	0	0					77.96	77.96	43.64	0	100	0.2	0.2	45.4	66				0	37.18	0.59	30					20			0	0		0					389.8	77.96	0.2	0	0	0	0				0	12.85	0.07	3.16	-	2.04	0.05	0	3.75	3.8	-	-	-	-	1.46	0.33	11.76	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	3.38	0	0.39	-	-	-	-	-	-	-	43.94	12.85	0.07	3.16	-	2.04	0.05	0	3.75	3.8	-	-	-	-	1.46	0.33	11.76	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	3.38	0	0.39	-	-	-	-	-	-	-	43.94
H1406_014_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2005.16	10.8	1762.81	1983.03	247.63	0.29	0.02	1004.6	700.42				0	476.49	6816.21	4768.01					4.45			7.56	0		0					105.53	0.57	2.25	0	0	0	0				175 per day (1-7)	175 per day (1-7)	0 per day (1-6) 100 per day (7-100)	0	100	20	20	30-50	0-200				0	0-200	15-30	30					0.2			0 - 0	0		0					500 per day (1-7)	175 per day (1-7)	20	0	0	0	0				136.43	136.43	29.09	0	100	0.2	0.2	45.4	66				0	25.99	15.29	30					0.2			0	0		0					389.8	136.43	0.2	0	0	0	0					136.43	136.43	29.09	0	100	0.2	0.2	45.4	66				0	25.99	15.29	30					0.2			0	0		0					389.8	136.43	0.2	0	0	0	0				0	22.8	0.12	4.27	-	2.06	0.06	0	3.8	3.85	-	-	-	-	1.03	8.69	11.92	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	3.43	0.01	0.45	-	-	-	-	-	-	-	63.39	22.8	0.12	4.27	-	2.06	0.06	0	3.8	3.85	-	-	-	-	1.03	8.69	11.92	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	3.43	0.01	0.45	-	-	-	-	-	-	-	63.39
H1406_021_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2016.84	10.86	1773.07	1994.57	249.08	0.26	0.02	1010.45	704.5				0	479.27	6855.9	4795.78					4.45			14.06	0		0					106.15	0.57	2.02	0	0	0	0				150 per day (1-7)	150 per day (1-7)	0 per day (1-6) 125 per day (7-100)	0	100	20	20	30-50	0-250				0	0-250	0-30	30					0.2			0 - 50	0		0					500 per day (1-7)	150 per day (1-7)	20	0	0	0	0				116.94	116.94	36.36	0	100	0.2	0.2	45.4	82.5				0	40.12	0.59	30					0.2			0.1	0		0					389.8	116.94	0.2	0	0	0	0					116.94	116.94	36.36	0	100	0.2	0.2	45.4	82.5				0	40.12	0.59	30					0.2			0.1	0		0					389.8	116.94	0.2	0	0	0	0				0	19.65	0.11	5.37	-	2.08	0.05	0	3.82	4.84	-	-	-	-	1.6	0.34	11.99	-	-	-	-	0.89	-	-	1.45	-	-	-	-	-	-	-	3.45	0.01	0.4	-	-	-	-	-	-	-	56.06	19.65	0.11	5.37	-	2.08	0.05	0	3.82	4.84	-	-	-	-	1.6	0.34	11.99	-	-	-	-	0.89	-	-	1.45	-	-	-	-	-	-	-	3.45	0.01	0.4	-	-	-	-	-	-	-	56.06
H1406_022_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1717.24	9.25	754.84	1632.34	212.88	0.23	0.02	863.61	602.12				0	409.62	5610.82	3924.83					4.45			0	0		0					90.38	0.49	1.78	0	0	0	0				160 per day (1-7)	160 per day (1-7)	0 per day (1-6) 100 per day (7-100)	0	100	20	20	30-50	0-200				0	0-200	0-30	30					20			0	0		0					500 per day (1-7)	160 per day (1-7)	20	0	0	0	0				124.74	124.74	58.18	0	100	0.2	0.2	45.4	66				0	33.83	0.59	30					20			0	0		0					389.8	124.74	0.2	0	0	0	0					124.74	124.74	58.18	0	100	0.2	0.2	45.4	66				0	33.83	0.59	30					20			0	0		0					389.8	124.74	0.2	0	0	0	0				0	17.85	0.1	3.66	-	1.77	0.05	0	3.27	3.31	-	-	-	-	1.15	0.28	9.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.94	0.01	0.36	-	-	-	-	-	-	-	45.44	17.85	0.1	3.66	-	1.77	0.05	0	3.27	3.31	-	-	-	-	1.15	0.28	9.81	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.94	0.01	0.36	-	-	-	-	-	-	-	45.44
H1406_023_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1761.52	9.49	1548.61	1674.43	218.37	0.24	0.02	885.87	617.64				0	420.18	5755.49	4026.03					4.45			14.06	0		0					92.71	0.5	1.88	0	0	0	0				225 per day (1-7)	225 per day (1-7)	0 per day (1-6) 125 per day (7-100)	0	100	20	20	30-50	0-250				0	0-250	0-30	30					0.2			0 - 50	0		0					500 per day (1-7)	225 per day (1-7)	20	0	0	0	0				175.41	175.41	36.36	0	100	0.2	0.2	45.4	82.5				0	36.98	0.59	30					0.2			0.1	0		0					389.8	175.41	0.2	0	0	0	0					175.41	175.41	36.36	0	100	0.2	0.2	45.4	82.5				0	36.98	0.59	30					0.2			0.1	0		0					389.8	175.41	0.2	0	0	0	0				0	25.75	0.14	4.69	-	1.82	0.05	0	3.35	4.25	-	-	-	-	1.29	0.28	10.07	-	-	-	-	0.89	-	-	1.45	-	-	-	-	-	-	-	3.01	0.01	0.38	-	-	-	-	-	-	-	57.43	25.75	0.14	4.69	-	1.82	0.05	0	3.35	4.25	-	-	-	-	1.29	0.28	10.07	-	-	-	-	0.89	-	-	1.45	-	-	-	-	-	-	-	3.01	0.01	0.38	-	-	-	-	-	-	-	57.43
H1406_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2017.03	10.86	1773.24	1994.76	249.1	0.26	0.02	1010.54	704.56				0	479.32	6856.55	4796.23					4.45			0	0		0					106.16	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	37.82	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	37.82	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	34.3	0.18	1.63	-	2.08	0.05	0	3.9	11.74	-	-	-	-	1.51	12.88	14.89	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.81	0.01	-	-	-	-	-	-	-	-	85.88	34.3	0.18	1.63	-	2.08	0.05	0	3.9	11.74	-	-	-	-	1.51	12.88	14.89	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.81	0.01	-	-	-	-	-	-	-	-	85.88
H1406_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2017.02	10.86	1773.23	1994.75	249.1	0.26	0.02	1010.54	704.56				0	479.31	6856.52	4796.21					4.45			0	0		0					106.16	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	37.82	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	37.82	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	34.3	0.18	1.63	-	2.08	0.05	0	3.9	11.74	-	-	-	-	1.51	12.88	14.89	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.81	0.01	-	-	-	-	-	-	-	-	85.87	34.3	0.18	1.63	-	2.08	0.05	0	3.9	11.74	-	-	-	-	1.51	12.88	14.89	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.81	0.01	-	-	-	-	-	-	-	-	85.87
H1406_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2017.03	10.86	1773.24	1994.76	249.1	0.26	0.02	1010.54	704.56				0	479.32	6856.55	4796.23					4.45			0	0		0					106.16	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	37.82	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	37.82	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	34.3	0.18	1.63	-	2.08	0.05	0	3.9	11.74	-	-	-	-	1.51	12.88	14.89	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.81	0.01	-	-	-	-	-	-	-	-	85.88	34.3	0.18	1.63	-	2.08	0.05	0	3.9	11.74	-	-	-	-	1.51	12.88	14.89	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.81	0.01	-	-	-	-	-	-	-	-	85.88
H1406_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2017.02	10.86	1773.23	1994.75	249.1	0.26	0.02	1010.54	704.56				0	479.31	6856.52	4796.21					4.45			0	0		0					106.16	0.57	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	37.82	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	37.82	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	34.3	0.18	1.63	-	2.08	0.05	0	3.9	11.74	-	-	-	-	1.51	12.88	14.89	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.81	0.01	-	-	-	-	-	-	-	-	85.87	34.3	0.18	1.63	-	2.08	0.05	0	3.9	11.74	-	-	-	-	1.51	12.88	14.89	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.81	0.01	-	-	-	-	-	-	-	-	85.87
H1407_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2042.23	58.05	5148.72	3133.86	21.14	15.66	1.18	14.04	32.68				4.06	65.75	46.19	203.85					4.45			0	0		0					107.49	3.06	0	0	2554.33	8572.54	12862.24				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					82.73	122.44	23.42	0	0.14	0.14	0.14	0.14	0.14				0.14	0.12	0	0					0.2			0	0		0					82.73	122.44	0	0	0	9.94	19.87				0	14.08	0.59	10.05	-	2.86	2.12	0.16	1.9	4.42	-	-	-	0.55	7.93	0.12	0.55	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.74	0.03	-	-	-	7.1	21.3	-	-	-	75.38	14.08	0.59	10.05	-	2.86	2.12	0.16	1.9	4.42	-	-	-	0.55	7.93	0.12	0.55	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.74	0.03	-	-	-	7.1	21.3	-	-	-	75.38
H1415_004_0	2006																						D	D	D	V	T	Coin		V	P	P	P	P	P	P	V	V	V	V	V	V		V	T	V	V		V																																																									-	1358.85	29.19	837.9		247.02	15.15		221.48	237.3	541.65	539.22	24.75	172.27	458.77	6145.67	2293	304.26	44	167.65	51		447.07	150	34	112.83		41															175 per day	500 per admission	125 per day		100 copay	0		50 copay	100 copay	100 copay	250 copay	200 copay	30 copay	15 copay	10 copay	30 copay	30 copay	50 copay	75 copay	10 copay		15 copay	3.50/Trip	30 copay	30 copay		30 copay															166.25	82.75	112.5		100	0.2		50	100	100	250	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																166.25	82.75	112.5		100	0.2		50	100	100	250	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																18.83	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	0.57	5.12	5.73	0.76	0.18	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66	18.83	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	0.57	5.12	5.73	0.76	0.18	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66
H1415_005_0	2006																						D	D	D	V	T	Coin		V	P	P	P	P	P	P	V	V	V	V	V	V		V	T	V	V		V																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H1415_008_0	2006																						D	D	D	V	T	Coin		V	P	P	P	P	P	P	V	V	V	V	V	V		V	T	V	V		V																																																									-	1358.85	29.19	837.9		247.02	15.15		221.48	237.3	541.65	539.22	24.75	172.27	458.77	6145.67	2293	304.26	44	167.65	51		447.07	150	34	112.83		41															175 per day	500 per admission	125 per day		100 copay	0		50 copay	100 copay	100 copay	250 copay	200 copay	30 copay	15 copay	10 copay	30 copay	30 copay	50 copay	75 copay	10 copay		15 copay	3.50/Trip	30 copay	30 copay		30 copay															166.25	82.75	112.5		100	0.2		50	100	100	250	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																166.25	82.75	112.5		100	0.2		50	100	100	250	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																18.83	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	0.57	5.12	5.73	0.76	0.18	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66	18.83	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	0.57	5.12	5.73	0.76	0.18	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66
H1415_009_0	2006																						D	D	D	V	T	Coin		V	P	P	P	P	P	P	V	V	V	V	V	V		V	T	V	V		V																																																									-	1358.85	29.19	837.9		247.02	15.15		221.48	237.3	541.65	539.22	24.75	172.27	458.77	6145.67	2293	304.26	44	167.65	51		447.07	150	34	112.83		41															175 per day	500 per admission	125 per day		100 copay	0		50 copay	100 copay	100 copay	250 copay	200 copay	30 copay	15 copay	10 copay	30 copay	30 copay	50 copay	75 copay	10 copay		15 copay	3.50/Trip	30 copay	30 copay		30 copay															166.25	82.75	112.5		100	0.2		50	100	100	250	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																166.25	82.75	112.5		100	0.2		50	100	100	250	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																18.83	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	0.57	5.12	5.73	0.76	0.18	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66	18.83	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	0.57	5.12	5.73	0.76	0.18	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66
H1415_010_0	2006																						D	D	D	V	T	Coin		V	P	P	P	P	P	P	V	V	V	V	V	V		V	T	V	V		V																																																									-	2581.82	55.46	1592.01	0	469.34	28.79	0	420.81	450.87	1029.14	1024.52	47.03	327.31	871.66	11676.77	4356.7	578.09	83.6	318.54	96.9	0	849.43	285	64.6	214.38	0	77.9															500 per admission	500 per admission	125 per day		100 copay	0		50 copay	100 copay	100 copay	250 copay	200 copay	30 copay	15 copay	10 copay	30 copay	30 copay	50 copay	75 copay	10 copay		15 copay	3.50/Trip	30 copay	30 copay		30 copay															104.4	82.75	112.5		100	0.2		50	100	100	100	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																104.4	82.75	112.5		100	0.2		50	100	100	100	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																22.46	0.38	14.93	-	3.91	5.76	-	1.75	3.76	8.58	8.54	0.78	0.82	1.09	9.73	10.89	1.45	0.35	1.99	0.08	-	1.06	0.08	0.16	0.54	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.28	22.46	0.38	14.93	-	3.91	5.76	-	1.75	3.76	8.58	8.54	0.78	0.82	1.09	9.73	10.89	1.45	0.35	1.99	0.08	-	1.06	0.08	0.16	0.54	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.28
H1415_012_0	2006																						D	D	D	V	T	Coin		V	P	P	P	P	P	P	V	V	V	V	V	V		V	T	V	V		V																																																									-	1358.85	29.19	837.9		247.02	15.15		221.48	237.3	541.65	539.22	24.75	172.27	458.77	6145.67	2293	304.26	44	167.65	51		447.07	150	34	112.83		41															175 per day	500 per admission	125 per day		100 copay	0		50 copay	50 copay	100 copay	100 copay	50 copay	30 copay	15 copay	5 copay	30 copay	30 copay	50 copay	0 copay	10 copay		15 copay	3.50/Trip	30 copay	30 copay		30 copay															166.25	82.75	112.5		100	0.2		50	50	100	100	50	30	15	5	30	30	50	0	10		15	3.5	30	30		30																166.25	82.75	112.5		100	0.2		50	50	100	100	50	30	15	5	30	30	50	0	10		15	3.5	30	30		30																18.83	0.2	7.86	-	2.06	3.03	-	0.92	0.99	4.51	4.49	0.1	0.43	0.57	2.56	5.73	0.76	0.18	-	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.35	18.83	0.2	7.86	-	2.06	3.03	-	0.92	0.99	4.51	4.49	0.1	0.43	0.57	2.56	5.73	0.76	0.18	-	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.35
H1415_013_0	2006																						D	D	D	V	T	Coin		V	P	P	P	P	P	P	V	V	V	V	V	V		V	T	V	V		V																																																									-	1358.85	29.19	837.9		247.02	15.15		221.48	237.3	541.65	539.22	24.75	172.27	458.77	6145.67	2293	304.26	44	167.65	51		447.07	150	34	112.83		41															175 per day	500 per admission	125 per day		100 copay	0		50 copay	50 copay	100 copay	100 copay	50 copay	30 copay	15 copay	5 copay	30 copay	30 copay	50 copay	0 copay	10 copay		15 copay	3.50/Trip	30 copay	30 copay		30 copay															166.25	82.75	112.5		100	0.2		50	50	100	100	50	30	15	5	30	30	50	0	10		15	3.5	30	30		30																166.25	82.75	112.5		100	0.2		50	50	100	100	50	30	15	5	30	30	50	0	10		15	3.5	30	30		30																18.83	0.2	7.86	-	2.06	3.03	-	0.92	0.99	4.51	4.49	0.1	0.43	0.57	2.56	5.73	0.76	0.18	-	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.35	18.83	0.2	7.86	-	2.06	3.03	-	0.92	0.99	4.51	4.49	0.1	0.43	0.57	2.56	5.73	0.76	0.18	-	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.35
H1415_014_0	2006																						D	D	D	V	T	Coin		V	P	P	P	P	P	P	V	V	V	V	V	V		V	T	V	V		V																																																									-	1358.85	29.19	837.9		247.02	15.15		221.48	237.3	541.65	539.22	24.75	172.27	458.77	6145.67	2293	304.26	44	167.65	51		447.07	150	34	112.83		41															175 per day	500 per admission	125 per day		100 copay	0		50 copay	100 copay	100 copay	250 copay	200 copay	30 copay	15 copay	10 copay	30 copay	30 copay	50 copay	75 copay	10 copay		15 copay	3.50/Trip	30 copay	30 copay		30 copay															166.25	82.75	112.5		100	0.2		50	100	100	250	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																166.25	82.75	112.5		100	0.2		50	100	100	250	200	30	15	10	30	30	50	75	10		15	3.5	30	30		30																18.83	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	0.57	5.12	5.73	0.76	0.18	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66	18.83	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	0.57	5.12	5.73	0.76	0.18	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66
H1415_802_0	2006	Professional											Colorectal										D	D	D		T	Coin		V	P	P	P	P	P	P	V	V	V	V	V	V		V	T	V	V		V					V																																																				-	1353	29.19	837.9		247.02	15.15		221.48	237.3	541.65	539.22	24.75	172.27		6145.67	2293	304.26	458.77	167.65	51		447.07	150	34	112.83		41					44										225 per day	500 per admission	125 per day		100 copay	0 copay		50 copay	100 copay	100 copay	250 copay	200 copay	30 copay		25 copay	30 copay	30 copay	15 copay	75 copay	10 copay		15 copay	3.50/Trip	30 copay	30 copay		30 copay					50 copay										213.75	82.75	112.5		100	0.2		50	100	100	250	200	30		25	30	30	15	75	10		15	3.5	30	30		30					50											213.75	82.75	112.5		100	0.2		50	100	100	250	200	30		25	30	30	15	75	10		15	3.5	30	30		30					50											24.1	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	-	12.8	5.73	0.76	0.57	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	0.18	-	-	-	-	-	-	-	-	-	78.95	24.1	0.2	7.86	-	2.06	3.03	-	0.92	1.98	4.51	11.23	0.41	0.43	-	12.8	5.73	0.76	0.57	1.05	0.04	-	0.56	0.04	0.09	0.28	-	0.1	-	-	-	-	0.18	-	-	-	-	-	-	-	-	-	78.95
H1416_001_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1339.51	25.2	1030.87	1558.27	339.05	18584.96	19182.59	258.24	229.32	1912.47	752.29	0	45.93	517.74	6278.59	8879.91	166	213.51	3369.39	9090.24	363.84	694.45	0	381	308.61	262.81	132.26	17.06	0	0	25.13											175 days 1 to 7	175 days 1 to 7	100 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 30	Eff. copay 15 to 100	0		Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 35	Eff. copay 20 to 30	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											106.53	117.69	75.87	10	100	1.01	1.33	50	116.67	6.48	35.78	0	0	4.92	6.88	19.84	29	35	0	5.06	27.41	18.55	0	0	25	25	25	0	0	0	1.76											N/A	106.53	117.69	75.87	10	100	1.01	1.33	50	116.67	6.48	35.78	0	0	4.92	6.88	19.84	29	35	0	5.06	27.41	18.55	0	0	25	25	25	0	0	0	1.76												11.89	0.25	6.52	1.3	2.83	1.56	2.13	1.08	2.23	1.03	2.24	-	-	0.21	3.6	14.68	0.4	0.62	-	3.84	0.83	1.07	-	-	0.64	0.55	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.79	11.89	0.25	6.52	1.3	2.83	1.56	2.13	1.08	2.23	1.03	2.24	-	-	0.21	3.6	14.68	0.4	0.62	-	3.84	0.83	1.07	-	-	0.64	0.55	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.79
H1416_002_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1411.06	26.74	1143.84	1696.11	348.76	19143.39	19755.69	264.42	235.22	1964.13	771.65	0	46.98	529.96	6428.64	9087.4	169.98	218.32	3457.72	9309.75	372.15	707.3	0	381	313.49	267.5	134.35	17.34	0	100	25.47											175 days 1 to 7	175 days 1 to 7	100 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 30	Eff. copay 15 to 100	0	0	Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 35	Eff. copay 20 to 30	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											112.55	124.34	75.87	10	100	1.02	1.35	50	116.67	6.46	35.77	0	0	4.93	6.84	19.81	29	35	0	5.14	27.63	18.52	0	0	25	25	25	0	0	0	1.76											N/A	112.55	124.34	75.87	10	100	1.02	1.35	50	116.67	6.46	35.77	0	0	4.93	6.84	19.81	29	35	0	5.14	27.63	18.52	0	0	25	25	25	0	0	0	1.76												13.24	0.28	7.23	1.41	2.91	1.63	2.22	1.1	2.29	1.06	2.3	-	-	0.22	3.66	15	0.41	0.64	-	3.99	0.86	1.09	-	-	0.65	0.56	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	63.02	13.24	0.28	7.23	1.41	2.91	1.63	2.22	1.1	2.29	1.06	2.3	-	-	0.22	3.66	15	0.41	0.64	-	3.99	0.86	1.09	-	-	0.65	0.56	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	63.02
H1416_003_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1903.42	36.14	1603.48	2262.26	482.26	26471.11	27319.12	366.54	326.07	2775.99	1089.63	0	65.12	734.65	9112.48	12760.65	238.97	306.84	4896.32	13080.37	515.88	978.68	0	381	433.48	369.89	185.78	23.97	0	100	35.22											100 days 1 to 5	100 days 1 to 5	00 days 1 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 50	Eff. copay 0 to 20	Eff. copay 15 to 50	0		Eff. copay 0 to 25	Eff. copay 0 to 05	Eff. copay 0 to 20	Eff. copay 10 to 20	20		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											64.99	64.75	0	10	100	1.01	1.34	50	41.67	4.22	23.54	0	0	1.23	3.64	11.49	19	20	0	3.77	27.63	18.51	0	0	25	25	25	0	0	0	0.4											N/A	64.99	64.75	0	10	100	1.01	1.34	50	41.67	4.22	23.54	0	0	1.23	3.64	11.49	19	20	0	3.77	27.63	18.51	0	0	25	25	25	0	0	0	0.4												10.31	0.19	-	1.89	4.02	2.23	3.04	1.53	1.13	0.98	2.14	-	-	0.08	2.76	12.22	0.38	0.51	-	4.11	1.19	1.51	-	-	0.9	0.77	0.39	-	-	-	0	-	-	-	-	-	-	-	-	-	-	52.27	10.31	0.19	-	1.89	4.02	2.23	3.04	1.53	1.13	0.98	2.14	-	-	0.08	2.76	12.22	0.38	0.51	-	4.11	1.19	1.51	-	-	0.9	0.77	0.39	-	-	-	0	-	-	-	-	-	-	-	-	-	-	52.27
H1416_004_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1868.97	35.85	1664.3	2286.56	468.23	25751.92	26573.03	355.26	316.85	2703.74	1059.33	0	63.01	711.71	8792.58	12300.72	230.58	295.46	4740.36	12624.02	499.2	937.62	0	381	413.1	353.56	177.04	22.86	0	0	33.45											100 days 1 to 5	100 days 1 to 5	00 days 1 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 50	Eff. copay 0 to 20	Eff. copay 15 to 50	0		Eff. copay 0 to 25	Eff. copay 0 to 5	Eff. copay 0 to 20	Eff. copay 10 to 20	20		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											64.99	64.75	0	10	100	1	1.32	50	41.67	4.2	23.54	0	0	1.24	3.61	11.41	19	20	0	3.75	27.29	18.44	0	0	25	25	25	0	0	0	0.39											N/A	64.99	64.75	0	10	100	1	1.32	50	41.67	4.2	23.54	0	0	1.24	3.61	11.41	19	20	0	3.75	27.29	18.44	0	0	25	25	25	0	0	0	0.39												10.12	0.19	-	1.91	3.9	2.14	2.91	1.48	1.1	0.95	2.08	-	-	0.07	2.65	11.69	0.37	0.49	-	3.94	1.14	1.44	-	-	0.86	0.74	0.37	-	-	-	0	-	-	-	-	-	-	-	-	-	-	50.54	10.12	0.19	-	1.91	3.9	2.14	2.91	1.48	1.1	0.95	2.08	-	-	0.07	2.65	11.69	0.37	0.49	-	3.94	1.14	1.44	-	-	0.86	0.74	0.37	-	-	-	0	-	-	-	-	-	-	-	-	-	-	50.54
H1416_005_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1476.4	28.3	1219.23	1735.91	360.63	19834.36	20464.43	272.01	242.6	2070.18	811.1	0	48.25	544.94	6774.68	9486.52	182.08	233.22	3651.07	9743.66	382.23	721.05	0	381	318.17	272.31	136.36	17.6	0	100	25.76											100 days 1 to 7	100 days 1 to 7	50 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 50	Eff. copay 0 to 15	Eff. copay 15 to 100	0	0	Eff. copay 0 to 25	Eff. copay 0 to 05	Eff. copay 0 to 15	Eff. copay 05 to 15	15		Eff. copay 20 coins. 0 to 25	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											68.04	75.17	37.93	10	100	1.03	1.35	50	41.67	3.15	35.74	0	0	1.24	3.54	8.76	14	15	0	3.54	27.72	18.47	0	0	25	25	25	0	0	0	1.78											N/A	68.04	75.17	37.93	10	100	1.03	1.35	50	41.67	3.15	35.74	0	0	1.24	3.54	8.76	14	15	0	3.54	27.72	18.47	0	0	25	25	25	0	0	0	1.78												8.37	0.18	3.85	1.45	3.01	1.7	2.3	1.13	0.84	0.54	2.42	-	-	0.06	2	6.92	0.21	0.29	-	2.88	0.88	1.11	-	-	0.66	0.57	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	41.66	8.37	0.18	3.85	1.45	3.01	1.7	2.3	1.13	0.84	0.54	2.42	-	-	0.06	2	6.92	0.21	0.29	-	2.88	0.88	1.11	-	-	0.66	0.57	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	41.66
H1416_006_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1413.12	27.09	1104.76	1587.13	351.34	19323.45	19937.71	265.29	236.61	2019.03	791.06	0	47.06	531.48	6600.17	9242.16	177.39	227.21	3557.02	9492.68	372.78	702.67	0	381	309.98	265.3	132.85	17.15	0	0	25.1											100 days 1 to 7	100 days 1 to 7	50 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 50	Eff. copay 0 to 15	Eff. copay 15 to 100	0		Eff. copay 0 to 25	Eff. copay 0 to 05	Eff. copay 0 to 15	Eff. copay 5 to 15	15		Eff. copay 20 coins. 0 to 25 copay	Eff. copay 20 coins.	Eff. copay 0 to 25			25	25	25		0	0	Eff. copay 0 to 50											68.04	75.17	37.93	10	100	1.01	1.33	50	41.67	3.15	35.74	0	0	1.24	3.54	8.75	14	15	0	3.51	27.37	18.47	0	0	25	25	25	0	0	0	1.78											N/A	68.04	75.17	37.93	10	100	1.01	1.33	50	41.67	3.15	35.74	0	0	1.24	3.54	8.75	14	15	0	3.51	27.37	18.47	0	0	25	25	25	0	0	0	1.78												8.01	0.17	3.49	1.32	2.93	1.63	2.21	1.11	0.82	0.53	2.36	-	-	0.05	1.95	6.74	0.21	0.28	-	2.77	0.85	1.08	-	-	0.65	0.55	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	40	8.01	0.17	3.49	1.32	2.93	1.63	2.21	1.11	0.82	0.53	2.36	-	-	0.05	1.95	6.74	0.21	0.28	-	2.77	0.85	1.08	-	-	0.65	0.55	0.28	-	-	-	0	-	-	-	-	-	-	-	-	-	-	40
H1416_007_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1955.3	36.25	1621.61	2498.82	1532.79	27928.11	28835.68	414.65	347.33	3102.31	1188.7	0	69.97	787.48	10289.19	14367.49	256.47	375.33	5564.31	14824.38	554.27	1179.21	0	381	0	0	0	0	0	100	159.01											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.09	175.1	54.11	0	14.09	0	0	35.23	179.73	0	56.39	0	3.05	35	0	0	18.02	0	0	1.95	27.78	0	0	0	0	0	0	0	0	0	0.3											N/A	180.09	175.1	54.11	0	14.09	0	0	35.23	179.73	0	56.39	0	3.05	35	0	0	18.02	0	0	1.95	27.78	0	0	0	0	0	0	0	0	0	0.3												29.34	0.53	7.31	-	1.8	-	-	1.22	5.2	-	5.59	-	0.02	2.3	-	-	0.39	-	-	2.41	1.28	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.39	29.34	0.53	7.31	-	1.8	-	-	1.22	5.2	-	5.59	-	0.02	2.3	-	-	0.39	-	-	2.41	1.28	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.39
H1416_008_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1847.01	34.07	1626.91	2496.6	1450.06	26397.74	27259.97	395.26	330.08	2943.47	1153.47	0	66.61	749.33	9754.91	13628.02	248.83	355.76	5266.54	14050.36	527.68	1121.67	0	0	0	0	0	0	0	0	157.24											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff copay 20 to 00coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.	0		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.09	175.1	54.11	0	13.68	0	0	34.49	175.6	0	40.48	0	2.98	34.16	0	0	17.49	0	0	1.9	27.13	0	0	0	0	0	0	0	0	0	0.28											N/A	180.09	175.1	54.11	0	13.68	0	0	34.49	175.6	0	40.48	0	2.98	34.16	0	0	17.49	0	0	1.9	27.13	0	0	0	0	0	0	0	0	0	0.28												27.72	0.5	7.34	-	1.65	-	-	1.14	4.83	-	3.89	-	0.02	2.13	-	-	0.36	-	-	2.23	1.19	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	53	27.72	0.5	7.34	-	1.65	-	-	1.14	4.83	-	3.89	-	0.02	2.13	-	-	0.36	-	-	2.23	1.19	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	53
H1417_001_0	2006											1500	0	0	0	0	0	0	0	0	0	0						Coin	Coin	V							V	V	V	V		V					V		V																																																									-						8.9	11.03	291.52							3097.51	4212.83	107.78	954.06		673.34					124		222																				10	10	50/visit							10/visit	10/visit	10/visit	10/visit		10/visit					10/visit		10/visit																				0.1	0.1	50							10	10	10	10		10					10		10																					0.09	0.09	45.46							9.09	9.09	9.09	9.09		9.09					9.09		9.09																-	-	-	-	-	0.81	1	1.1	-	-	-	-	-	-	2.35	3.19	0.08	0.72	-	0.51	-	-	-	-	0.09	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.03	-	-	-	-	-	0.81	1	1.1	-	-	-	-	-	-	2.35	3.19	0.08	0.72	-	0.51	-	-	-	-	0.09	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.03
H1417_002_0	2006											1500	0	0	0	0	0	0	0	0	0	0						Coin	Coin	V							V	V	V	V		V					V		V																																																									-						9.45	11.71	309.52							3284.59	4473.41	114.44	1013.07		715					124		222																				10	10	50/visit							10/visit	10/visit	10/visit	10/visit		10/visit					10/visit		10/visit																				0.1	0.1	50							10	10	10	10		10					10		10																					0.09	0.09	45.08							9.02	9.02	9.02	9.02		9.02					9.02		9.02																-	-	-	-	-	0.85	1.06	1.16	-	-	-	-	-	-	2.47	3.36	0.09	0.76	-	0.54	-	-	-	-	0.09	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.54	-	-	-	-	-	0.85	1.06	1.16	-	-	-	-	-	-	2.47	3.36	0.09	0.76	-	0.54	-	-	-	-	0.09	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.54
H1417_801_0	2006											1500	0	0	0	0	0	0	0	0	0	0						Coin	Coin	V							V	V	V	V		V					V		V																																																									-						8.9	11.03	291.53							3097.61	4212.97	107.78	954.09		673.37					124		222																				10	10	50/visit							10/visit	10/visit	10/visit	10/visit		10/visit					10/visit		10/visit																				0.1	0.1	50							10	10	10	10		10					10		10																					0.09	0.09	45.46							9.09	9.09	9.09	9.09		9.09					9.09		9.09																-	-	-	-	-	0.81	1	1.1	-	-	-	-	-	-	2.35	3.19	0.08	0.72	-	0.51	-	-	-	-	0.09	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.03	-	-	-	-	-	0.81	1	1.1	-	-	-	-	-	-	2.35	3.19	0.08	0.72	-	0.51	-	-	-	-	0.09	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.03
H1417_802_0	2006											1500	0	0	0	0	0	0	0	0	0	0						Coin	Coin	V							V	V	V	V		V					V		V																																																									-						9.45	11.71	309.53							3284.7	4473.57	114.45	1013.11		715.02					124		222																				10	10	50/visit							10/visit	10/visit	10/visit	10/visit		10/visit					10/visit		10/visit																				0.1	0.1	50							10	10	10	10		10					10		10																					0.09	0.09	45.08							9.02	9.02	9.02	9.02		9.02					9.02		9.02																-	-	-	-	-	0.85	1.06	1.16	-	-	-	-	-	-	2.47	3.36	0.09	0.76	-	0.54	-	-	-	-	0.09	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.54	-	-	-	-	-	0.85	1.06	1.16	-	-	-	-	-	-	2.47	3.36	0.09	0.76	-	0.54	-	-	-	-	0.09	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.54
H1418_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1019.88	21.6	1067.7	497.67	139.51	18.24	1.37	393.12	311.47				16.98	1919.31	6157.44	10738.32					4.45			8.44	0		0					53.68	1.14	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	0	100	20	20	35-50	100-150				0	0-75	Oct-50	35-50					0.2			0 - 50								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	0	100	0.2	0.2	40.7	116.5				0	50.09	10.78	35.29					0.2			0.1	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	0	100	0.2	0.2	40.7	116.5				0	50.09	10.78	35.29					0.2			0.1	0		0					119.04	119.04	0	0	0	0	0				0	10.12	0.21	1.05	-	1.16	3.65	0.27	1.33	3.02	-	-	-	-	8.01	5.53	31.58	-	-	-	-	0.89	-	-	0.87	-	-	-	-	-	-	-	0.53	0.01	-	-	-	-	-	-	-	-	68.25	10.12	0.21	1.05	-	1.16	3.65	0.27	1.33	3.02	-	-	-	-	8.01	5.53	31.58	-	-	-	-	0.89	-	-	0.87	-	-	-	-	-	-	-	0.53	0.01	-	-	-	-	-	-	-	-	68.25
H1418_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	254.6	5.79	1138.44	530.64	148.75	20.47	1.54	419.17	332.11				18.11	2046.48	6565.4	11449.79					4.45			0	0		0					13.4	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.78	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.78	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.73	0.29	0.84	0.44	1.24	5.12	0.39	1.58	5.54	-	-	-	-	5.93	13.79	33.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	82.84	12.73	0.29	0.84	0.44	1.24	5.12	0.39	1.58	5.54	-	-	-	-	5.93	13.79	33.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	82.84
H1418_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	254.6	5.79	1138.44	530.64	148.75	20.47	1.54	419.17	332.11				18.11	2046.48	6565.41	11449.81					4.45			0	0		0					13.4	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.78	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.78	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.73	0.29	0.84	0.44	1.24	5.12	0.39	1.58	5.54	-	-	-	-	5.93	13.79	33.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	82.84	12.73	0.29	0.84	0.44	1.24	5.12	0.39	1.58	5.54	-	-	-	-	5.93	13.79	33.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	82.84
H1418_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	254.6	5.79	1138.44	530.64	148.75	20.47	1.54	419.17	332.11				18.11	2046.48	6565.4	11449.79					4.45			0	0		0					13.4	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.78	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.78	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.73	0.29	0.84	0.44	1.24	5.12	0.39	1.58	5.54	-	-	-	-	5.93	13.79	33.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	82.84	12.73	0.29	0.84	0.44	1.24	5.12	0.39	1.58	5.54	-	-	-	-	5.93	13.79	33.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	82.84
H1418_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	254.6	5.79	1138.44	530.64	148.75	20.47	1.54	419.17	332.11				18.11	2046.48	6565.41	11449.81					4.45			0	0		0					13.4	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.78	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.78	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.73	0.29	0.84	0.44	1.24	5.12	0.39	1.58	5.54	-	-	-	-	5.93	13.79	33.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	82.84	12.73	0.29	0.84	0.44	1.24	5.12	0.39	1.58	5.54	-	-	-	-	5.93	13.79	33.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	82.84
H1419_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1633.52	16.67	1383.8	899.97	185.32	16.43	1.23	163.28	34.17	299.83	237.49	0.36	248.05	19.94	3575.25	7765.05	3.63	919.04	487.97		270.73	799.02			0		0			0												150/d 7	150/d 7	0 for days 1-8 75 for days 9-14 125 for days 15-100																																							107.77	107.77	78.57	20	100	0.2	0.2	47.4	100	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													107.77	107.77	78.57	20	100	0.2	0.2	47.4	100	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													14.67	0.15	9.06	1.5	1.54	3.29	0.25	0.64	0.28	0.75	0.73	0	0.62	0.05	2.98	19.41	0.01	2.3	1.22	-	1.02	2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.47	14.67	0.15	9.06	1.5	1.54	3.29	0.25	0.64	0.28	0.75	0.73	0	0.62	0.05	2.98	19.41	0.01	2.3	1.22	-	1.02	2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.47
H1419_002_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1744.22	17.8	1477.57	960.96	197.88	17.54	1.31	174.35	36.48	320.15	253.59	0.39	264.86	21.29	3817.53	8291.24	3.88	981.32	521.04		0	0			0		0			0												50/d10	50/d10	0 for days 1-8 75 for days 9-14 125 for days 15-100																																							40.82	40.82	78.57	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20			0		0			0													40.82	40.82	78.57	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20			0		0			0													5.93	0.06	9.67	1.6	1.65	3.51	0.26	0.68	0.3	0.53	0.64	0	0.44	0.04	3.18	13.82	0.01	1.64	0.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83	5.93	0.06	9.67	1.6	1.65	3.51	0.26	0.68	0.3	0.53	0.64	0	0.44	0.04	3.18	13.82	0.01	1.64	0.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83
H1419_003_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1830	18.67	1550.23	1008.21	207.61	18.4	1.37	182.92	38.28	335.9	266.06	0.41	277.89	22.34	4005.27	8698.99	4.07	1029.58	546.66		0	0			0		0			0														0 for days 1-8 75 for days 9-14 125 for days 15-100																																							0	0	78.57	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	0	20	20	20	20		45	20			0		0			0													0	0	78.57	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	0	20	20	20	20		45	20			0		0			0													-	-	10.15	1.68	1.73	3.68	0.27	0.71	0.32	0.56	0.67	0	0.46	0.04	-	14.5	0.01	1.72	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.41	-	-	10.15	1.68	1.73	3.68	0.27	0.71	0.32	0.56	0.67	0	0.46	0.04	-	14.5	0.01	1.72	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.41
H1419_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1571.71	15.88	1209.07	1180.49	212.37	1.96	0.02	221.71	44.97	829.02	254.88		61.19	38.67	2446.54	9281.05	0.37	631.42	563.44		271.1	672.49																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													18.82	0.19	10.08	3.44	2.65	0.59	0.01	0.92	0.56	0.56	2.09	-	0.18	0.11	7.14	27.07	0	1.84	1.64	-	1.52	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.38	18.82	0.19	10.08	3.44	2.65	0.59	0.01	0.92	0.56	0.56	2.09	-	0.18	0.11	7.14	27.07	0	1.84	1.64	-	1.52	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.38
H1419_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1571.71	15.88	1209.07	1180.49	212.37	1.96	0.02	221.71	44.97	829.02	254.88		61.19	38.67	2446.54	9281.05	0.37	631.42	563.44		271.1	672.49																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													18.82	0.19	10.08	3.44	2.65	0.59	0.01	0.92	0.56	0.56	2.09	-	0.18	0.11	7.14	27.07	0	1.84	1.64	-	1.52	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.38	18.82	0.19	10.08	3.44	2.65	0.59	0.01	0.92	0.56	0.56	2.09	-	0.18	0.11	7.14	27.07	0	1.84	1.64	-	1.52	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.38
H1419_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1571.71	15.88	1209.07	1180.49	212.37	1.96	0.02	221.71	44.97	829.02	254.88		61.19	38.67	2446.54	9281.05	0.37	631.42	563.44		271.1	672.49																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													18.82	0.19	10.08	3.44	2.65	0.59	0.01	0.92	0.56	0.56	2.09	-	0.18	0.11	7.14	27.07	0	1.84	1.64	-	1.52	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.38	18.82	0.19	10.08	3.44	2.65	0.59	0.01	0.92	0.56	0.56	2.09	-	0.18	0.11	7.14	27.07	0	1.84	1.64	-	1.52	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.38
H1420_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												5000	0	0							0																																	-	1477.39	14.92	1251.54	813.95	167.61	16.88	1.26	147.68	30.9	271.18	214.79	0.33	224.35	18.03	3233.54	7022.87	3.28	831.2	441.33		244.85	722.65																				100/d 7	100/d 7	0 d 1-8 75 d 9-14 125 d 15-100																																							71.85	71.85	78.57	20	100	0.2	0.2	47.4	200	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													71.85	71.85	78.57	20	100	0.2	0.2	47.4	200	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													8.85	0.09	8.19	1.36	1.4	3.38	0.25	0.58	0.52	0.68	0.66	0	0.56	0.05	2.69	17.56	0.01	2.08	1.1	-	0.92	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72	8.85	0.09	8.19	1.36	1.4	3.38	0.25	0.58	0.52	0.68	0.66	0	0.56	0.05	2.69	17.56	0.01	2.08	1.1	-	0.92	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72
H1420_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1383.1	13.97	1063.98	1038.83	186.89	1.73	0.02	195.1	39.58	729.54	224.29		53.84	34.03	2152.95	8167.32	0.33	555.65	495.83		238.57	591.79																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													16.56	0.17	8.87	3.03	2.34	0.52	0.01	0.81	0.49	0.49	1.84	-	0.16	0.1	6.28	23.82	0	1.62	1.45	-	1.34	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.61	16.56	0.17	8.87	3.03	2.34	0.52	0.01	0.81	0.49	0.49	1.84	-	0.16	0.1	6.28	23.82	0	1.62	1.45	-	1.34	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.61
H1420_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1383.1	13.97	1063.98	1038.83	186.89	1.73	0.02	195.1	39.58	729.54	224.29		53.84	34.03	2152.95	8167.32	0.33	555.65	495.83		238.57	591.79																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													16.56	0.17	8.87	3.03	2.34	0.52	0.01	0.81	0.49	0.49	1.84	-	0.16	0.1	6.28	23.82	0	1.62	1.45	-	1.34	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.61	16.56	0.17	8.87	3.03	2.34	0.52	0.01	0.81	0.49	0.49	1.84	-	0.16	0.1	6.28	23.82	0	1.62	1.45	-	1.34	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.61
H1420_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1383.1	13.97	1063.98	1038.83	186.89	1.73	0.02	195.1	39.58	729.54	224.29		53.84	34.03	2152.95	8167.32	0.33	555.65	495.83		238.57	591.79																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													16.56	0.17	8.87	3.03	2.34	0.52	0.01	0.81	0.49	0.49	1.84	-	0.16	0.1	6.28	23.82	0	1.62	1.45	-	1.34	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.61	16.56	0.17	8.87	3.03	2.34	0.52	0.01	0.81	0.49	0.49	1.84	-	0.16	0.1	6.28	23.82	0	1.62	1.45	-	1.34	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.61
H1463_001_0	2006	OP Facility - Emergency	Professional	Professional	Professional							500		PCP	PCP	Radiology							A	A	D	V	P	Coin	Coin	V	P	P	P	V	P	V	V	V	V	V		V	S	V			V	P	V					V	V	V	V																																																	-	287.1	7.75				12.59		350						2.25	3108.3	0.14	77.83			1084.95		831.14			72.96							0.14	286.73	103.81	3881.58							100/Admit	100/Admit				0	0	50						20	20	20	20			20		20			20		20					20	20	20	20							100	100				0.1	0.1	50						20	20	20	20			20		20			20		20					20	20	20	20								67.09	67.09				0.07	0.07	33.54						13.42	20	13.42	13.42			13.42		13.42			13.42		13.42					13.42	13.42	13.42	20								1.61	0.04	-	-	-	0.84	-	0.98	-	-	-	-	-	0	5.18	0	0.09	-	-	1.21	-	0.93	-	-	0.08	-	-	-	-	-	-	0	0.32	0.12	6.47	-	-	-	-	-	-	17.87	1.61	0.04	-	-	-	0.84	-	0.98	-	-	-	-	-	0	5.18	0	0.09	-	-	1.21	-	0.93	-	-	0.08	-	-	-	-	-	-	0	0.32	0.12	6.47	-	-	-	-	-	-	17.87
H1463_002_0	2006	OP Facility - Emergency	Professional	Professional	Professional							1500		PCP	PCP	Radiology							A	A	D	V	P	Coin	Coin	V	P	P	P	V	P	V	V	V	V	V		V	S	V			V	P	V					V	V	V	V																																																	-	283.14	7.64	850.3			11.51		345.18	260.81					2.22	3065.46	0.14	76.76	442.93		1070		819.69										0.14	282.78		3828.09							500/Admit	500/Admit	0/50/0			20	20	50	75			30		30	20	30	30	10		30		30					30					20	20		30							500	500	32			0.2	0.2	50	75			30		30	20	30	30	10		30		30					30					20	20		30								288.86	288.86	32			0.12	0.12	28.89	43.33			17.33		17.33	20	17.33	17.33	5.78		17.33		17.33					17.33					11.55	11.55		17.33								6.82	0.18	2.27	-	-	1.33	-	0.83	0.94	-	-	-	-	0	5.11	0	0.11	0.21	-	1.55	-	1.18	-	-	-	-	-	-	-	-	-	0	0.27	-	5.53	-	-	-	-	-	-	26.34	6.82	0.18	2.27	-	-	1.33	-	0.83	0.94	-	-	-	-	0	5.11	0	0.11	0.21	-	1.55	-	1.18	-	-	-	-	-	-	-	-	-	0	0.27	-	5.53	-	-	-	-	-	-	26.34
H1463_003_0	2006	OP Facility - Emergency	Professional	Professional	Professional							500		PCP	PCP	Radiology							A	A	D	V	P	Coin	Coin	V	P	P	P	V	P	V	V	V	V	V		V	S	V			V	P	V					V	V	V	V																																																	-	300.57	8.11				13.18		366.43						2.35	3254.18	0.15	81.48			1135.87		870.15			76.38							0.15	300.19	108.69	4063.76							100/Admit	100/Admit				0	0	50						20	20	20	20			20		20			20		20					20	20	20	20							100	100				0.1	0.1	50						20	20	20	20			20		20			20		20					20	20	20	20								65.99	65.99				0.07	0.07	33						13.2	20	13.2	13.2			13.2		13.2			13.2		13.2					13.2	13.2	13.2	20								1.65	0.04	-	-	-	0.87	-	1.01	-	-	-	-	-	0	5.42	0	0.09	-	-	1.25	-	0.96	-	-	0.08	-	-	-	-	-	-	0	0.33	0.12	6.77	-	-	-	-	-	-	18.6	1.65	0.04	-	-	-	0.87	-	1.01	-	-	-	-	-	0	5.42	0	0.09	-	-	1.25	-	0.96	-	-	0.08	-	-	-	-	-	-	0	0.33	0.12	6.77	-	-	-	-	-	-	18.6
H1463_801_0	2006	OP Facility - Emergency	Professional	Professional	Professional							500		PCP	PCP	Radiology							A	A	D	V	P	Coin	Coin	V	P	P	P	V	P	V	V	V	V	V		V	S	V			V	P	V					V	V	V	V																																																	-	287.1	7.75				12.59		350						2.25	3108.3	0.14	77.83			1084.95		831.14			72.96							0.14	286.73	103.81	3881.58							100/Admit	100/Admit				0	0	50						20	20	20	20			20		20			20		20					20	20	20	20							100	100				0.1	0.1	50						20	20	20	20			20		20			20		20					20	20	20	20								67.09	67.09				0.07	0.07	33.54						13.42	20	13.42	13.42			13.42		13.42			13.42		13.42					13.42	13.42	13.42	20								1.61	0.04	-	-	-	0.84	-	0.98	-	-	-	-	-	0	5.18	0	0.09	-	-	1.21	-	0.93	-	-	0.08	-	-	-	-	-	-	0	0.32	0.12	6.47	-	-	-	-	-	-	17.87	1.61	0.04	-	-	-	0.84	-	0.98	-	-	-	-	-	0	5.18	0	0.09	-	-	1.21	-	0.93	-	-	0.08	-	-	-	-	-	-	0	0.32	0.12	6.47	-	-	-	-	-	-	17.87
H1463_802_0	2006	OP Facility - Emergency	Professional	Professional	Professional							500		PCP	PCP	Radiology							A	A	D	V	P	Coin	Coin	V	P	P	P	V	P	V	V	V	V	V		V	S	V			V	P	V					V	V	V	V																																																	-	300.57	8.11				13.18		366.43						2.35	3254.18	0.15	81.48			1135.87		870.15			76.38							0.15	300.19	108.69	4063.76							100/Admit	100/Admit				0	0	50						20	20	20	20			20		20			20		20					20	20	20	20							100	100				0.1	0.1	50						20	20	20	20			20		20			20		20					20	20	20	20								65.99	65.99				0.07	0.07	33						13.2	20	13.2	13.2			13.2		13.2			13.2		13.2					13.2	13.2	13.2	20								1.65	0.04	-	-	-	0.87	-	1.01	-	-	-	-	-	0	5.42	0	0.09	-	-	1.25	-	0.96	-	-	0.08	-	-	-	-	-	-	0	0.33	0.12	6.77	-	-	-	-	-	-	18.6	1.65	0.04	-	-	-	0.87	-	1.01	-	-	-	-	-	0	5.42	0	0.09	-	-	1.25	-	0.96	-	-	0.08	-	-	-	-	-	-	0	0.33	0.12	6.77	-	-	-	-	-	-	18.6
H1468_004_0	2006																						A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V																																																									-	326.03	4.33			224.21	17.84	6.34	361.09				146.65		273.33	4425.22	2797.16	413.7				40.73	725.32	33.01	0	126.99		21.74																																																													0.1															0.1																						150	150	0	0	50	0.09	0.1	49.01	0	0	0	20	0	20	10	15	20	0	0	0	0.09	15	25	12.5	12.5	0	12.5	0	0	0	0											0	4.08	0.05	-	-	0.93	1.61	0.63	1.47	-	-	-	0.24	-	0.46	3.69	3.5	0.69	-	-	-	3.67	0.91	0.07	-	0.13	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.15	4.08	0.05	-	-	0.93	1.61	0.63	1.47	-	-	-	0.24	-	0.46	3.69	3.5	0.69	-	-	-	3.67	0.91	0.07	-	0.13	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.15
H1468_005_0	2006																						A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V																																																									-	326.03	4.33			224.21	17.84	6.34	361.09				146.65		273.33	4425.22	2797.16	413.7				40.73	725.32	33.01	0	126.99		21.74																																																													0.1															0.1																						150	150	0	0	50	0.09	0.1	49.01	0	0	0	20	0	20	10	15	20	0	0	0	0.09	15	25	12.5	12.5	0	12.5	0	0	0	0											0	4.08	0.05	-	-	0.93	1.61	0.63	1.47	-	-	-	0.24	-	0.46	3.69	3.5	0.69	-	-	-	3.67	0.91	0.07	-	0.13	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.15	4.08	0.05	-	-	0.93	1.61	0.63	1.47	-	-	-	0.24	-	0.46	3.69	3.5	0.69	-	-	-	3.67	0.91	0.07	-	0.13	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.15
H1468_006_0	2006																						A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V																																																									-	326.03	4.33			224.21	17.84	6.34	361.09				146.65		273.33	4425.22	2797.16	413.7				40.73	725.32	33.01	0	126.99		21.74																																																													0.1															0.1																						150	150	0	0	50	0.09	0.1	49.01	0	0	0	20	0	20	10	15	20	0	0	0	0.09	15	25	12.5	12.5	0	12.5	0	0	0	0											0	4.08	0.05	-	-	0.93	1.61	0.63	1.47	-	-	-	0.24	-	0.46	3.69	3.5	0.69	-	-	-	3.67	0.91	0.07	-	0.13	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.15	4.08	0.05	-	-	0.93	1.61	0.63	1.47	-	-	-	0.24	-	0.46	3.69	3.5	0.69	-	-	-	3.67	0.91	0.07	-	0.13	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.15
H1468_007_0	2006																						A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V																																																									-	326.03	4.33			224.21	17.84	6.34	361.09				146.65		273.33	4425.22	2797.16	413.7				40.73	725.32	33.01	0	126.99		21.74																																																													0.1															0.1																						150	150	0	0	50	0.09	0.1	49.01	0	0	0	20	0	20	10	15	20	0	0	0	0.09	15	25	12.5	12.5	0	12.5	0	0	0	0											0	4.08	0.05	-	-	0.93	1.61	0.63	1.47	-	-	-	0.24	-	0.46	3.69	3.5	0.69	-	-	-	3.67	0.91	0.07	-	0.13	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.15	4.08	0.05	-	-	0.93	1.61	0.63	1.47	-	-	-	0.24	-	0.46	3.69	3.5	0.69	-	-	-	3.67	0.91	0.07	-	0.13	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.15
H1509_001_0	2006											3000											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1346.38	50.04	947.09		82.72	11.43	14.99	298.33	40.78		18.17	4.02	0.6	17.1	3804.66	4469.49	150.15	1.53	18.18	334.22	21.19				117.8		210.9															275	175	125		150	20	20	50	20		0/20	20	30	20/40/30	10.00/0	30	40/30	20	0/20	0/30	30				30		30															275	175	125		150	0.2	0.2	50	0.2		0.17	0.2	0.3	0.2	10	28.04	37.5	0.2	0.11	0.36	0.3				30		30																171.14	104.95	74.96		89.95	0.12	0.12	29.98	0.12		0.1	0.12	0.18	0.12	10	28.04	37.5	0.13	0.06	0.36	0.18				30		30																19.2	0.44	5.92	-	0.62	1.37	1.8	0.75	4.89	-	1.85	0.48	0.11	2.03	3.17	10.44	0.47	0.2	1.17	0.01	3.81	-	-	-	0.29	-	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.56	19.2	0.44	5.92	-	0.62	1.37	1.8	0.75	4.89	-	1.85	0.48	0.11	2.03	3.17	10.44	0.47	0.2	1.17	0.01	3.81	-	-	-	0.29	-	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.56
H1509_003_0	2006											2400											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1346.34	50.04	947.06	0	82.72	11.43	14.99	298.32	40.78	0	18.17	4.02	0.6	17.1	3804.54	4469.36	150.14	1.53	18.18	334.21	21.19	0	0	0	117.8	0	210.9	0	0	0	0											265	175	95	0	150	20	20	50	20	0	0/20	20	20	20/40/30	5.00/0	20	40/30	20	0/20	0/20	20	0			20		20															265	175	95	0	150	0.2	0.2	50	0.2	0	0.17	0.2	0.2	0.2	5	18.69	37.5	0.2	0.11	0.36	0.2	0	0	0	20	0	20	0	0	0	0												155.99	98.69	53.58	0	84.6	0.11	0.11	28.2	0.11	0	0.1	0.11	0.11	0.11	5	18.69	37.5	0.12	0.06	0.36	0.11	0	0	0	20	0	20	0	0	0	0												17.5	0.41	4.23	-	0.58	1.29	1.69	0.7	4.6	-	1.74	0.45	0.07	1.91	1.59	6.96	0.47	0.19	1.1	0.01	2.39	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.44	17.5	0.41	4.23	-	0.58	1.29	1.69	0.7	4.6	-	1.74	0.45	0.07	1.91	1.59	6.96	0.47	0.19	1.1	0.01	2.39	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.44
H1509_004_0	2006											600											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1576.23	59.89	869.4		109.32	15.1	19.82	498.21	68.15		32.56	6.72	1	28.63	8196.66	5643.58	210.15	1.9	25.34	421	26.7				117.8		305.36															25	25	15		100	20	20	40	15		0/10	15	20	10/15/8/4	Feb-00	4	04-Aug	10	0/10	0/4	20				4.00/5.00		4															25	25	15		100	0.2	0.2	40	0.01		0.02	0.02	0.2	0.05	1.28	3.74	7	0.09	0.08	0.35	0.2				4		4																16.42	15.91	9.54		63.62	0.13	0.13	25.45	0.01		0.01	0.01	0.13	0.03	1.28	3.74	7	0.06	0.05	0.35	0.13				4		4																2.16	0.08	0.69	-	0.58	1.92	2.52	1.06	0.52	-	0.39	0.08	0.13	0.98	0.87	1.76	0.12	0.12	1.28	0.01	3.4	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.81	2.16	0.08	0.69	-	0.58	1.92	2.52	1.06	0.52	-	0.39	0.08	0.13	0.98	0.87	1.76	0.12	0.12	1.28	0.01	3.4	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.81
H1509_801_0	2006											3600											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1396.88	41.85	962.47		82.6	11.51	15.61	304.76	43.88		22.42	4.3	0.53	17.82	4060.16	4809.22	135.18	1.65	19.54	358.69	22.6				126.64		226.72															265	175	125		150	30	30	50	30	20	20/30	30	30	30/40/30	35/0	35	40/30	30	0/30	0/35	30				35		35															265	175	125		150	0.3	0.3	50	0.3		0.24	0.3	0.3	0.3	35	32.75	10.5	0.3	0.29	0.32	0.3				35		35																163.45	103.74	74.1		88.92	0.18	0.18	29.64	0.18		0.15	0.18	0.18	0.18	35	32.75	10.5	0.19	0.17	0.32	0.18				35		35																19.03	0.36	5.94	-	0.61	2.05	2.78	0.75	7.8	-	3.25	0.76	0.09	3.12	11.84	13.13	0.12	0.32	3.35	0.01	4.02	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.37	19.03	0.36	5.94	-	0.61	2.05	2.78	0.75	7.8	-	3.25	0.76	0.09	3.12	11.84	13.13	0.12	0.32	3.35	0.01	4.02	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.37
H1510_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1057.43	22.4	553.5	515.99	144.65	19.23	1.45	407.59	322.94				17.61	1989.97	6384.12	11133.65					4.45			7.49	0		0					55.65	1.18	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-75	Oct-50	35-50					20			25								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.78	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.78	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0				0	10.49	0.22	1.09	0.43	1.21	3.85	0.29	1.38	3.14	-	-	-	-	8.26	5.74	32.75	-	-	-	-	0.89	-	-	2.64	-	-	-	-	-	-	-	0.55	0.01	-	-	-	-	-	-	-	-	72.92	10.49	0.22	1.09	0.43	1.21	3.85	0.29	1.38	3.14	-	-	-	-	8.26	5.74	32.75	-	-	-	-	0.89	-	-	2.64	-	-	-	-	-	-	-	0.55	0.01	-	-	-	-	-	-	-	-	72.92
H1510_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	259.9	5.91	1145.07	533.73	149.62	19.94	1.5	421.61	334.04				18.21	2058.39	6603.62	11516.45					4.45			0	0		0					13.68	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.81	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.81	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13	0.3	0.84	0.44	1.25	4.99	0.38	1.59	5.57	-	-	-	-	5.97	13.87	33.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	83.35	13	0.3	0.84	0.44	1.25	4.99	0.38	1.59	5.57	-	-	-	-	5.97	13.87	33.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	83.35
H1510_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	259.9	5.91	1145.05	533.73	149.62	19.94	1.5	421.6	334.04				18.21	2058.37	6603.56	11516.33					4.45			0	0		0					13.68	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.81	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.81	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13	0.3	0.84	0.44	1.25	4.99	0.38	1.59	5.57	-	-	-	-	5.97	13.87	33.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	83.35	13	0.3	0.84	0.44	1.25	4.99	0.38	1.59	5.57	-	-	-	-	5.97	13.87	33.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	83.35
H1510_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	259.9	5.91	1145.07	533.73	149.62	19.94	1.5	421.61	334.04				18.21	2058.39	6603.62	11516.45					4.45			0	0		0					13.68	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.81	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.81	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13	0.3	0.84	0.44	1.25	4.99	0.38	1.59	5.57	-	-	-	-	5.97	13.87	33.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	83.35	13	0.3	0.84	0.44	1.25	4.99	0.38	1.59	5.57	-	-	-	-	5.97	13.87	33.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	83.35
H1510_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	259.9	5.91	1145.05	533.73	149.62	19.94	1.5	421.6	334.04				18.21	2058.37	6603.56	11516.33					4.45			0	0		0					13.68	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.81	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.81	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13	0.3	0.84	0.44	1.25	4.99	0.38	1.59	5.57	-	-	-	-	5.97	13.87	33.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	83.35	13	0.3	0.84	0.44	1.25	4.99	0.38	1.59	5.57	-	-	-	-	5.97	13.87	33.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	83.35
H1511_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	367.72	6.53	372.62		295.82	10.89	3.74	337.03	425.02	825.03	1128.71	51.45	34.99	0.63	6092.5	1800.69	6.97	409.9			251.35				24.26		178.16					882.05	23.33	64.2	398.62	115.64	0.03	878.98	3.78			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/30/40/80 copay levels				50 max		50 max					30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			750	750	75		75	0.2	0.2	50	250	51.31	59.45	250	34.28	30	15	30	30	30			26.22				50		50					30	50	30	30	15	0.2	30	30			3500	577.86	639.15	69.3		69.3	0.2	0.2	46.2	231.01	47.42	54.93	231.01	31.68	27.72	13.86	27.72	27.72	27.72			24.23				46.2		46.2					27.72	46.2	27.72	27.72	13.86	0.2	27.72	27.72				17.71	0.35	2.15	-	1.71	2.18	0.75	1.3	8.18	3.26	5.17	0.99	0.09	0	7.04	4.16	0.02	0.95	-	-	0.51	-	-	-	0.09	-	0.69	-	-	-	-	2.04	0.09	0.15	0.92	0.13	0.01	2.03	0.01	-	-	62.66	17.71	0.35	2.15	-	1.71	2.18	0.75	1.3	8.18	3.26	5.17	0.99	0.09	0	7.04	4.16	0.02	0.95	-	-	0.51	-	-	-	0.09	-	0.69	-	-	-	-	2.04	0.09	0.15	0.92	0.13	0.01	2.03	0.01	-	-	62.66
H1511_005_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	0	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			D	D	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	2142.67	51.15	371.12		294.63	10.82	3.72	335.67	423.31	821.7	1124.16	51.25	34.85	0.63	6067.93	1793.43	6.94	408.25			250.34				24.16		177.45					878.49	23.23	63.94	397.01	115.17	0.03	875.43	3.77			175/day with 1750 yearly max	175/day with 1750 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	175 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	175 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/30/40/80 copay levels				50 max		50 max					30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			175	175	75		75	0.2	0.2	50	175	51.31	59.45	175	34.28	30	15	30	30	30			26.22				50		50					30	50	30	30	15	0.2	30	30			3500	103.97	122.64	69.13		69.13	0.2	0.2	46.09	161.31	47.3	54.8	161.31	31.6	27.65	13.83	27.65	27.65	27.65			24.17				46.09		46.09					27.65	46.09	27.65	27.65	13.83	0.2	27.65	27.65				18.57	0.52	2.14	-	1.7	2.16	0.74	1.29	5.69	3.24	5.13	0.69	0.09	0	6.99	4.13	0.02	0.94	-	-	0.5	-	-	-	0.09	-	0.68	-	-	-	-	2.02	0.09	0.15	0.91	0.13	0.01	2.02	0.01	-	-	60.66	18.57	0.52	2.14	-	1.7	2.16	0.74	1.29	5.69	3.24	5.13	0.69	0.09	0	6.99	4.13	0.02	0.94	-	-	0.5	-	-	-	0.09	-	0.68	-	-	-	-	2.02	0.09	0.15	0.91	0.13	0.01	2.02	0.01	-	-	60.66
H1511_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			none																																										-	363.15	4.05	385.58		311.17	10.66	4.84	286.99	535.18	804.89	1398.64	49.19	75.6	0	6836.48	2210.38	1.06	791.25			284.17											913.15	29.79	101.61	498.56	154.13	0.03	987.88	6.07			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/30/40/80 copay levels											30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			750	750	75		75	0.2	0.2	50	250	51.72	59.66	250	35	30	15	30	30	30			30.66											30	50	30	30	15	0.2	30	30			4000	601.86	700.77	72.34		72.34	0.2	0.2	48.22	241.12	49.88	57.54	241.12	33.76	28.93	14.47	28.93	28.93	28.93			29.57											28.93	48.22	28.93	28.93	14.47	0.2	28.93	28.93				18.21	0.24	2.32	-	1.88	2.13	0.97	1.15	10.75	3.35	6.71	0.99	0.21	-	8.24	5.33	0	1.91	-	-	0.7	-	-	-	-	-	-	-	-	-	-	2.2	0.12	0.25	1.2	0.19	0.01	2.38	0.01	-	-	71.45	18.21	0.24	2.32	-	1.88	2.13	0.97	1.15	10.75	3.35	6.71	0.99	0.21	-	8.24	5.33	0	1.91	-	-	0.7	-	-	-	-	-	-	-	-	-	-	2.2	0.12	0.25	1.2	0.19	0.01	2.38	0.01	-	-	71.45
H1607_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional				none											A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V							V	V	V	V	V	Coin	V				none																																										-	305.2	5.08	288.13		240.65	9.54	3.22	277.29	358.15	657.87	960.3	40.75	103.06	0.49	4915.66	1597.39	5.4	381.54			205.51				22.29							772.29	20.17	90.53	336.07	97.37	0.03	738.02				750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels				50 max							20 copay	50 copay	20 copay	20 copay	20 copay	20 coinsurance	20 copay				750	750	75		75	0.2	0.2	50	250	51.31	59.45	250	34.28	20	20	20	20	20			26.71				50							20	50	20	20	20	0.2	20				4000	602.59	670.82	72.12		72.12	0.2	0.2	48.08	240.41	49.34	57.17	240.41	32.97	19.23	19.23	19.23	19.23	19.23			25.69				48.08							19.23	48.08	19.23	19.23	19.23	0.2	19.23					15.33	0.28	1.73	-	1.45	1.91	0.64	1.11	7.18	2.71	4.57	0.82	0.28	0	7.88	2.56	0.01	0.61	-	-	0.44	-	-	-	0.09	-	-	-	-	-	-	1.24	0.08	0.15	0.54	0.16	0.01	1.18	-	-	-	52.94	15.33	0.28	1.73	-	1.45	1.91	0.64	1.11	7.18	2.71	4.57	0.82	0.28	0	7.88	2.56	0.01	0.61	-	-	0.44	-	-	-	0.09	-	-	-	-	-	-	1.24	0.08	0.15	0.54	0.16	0.01	1.18	-	-	-	52.94
H1607_002_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional				none											A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V							V	V	V	V	V	Coin	V				none																																										-	1813.88	39.9	288.77		241.07	9.52	3.21	277.75	358.66	659.13	961.6	40.83	102.57	0.5	5069.04	1646.22	5.59	392.53			205.86				22.31							796.28	20.19	92.03	347.01	100.25	0.03	762.16				175/day with 1750 yearly max	175/day with 1750 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	175 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	175 copay	15/35 copay for in-home/facility	15 Copay	15 Copay	15 Copay	15 Copay	15 Copay			15/40/30/80 copay levels				50 max							15 Copay	50 copay	15 Copay	15 Copay	15 Copay	20 coinsurance	15 Copay				175	175	75		75	0.2	0.2	50	175	51.31	59.45	175	34.28	15	15	15	15	15			26.22				50							15	50	15	15	15	0.2	15				4000	106.54	131.54	71.85		71.85	0.2	0.2	47.9	167.66	49.16	56.96	167.66	32.84	14.37	14.37	14.37	14.37	14.37			25.12				47.9							14.37	47.9	14.37	14.37	14.37	0.2	14.37					16.1	0.44	1.73	-	1.44	1.9	0.64	1.11	5.01	2.7	4.56	0.57	0.28	0	6.07	1.97	0.01	0.47	-	-	0.43	-	-	-	0.09	-	-	-	-	-	-	0.95	0.08	0.11	0.42	0.12	0.01	0.91	-	-	-	48.13	16.1	0.44	1.73	-	1.44	1.9	0.64	1.11	5.01	2.7	4.56	0.57	0.28	0	6.07	1.97	0.01	0.47	-	-	0.43	-	-	-	0.09	-	-	-	-	-	-	0.95	0.08	0.11	0.42	0.12	0.01	0.91	-	-	-	48.13
H1607_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			none																																										-	298.29	3.33	316.71		255.59	8.69	3.94	235.73	439.58	661.12	1148.82	40.4	62.09	0	5434.22	1900.01	0.91	680.15			233.41											784.93	24.47	87.34	428.55	122.52	0.03	849.16	5.22			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels											20 copay	50 copay	20 copay	20 copay	20 copay	20 coinsurance	20 copay	20 copay			750	750	75		75	0.2	0.2	50	250	51.72	59.66	250	35	20	20	20	20	20			30.66											20	50	20	20	20	0.2	20	20			4000	601.94	700.87	72.35		72.35	0.2	0.2	48.23	241.16	49.89	57.55	241.16	33.76	19.29	19.29	19.29	19.29	19.29			29.58											19.29	48.23	19.29	19.29	19.29	0.2	19.29	19.29				14.96	0.19	1.91	-	1.54	1.74	0.79	0.95	8.83	2.75	5.51	0.81	0.17	-	8.74	3.05	0	1.09	-	-	0.58	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.37	0.01	-	-	57.39	14.96	0.19	1.91	-	1.54	1.74	0.79	0.95	8.83	2.75	5.51	0.81	0.17	-	8.74	3.05	0	1.09	-	-	0.58	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.37	0.01	-	-	57.39
H1607_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			none																																										-	298.29	3.33	316.71		255.59	8.69	3.94	235.73	439.58	661.12	1148.82	40.4	62.09	0	5434.22	1900.01	0.91	680.15			233.41											784.93	24.47	87.34	428.55	122.52	0.03	849.16	5.22			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels											20 copay	50 copay	20 copay	20 copay	20 copay	20 coinsurance	20 copay	20 copay			750	750	75		75	0.2	0.2	50	250	51.72	59.66	250	35	20	20	20	20	20			30.66											20	50	20	20	20	0.2	20	20			4000	601.94	700.87	72.35		72.35	0.2	0.2	48.23	241.16	49.89	57.55	241.16	33.76	19.29	19.29	19.29	19.29	19.29			29.58											19.29	48.23	19.29	19.29	19.29	0.2	19.29	19.29				14.96	0.19	1.91	-	1.54	1.74	0.79	0.95	8.83	2.75	5.51	0.81	0.17	-	8.74	3.05	0	1.09	-	-	0.58	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.37	0.01	-	-	57.39	14.96	0.19	1.91	-	1.54	1.74	0.79	0.95	8.83	2.75	5.51	0.81	0.17	-	8.74	3.05	0	1.09	-	-	0.58	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.37	0.01	-	-	57.39
H1608_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1500	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	T	V	V	P	V	P	P	P	P	V	V	V	V	V																																																-	1516.47	67.85	314.29	0	257.67	0.77	1.07	250.87	423.92	1.01	16.14	1.24	7.05	17.17	3365.25	3661.78	230.05	399.49	145.78	0	8.51	0	0	0	98.71	0	4.66	0	0	0	0	0	0	1156.85	188.77	0.03						150/day days 1-7	150/day days 1-7	75/day days 7+													30	varies		varies																							81.76	81.66	26.8	0	115	0.3	0.3	50	100	0.2	0.2	0.2	0.2	0.2	10	29.7	30	25	6.85	0	0.2	0	0	0	30	0	30	0	0	0	0	0	0	15	15	100							48.12	48.06	15.78	0	67.68	0.18	0.18	29.43	58.85	0.12	0.12	0.12	0.12	0.12	5.89	17.48	17.66	14.71	4.03	0	0.12	0	0	0	30	0	30	0	0	0	0	0	0	8.83	8.83	58.85							6.08	0.27	0.41	-	1.45	0.14	0.19	0.62	2.08	0.12	1.9	0.15	0.83	2.02	1.65	5.33	0.34	0.49	0.05	-	1	-	-	-	0.25	-	0.01	-	-	-	-	-	-	0.85	0.14	0	-	-	-	-	-	26.37	6.08	0.27	0.41	-	1.45	0.14	0.19	0.62	2.08	0.12	1.9	0.15	0.83	2.02	1.65	5.33	0.34	0.49	0.05	-	1	-	-	-	0.25	-	0.01	-	-	-	-	-	-	0.85	0.14	0	-	-	-	-	-	26.37
H1608_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1500	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin																																																-	1489.94	67.85	314.29	0	6.14	1.64	0.19	250.19	26.95	1.01	16.14	1.24	7.05	17.17	27.69	94.09	2.36	3.02	15.87	0	8.51	0	0	0	0	0	0	0	0	0	0	0	0	4.7	0.95	0.01						150 days 1-7	150 days 1-7	75 days 7-26																																							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49	10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49
H1608_802_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1500	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin																																																-	1489.94	67.85	314.29	0	6.14	1.64	0.19	250.19	26.95	1.01	16.14	1.24	7.05	17.17	27.69	94.09	2.36	3.02	15.87	0	8.51	0	0	0	0	0	0	0	0	0	0	0	0	4.7	0.95	0.01						150 days 1-7	150 days 1-7	75 days 7-26																																							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49	10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49
H1608_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1500	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin																																																-	1489.94	67.85	314.29	0	6.14	1.64	0.19	250.19	26.95	1.01	16.14	1.24	7.05	17.17	27.69	94.09	2.36	3.02	15.87	0	8.51	0	0	0	0	0	0	0	0	0	0	0	0	4.7	0.95	0.01						150 days 1-7	150 days 1-7	75 days 7-26																																							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49	10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49
H1608_804_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1500	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin																																																-	1489.94	67.85	314.29	0	6.14	1.64	0.19	250.19	26.95	1.01	16.14	1.24	7.05	17.17	27.69	94.09	2.36	3.02	15.87	0	8.51	0	0	0	0	0	0	0	0	0	0	0	0	4.7	0.95	0.01						150 days 1-7	150 days 1-7	75 days 7-26																																							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49	10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49
H1608_805_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1500	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin																																																-	1489.94	67.85	314.29	0	6.14	1.64	0.19	250.19	26.95	1.01	16.14	1.24	7.05	17.17	27.69	94.09	2.36	3.02	15.87	0	8.51	0	0	0	0	0	0	0	0	0	0	0	0	4.7	0.95	0.01						150 days 1-7	150 days 1-7	75 days 7-26																																							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49	10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49
H1608_806_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1500	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin																																																-	1489.94	67.85	314.29	0	6.14	1.64	0.19	250.19	26.95	1.01	16.14	1.24	7.05	17.17	27.69	94.09	2.36	3.02	15.87	0	8.51	0	0	0	0	0	0	0	0	0	0	0	0	4.7	0.95	0.01						150 days 1-7	150 days 1-7	75 days 7-26																																							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							81.76	81.66	26.8	0	0.2	0.3	0.3	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2							10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49	10.15	0.46	0.7	-	1.23	0.49	0.06	1.04	5.39	0.2	3.23	0.25	1.41	3.43	5.54	18.82	0.47	0.6	3.17	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	0.94	0.19	0	-	-	-	-	-	59.49
H1609_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1500	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	P	V	P	V	V	V	V	V	V																																																-	1651.11	75.39	342.02	0	280.41	1.79	0.25	273.01	461.33	1.1	17.56	1.35	9.46	18.69	3662.21	3801.92	255.61	434.75	0.45	0	9.34	0	0	0	107.42	0	5.07	0	0	0	0	0	0	1258.95	205.43	0.04						150 days 1-7	150 days 1-7	0 days 1-6 75 7-22		115	0	0	50	50	0	0.2	0.2	0.2	0	10	30	30	25	20		0.2				25		30							20	15	50						81.76	81.66	26.8	0	115	0.3	0.3	50	50	0.2	0.2	0.2	0.2	0.2	10	30	30	25	0.2	0	0.2	0	0	0	30	0	30	0	0	0	0	0	0	20	15	50							31.92	31.88	10.46	0	44.9	0.12	0.12	19.52	19.52	0.08	0.08	0.08	0.08	0.08	10	30	30	9.76	0.2	0	0.2	0	0	0	30	0	11.71	0	0	0	0	0	0	7.81	5.86	19.52							4.39	0.2	0.3	-	1.05	0.21	0.03	0.44	0.75	0.09	1.37	0.11	0.74	1.46	3.05	9.5	0.64	0.35	0.09	-	1.87	-	-	-	0.27	-	0	-	-	-	-	-	-	0.82	0.1	0	-	-	-	-	-	27.83	4.39	0.2	0.3	-	1.05	0.21	0.03	0.44	0.75	0.09	1.37	0.11	0.74	1.46	3.05	9.5	0.64	0.35	0.09	-	1.87	-	-	-	0.27	-	0	-	-	-	-	-	-	0.82	0.1	0	-	-	-	-	-	27.83
H1609_002_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1000	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	P	V	P	V	V	V	V	V	V																																																-	1651.11	75.39	342.02	0	280.41	1.79	0.25	273.01	461.33	1.1	17.56	1.35	9.46	18.69	3662.21	3801.92	255.61	434.75	0.45	0	9.34	0	0	0	107.42	0	5.07	0	0	0	0	0	0	1258.95	205.43	0.04						125 days 1-7	125 days 1-7	0 days 1-6 75 7-26		115	0	0	50	50	0	0.1	0.1	0.1	0	10	15	15	15	10		0.1				15		15				15	15	15	15	15	50						68.15	68.05	26.8	0	115	0.1	0.1	50	50	0.1	0.1	0.1	0.1	0.1	10	15	15	15	0.1	0	0.1	0	0	0	15	0	15	0	0	0	0	0	0	15	15	50							23.29	23.25	9.16	0	39.3	0.03	0.03	17.09	17.09	0.03	0.03	0.03	0.03	0.03	10	15	15	5.13	0.1	0	0.1	0	0	0	15	0	5.13	0	0	0	0	0	0	5.13	5.13	17.09							3.2	0.15	0.26	-	0.92	0.06	0.01	0.39	0.66	0.04	0.6	0.05	0.32	0.64	3.05	4.75	0.32	0.19	0.05	-	0.93	-	-	-	0.13	-	0	-	-	-	-	-	-	0.54	0.09	0	-	-	-	-	-	17.34	3.2	0.15	0.26	-	0.92	0.06	0.01	0.39	0.66	0.04	0.6	0.05	0.32	0.64	3.05	4.75	0.32	0.19	0.05	-	0.93	-	-	-	0.13	-	0	-	-	-	-	-	-	0.54	0.09	0	-	-	-	-	-	17.34
H1609_003_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery						1300	Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	P	V	P	V	V	V	V	V	V																																																-	1651.39	75.39	342.02	0	280.41	1.8	0.25	273.01	461.33	1.11	17.71	1.36	9.53	18.85	3662.21	3801.92	255.61	434.75	0.45	0	9.38	0	0	0	107.42	0	5.07	0	0	0	0	0	0	1258.95	205.43	0.04						125 days 1-7	125 days 1-7	0 days 1-6 75 7-19		115	0	0	50	50	0	0.2	0.2	0.2	0	10	20	20	15	20		0.2				20		20							15	15	50						68.15	68.05	26.8	0	115	0.2	0.2	50	50	0.2	0.2	0.2	0.2	0.17	9.99	20	20	15	0.2	0	0.2	0	0	0	20	0	20	0	0	0	0	0	0	15	15	50							26.34	26.3	10.36	0	44.45	0.08	0.08	19.33	19.33	0.08	0.08	0.08	0.08	0.07	9.99	20	7.73	5.8	0.2	0	0.2	0	0	0	20	0	20	0	0	0	0	0	0	5.8	5.8	19.33							3.63	0.17	0.3	-	1.04	0.14	0.02	0.44	0.74	0.09	1.37	0.11	0.74	1.25	3.05	6.34	0.16	0.21	0.09	-	1.88	-	-	-	0.18	-	0.01	-	-	-	-	-	-	0.61	0.1	0	-	-	-	-	-	22.64	3.63	0.17	0.3	-	1.04	0.14	0.02	0.44	0.74	0.09	1.37	0.11	0.74	1.25	3.05	6.34	0.16	0.21	0.09	-	1.88	-	-	-	0.18	-	0.01	-	-	-	-	-	-	0.61	0.1	0	-	-	-	-	-	22.64
H1609_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery							Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	167.52	3.86	8.75	0	6.69	1.79	0.21	272.27	29.33	1.1	17.56	1.35	9.46	18.69	30.14	114.89	2.62	3.28	22.39	0	9.34	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.01																																															0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91	14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91
H1609_802_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery							Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	167.52	3.86	8.75	0	6.69	1.79	0.21	272.27	29.33	1.1	17.56	1.35	9.46	18.69	30.14	114.89	2.62	3.28	22.39	0	9.34	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.01																																															0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91	14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91
H1609_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery							Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	167.52	3.86	8.75	0	6.69	1.79	0.21	272.27	29.33	1.1	17.56	1.35	9.46	18.69	30.14	114.89	2.62	3.28	22.39	0	9.34	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.01																																															0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91	14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91
H1609_804_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery							Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	167.52	3.86	8.75	0	6.69	1.79	0.21	272.27	29.33	1.1	17.56	1.35	9.46	18.69	30.14	114.89	2.62	3.28	22.39	0	9.34	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.01																																															0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91	14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91
H1609_805_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery							Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	167.52	3.86	8.75	0	6.69	1.79	0.21	272.27	29.33	1.1	17.56	1.35	9.46	18.69	30.14	114.89	2.62	3.28	22.39	0	9.34	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.01																																															0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91	14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91
H1609_806_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Surgery							Radiology Copay	Lab Copay	Radiology Copay	Lab Copay	Transplant						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	167.52	3.86	8.75	0	6.69	1.79	0.21	272.27	29.33	1.1	17.56	1.35	9.46	18.69	30.14	114.89	2.62	3.28	22.39	0	9.34	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.01																																															0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							0.09	0.09	0.14	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.23							14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91	14.6	0.34	1.2	-	1.56	0.42	0.05	1.13	6.83	0.26	4.09	0.32	2.21	4.35	7.02	26.77	0.61	0.76	5.22	-	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	79.91
H1716_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V				8000	0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	233.67	5.31	520.03	484.79	135.9	17.38	1.31	382.95	303.41				16.54	1869.63	5998.06	10460.37					4.45			3.79	0		0					12.3	0.28	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-13) 100 per day (14-100)	5	100	20	20	35-50	100				0	0-100	10-100	35-100					20			0			0					600 per admit	600 per admit	0	0	0	0	0				600	600	31.45	5	100	0.2	0.2	40.7	100				0	38.19	11.77	36.28					20			0	0		0					600	600	0	0	0	0	0					454.37	600	23.82	3.79	75.73	0.15	0.15	30.82	75.73				0	28.92	8.91	27.47					20			0	0		0					454.37	600	0	0	0	0	0				0	8.85	0.27	1.03	0.15	0.86	2.63	0.2	0.98	1.91	-	-	-	-	4.51	4.45	23.95	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	-	-	-	-	-	51.16	8.85	0.27	1.03	0.15	0.86	2.63	0.2	0.98	1.91	-	-	-	-	4.51	4.45	23.95	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	-	-	-	-	-	51.16
H1716_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	243.18	5.53	1075.9	501.49	140.58	18.82	1.42	396.14	313.86				17.11	1934.06	6204.75	10820.82					4.45			0	0		0					12.8	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.48	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.48	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.16	0.28	0.79	0.42	1.17	4.71	0.35	1.49	5.23	-	-	-	-	5.56	13.03	31.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	78.29	12.16	0.28	0.79	0.42	1.17	4.71	0.35	1.49	5.23	-	-	-	-	5.56	13.03	31.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	78.29
H1716_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	243.18	5.53	1075.91	501.49	140.58	18.82	1.42	396.14	313.87				17.11	1934.07	6204.78	10820.87					4.45			0	0		0					12.8	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.48	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.48	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.16	0.28	0.79	0.42	1.17	4.71	0.35	1.49	5.23	-	-	-	-	5.56	13.03	31.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	78.29	12.16	0.28	0.79	0.42	1.17	4.71	0.35	1.49	5.23	-	-	-	-	5.56	13.03	31.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	78.29
H1716_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	243.18	5.53	1075.9	501.49	140.58	18.82	1.42	396.14	313.86				17.11	1934.06	6204.75	10820.82					4.45			0	0		0					12.8	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.48	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.48	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.16	0.28	0.79	0.42	1.17	4.71	0.35	1.49	5.23	-	-	-	-	5.56	13.03	31.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	78.29	12.16	0.28	0.79	0.42	1.17	4.71	0.35	1.49	5.23	-	-	-	-	5.56	13.03	31.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	78.29
H1716_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	243.18	5.53	1075.91	501.49	140.58	18.82	1.42	396.14	313.87				17.11	1934.07	6204.78	10820.87					4.45			0	0		0					12.8	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.48	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.48	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.16	0.28	0.79	0.42	1.17	4.71	0.35	1.49	5.23	-	-	-	-	5.56	13.03	31.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	78.29	12.16	0.28	0.79	0.42	1.17	4.71	0.35	1.49	5.23	-	-	-	-	5.56	13.03	31.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	78.29
H1717_001_0	2006											4200											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1506.05	77.2	717.66	0	96.25	11.09	14.77	290.3	38.63	0	16.95	8.46	0	24.64	3420.73	4858.88	251.44	1.61	18.93	298.22	23.13	0			117.8		210.9															265	175	125	0	150	20	20	50	20	0	0/20	20	30	20/40/30	15/0	25	40/30	20	0/20	0/25	30	0			25		25															265	175	125	0	150	0.2	0.2	50	0.2	0	0.17	0.2	0	0.2	15	23.41	37.5	0.2	0.11	0.4	0.3	0			25		25																176.9	116.82	83.44	0	100.13	0.13	0.13	33.38	0.13	0	0.11	0.13	0	0.13	15	23.41	37.5	0.13	0.07	0.4	0.2	0			25		25																22.2	0.75	4.99	-	0.8	1.48	1.97	0.81	5.16	-	1.91	1.13	-	3.29	4.28	9.48	0.79	0.22	1.35	0.01	4.63	-			0.25		0.44															65.93	22.2	0.75	4.99	-	0.8	1.48	1.97	0.81	5.16	-	1.91	1.13	-	3.29	4.28	9.48	0.79	0.22	1.35	0.01	4.63	-			0.25		0.44															65.93
H1717_003_0	2006											3800											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1506.05	77.2	717.66	0	96.25	11.09	14.77	290.3	38.63	0	16.95	8.46	0	24.64	3420.73	4858.88	251.44	1.61	18.93	298.22	23.13	0			117.8		210.9															265	175	75	0	150	20	20	50	15	0	0/15	15	20	15/40/30	Oct-00	20	40/30	15	0/15	0/20	20	0			20		20															265	175	75	0	150	0.2	0.2	50	0.15	0	0.13	0.15	0	0.15	10	18.73	37.5	0.15	0.08	0.4	0.2	0			20		20																179.62	118.62	50.84	0	101.67	0.14	0.14	33.89	0.1	0	0.09	0.1	0	0.1	10	18.73	37.5	0.1	0.05	0.4	0.14	0			20		20																22.54	0.76	3.04	-	0.82	1.5	2	0.82	3.93	-	1.46	0.86	-	2.51	2.85	7.58	0.79	0.16	1.03	0.01	3.14	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.35	22.54	0.76	3.04	-	0.82	1.5	2	0.82	3.93	-	1.46	0.86	-	2.51	2.85	7.58	0.79	0.16	1.03	0.01	3.14	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.35
H1717_006_0	2006											600											D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	P	T		V	V	V	V																																																								-	1732.81	88.83	707.76	0	133.36	15.37	20.46	468.94	629.12	0	733.83	235.18	0	2959.62	8754.62	6419.22	368.49	237.93	5097.85	393.34	30.5	0	0		117.8	0	309.08	0														25	25	15	0	100	20	20	40	15	0	0/10	15	20	15/10/8/4	Feb-00	4	04-Aug	10	0/10	0/4	20	0	0		05-Apr	0	4	0														25	25	15	0	100	0.2	0.2	40	15	0	9.49	15	0	14.33	1.09	3.75	7	10	5.36	0.31	0.2	0	0		4.95	0	4	0															15.05	15.05	9.03	0	60.21	0.12	0.12	24.09	9.03	0	5.71	9.03	0	8.63	1.09	3.75	7	6.02	3.23	0.31	0.12	0	0		4.95	0	4	0															2.17	0.11	0.53	-	0.67	1.85	2.46	0.94	0.47	-	0.35	0.18	-	2.13	0.79	2	0.21	0.12	1.37	0.01	3.67	-	-		0.05	-	0.1	-														20.21	2.17	0.11	0.53	-	0.67	1.85	2.46	0.94	0.47	-	0.35	0.18	-	2.13	0.79	2	0.21	0.12	1.37	0.01	3.67	-	-		0.05	-	0.1	-														20.21
H1717_801_0	2006											3800											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1578.51	68.85	737.46	0	99.16	11.29	15.35	302.41	41.5	1357.92	21.54	9.21	0	26.05	3660.8	5251.13	242.94	1.74	20.42	325.62	24.82	0			126.64		226.72															265	175	120	0	150	30	30	50	30	20	20/30	30	30	30/40/30	35/0	35	40/30	30	0/30	0/35	30	0			35		35															265	175	120	0	150	0.3	0.3	50	0.3	20	0.24	0.3	0	0.3	35	32.81	37.5	0.3	0.29	0.37	0.3	0			35		35																153.63	101.46	69.57	0	86.96	0.17	0.17	28.99	0.17	11.6	0.14	0.17	0	0.17	35	32.81	37.5	0.17	0.17	0.37	0.17	0			35		35																20.21	0.58	4.28	-	0.72	1.96	2.67	0.73	7.22	1.31	2.94	1.6	-	4.51	10.68	14.36	0.76	0.3	3.42	0.01	4.32	-			0.37		0.66															83.6	20.21	0.58	4.28	-	0.72	1.96	2.67	0.73	7.22	1.31	2.94	1.6	-	4.51	10.68	14.36	0.76	0.3	3.42	0.01	4.32	-			0.37		0.66															83.6
H1804_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	870.85	18.19	582.68	564.42	7.09	14.32	1.08	9.1	28.32				0.93	52.99	35.46	111.66					4.45			0	0		0					45.83	0.96	0	0	2261.34	6595.15	10794.55				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					94.21	122.44	53.34	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					94.21	122.44	0	0	0	11.32	22.63				0	6.84	0.19	2.59	-	1.09	2.2	0.17	1.4	4.36	-	-	-	0.14	7.14	0.11	0.34	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.36	0.01	-	-	-	6.22	20.36	-	-	-	54.41	6.84	0.19	2.59	-	1.09	2.2	0.17	1.4	4.36	-	-	-	0.14	7.14	0.11	0.34	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.36	0.01	-	-	-	6.22	20.36	-	-	-	54.41
H1804_005_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1115.18	23.62	583.73	544.17	8.28	18.02	1.36	11.63	32.17				0.99	64.78	40.55	158.17					4.45			0	0		0					58.69	1.24	0	0	2222.09	6378.4	11741.66				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.13	122.44	51.6	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.13	122.44	0	0	0	10.95	21.89				0	8.47	0.24	2.51	-	1.23	2.68	0.2	1.73	4.79	-	-	-	0.15	8.6	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.82	21.42	-	-	-	59.77	8.47	0.24	2.51	-	1.23	2.68	0.2	1.73	4.79	-	-	-	0.15	8.6	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.82	21.42	-	-	-	59.77
H1804_006_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1073.5	22.74	561.91	523.83	8	17.41	1.31	11.24	31.1				0.96	62.61	39.19	152.88					4.45			0	0		0					56.5	1.2	0	0	2139.05	6140.04	11302.87				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					92.09	122.44	52.14	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					92.09	122.44	0	0	0	11.06	22.12				0	8.24	0.23	2.44	-	1.2	2.62	0.2	1.69	4.68	-	-	-	0.14	8.37	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.43	0.01	-	-	-	5.66	20.84	-	-	-	58.23	8.24	0.23	2.44	-	1.2	2.62	0.2	1.69	4.68	-	-	-	0.14	8.37	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.43	0.01	-	-	-	5.66	20.84	-	-	-	58.23
H1804_007_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1092.63	23.15	571.92	533.16	8	17.4	1.31	11.23	31.08				0.95	62.58	39.17	152.8					4.45			0	0		0					57.51	1.22	0	0	2177.16	6249.42	11504.21				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.78	122.44	51.97	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.78	122.44	0	0	0	11.02	22.05				0	8.36	0.24	2.48	-	1.2	2.61	0.2	1.68	4.66	-	-	-	0.14	8.34	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.74	21.14	-	-	-	58.7	8.36	0.24	2.48	-	1.2	2.61	0.2	1.68	4.66	-	-	-	0.14	8.34	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.74	21.14	-	-	-	58.7
H1804_008_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1113.86	23.6	1166.08	543.53	8.32	18.11	1.36	11.69	32.34				0.99	65.13	40.76	159.01					4.45			0	0		0					58.62	1.24	0	0	2219.47	6370.88	11727.8				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.1	122.44	25.79	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					91.1	122.44	0	0	0	10.94	21.88				0	8.46	0.24	2.51	-	1.24	2.7	0.2	1.74	4.81	-	-	-	0.15	8.64	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.81	21.39	-	-	-	59.82	8.46	0.24	2.51	-	1.24	2.7	0.2	1.74	4.81	-	-	-	0.15	8.64	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.81	21.39	-	-	-	59.82
H1804_009_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1102.97	23.36	577.34	538.21	8.21	17.86	1.34	11.53	31.89				0.98	64.22	40.2	156.8					4.45			0	0		0					58.05	1.23	0	0	2197.76	6308.56	11613.09				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.4	122.44	51.75	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.4	122.44	0	0	0	10.98	21.96				0	8.4	0.24	2.49	-	1.23	2.67	0.2	1.72	4.76	-	-	-	0.15	8.54	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.77	21.25	-	-	-	59.34	8.4	0.24	2.49	-	1.23	2.67	0.2	1.72	4.76	-	-	-	0.15	8.54	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.77	21.25	-	-	-	59.34
H1804_011_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1139.54	24.14	1192.96	556.06	8.64	18.81	1.42	12.14	33.59				1.03	67.64	42.34	165.14					4.45			0	0		0					59.98	1.27	0	0	2270.64	6517.75	11998.16				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.37	122.44	25.59	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.37	122.44	0	0	0	10.85	21.71				0	8.58	0.25	2.54	-	1.28	2.78	0.21	1.79	4.96	-	-	-	0.15	8.93	0.12	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.71	-	-	-	61.03	8.58	0.25	2.54	-	1.28	2.78	0.21	1.79	4.96	-	-	-	0.15	8.93	0.12	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.71	-	-	-	61.03
H1804_013_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1145.48	24.27	1199.18	558.95	8.94	19.45	1.46	12.56	34.74				1.07	69.95	43.79	170.8					4.45			0	0		0					60.29	1.28	0	0	2282.46	6551.7	12060.66				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.01	122.44	25.48	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.01	122.44	0	0	0	10.81	21.62				0	8.59	0.25	2.55	-	1.31	2.86	0.22	1.85	5.11	-	-	-	0.16	9.22	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.73	-	-	-	61.73	8.59	0.25	2.55	-	1.31	2.86	0.22	1.85	5.11	-	-	-	0.16	9.22	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.73	-	-	-	61.73
H1804_014_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1125.13	23.83	1177.87	549.02	8.93	19.44	1.46	12.55	34.72				1.07	69.92	43.76	170.71					4.45			0	0		0					59.22	1.25	0	0	2241.92	6435.31	11846.41				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.32	122.44	25.57	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.32	122.44	0	0	0	10.85	21.7				0	8.47	0.24	2.51	-	1.32	2.87	0.22	1.85	5.12	-	-	-	0.16	9.25	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.82	21.42	-	-	-	61.22	8.47	0.24	2.51	-	1.32	2.87	0.22	1.85	5.12	-	-	-	0.16	9.25	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.82	21.42	-	-	-	61.22
H1804_016_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1132.63	23.99	1185.73	552.68	8.8	19.15	1.44	12.36	34.19				1.05	68.85	43.1	168.11					4.45			0	0		0					59.61	1.26	0	0	2256.86	6478.21	11925.39				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.34	122.44	25.58	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.34	122.44	0	0	0	10.85	21.7				0	8.53	0.24	2.53	-	1.3	2.83	0.21	1.82	5.05	-	-	-	0.16	9.1	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.86	21.57	-	-	-	61.15	8.53	0.24	2.53	-	1.3	2.83	0.21	1.82	5.05	-	-	-	0.16	9.1	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.86	21.57	-	-	-	61.15
H1804_018_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1159.61	24.56	1213.97	565.85	9.18	19.98	1.5	12.9	35.68				1.1	71.85	44.97	175.44					4.45			0	0		0					61.03	1.29	0	0	2310.63	6632.53	12209.47				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.56	122.44	25.36	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.56	122.44	0	0	0	10.76	21.51				0	8.65	0.25	2.57	-	1.34	2.92	0.22	1.89	5.22	-	-	-	0.16	9.44	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.95	21.89	-	-	-	62.5	8.65	0.25	2.57	-	1.34	2.92	0.22	1.89	5.22	-	-	-	0.16	9.44	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.95	21.89	-	-	-	62.5
H1804_019_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1151.48	24.39	1205.46	561.88	8.94	19.45	1.46	12.56	34.74				1.07	69.95	43.78	170.79					4.45			0	0		0					60.6	1.28	0	0	2294.43	6586.04	12123.88				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.94	122.44	25.46	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.94	122.44	0	0	0	10.8	21.6				0	8.63	0.25	2.56	-	1.31	2.86	0.22	1.84	5.1	-	-	-	0.16	9.21	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.93	21.83	-	-	-	61.88	8.63	0.25	2.56	-	1.31	2.86	0.22	1.84	5.1	-	-	-	0.16	9.21	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.93	21.83	-	-	-	61.88
H1804_020_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1162.4	24.62	1216.89	567.21	9.34	20.32	1.53	13.12	36.3				1.11	73.08	45.75	178.44					4.45			0	0		0					61.18	1.3	0	0	2316.18	6648.49	12238.84				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.38	122.44	25.31	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.38	122.44	0	0	0	10.74	21.47				0	8.66	0.25	2.57	-	1.36	2.97	0.22	1.92	5.3	-	-	-	0.16	9.59	0.13	0.52	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.95	21.9	-	-	-	62.86	8.66	0.25	2.57	-	1.36	2.97	0.22	1.92	5.3	-	-	-	0.16	9.59	0.13	0.52	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.95	21.9	-	-	-	62.86
H1804_022_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1087.63	23.04	569.31	530.72	7.87	17.14	1.29	11.06	30.6				0.94	61.62	38.57	150.46					4.45			0	0		0					57.24	1.21	0	0	2167.2	6220.83	11451.58				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.99	122.44	52.09	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.99	122.44	0	0	0	11.05	22.1				0	8.34	0.24	2.47	-	1.18	2.58	0.19	1.66	4.6	-	-	-	0.14	8.22	0.12	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.73	21.09	-	-	-	58.35	8.34	0.24	2.47	-	1.18	2.58	0.19	1.66	4.6	-	-	-	0.14	8.22	0.12	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.73	21.09	-	-	-	58.35
H1804_023_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1037.34	21.7	1356.58	654.98	8.44	17.18	1.29	10.94	33.64				1.1	63.4	42.16	135.75					4.45			0	0		0					54.6	1.14	0	0	2628.21	7655.18	12656.02				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.13	122.44	25.52	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.13	122.44	0	0	0	10.83	21.65				0	7.79	0.22	2.88	-	1.24	2.53	0.19	1.61	4.95	-	-	-	0.16	8.31	0.12	0.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.41	0.01	-	-	-	6.91	22.84	-	-	-	61.47	7.79	0.22	2.88	-	1.24	2.53	0.19	1.61	4.95	-	-	-	0.16	8.31	0.12	0.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.41	0.01	-	-	-	6.91	22.84	-	-	-	61.47
H1804_025_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1108.02	23.47	579.98	577.31	7.18	15.64	1.18	10.09	27.92				0.86	56.23	35.2	137.29					4.45			0	0		0					58.32	1.24	0	0	2294.41	6766.9	12456.82				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.68	122.44	51.91	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.68	122.44	0	0	0	11.01	22.02				0	8.46	0.24	2.51	-	1.08	2.34	0.18	1.51	4.18	-	-	-	0.13	7.42	0.11	0.41	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	6.21	22.86	-	-	-	58.98	8.46	0.24	2.51	-	1.08	2.34	0.18	1.51	4.18	-	-	-	0.13	7.42	0.11	0.41	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	6.21	22.86	-	-	-	58.98
H1804_061_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1076.51	22.8	563.49	525.3	7.74	16.85	1.27	10.88	30.09				0.92	60.59	37.92	147.94					4.45			0	0		0					56.66	1.2	0	0	2145.05	6157.24	11334.53				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					92.32	122.44	52.28	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					92.32	122.44	0	0	0	11.09	22.18				0	8.28	0.23	2.45	-	1.17	2.54	0.19	1.64	4.54	-	-	-	0.14	8.1	0.11	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.69	20.95	-	-	-	57.82	8.28	0.23	2.45	-	1.17	2.54	0.19	1.64	4.54	-	-	-	0.14	8.1	0.11	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.69	20.95	-	-	-	57.82
H1804_063_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1143.26	24.22	1196.86	557.87	8.78	19.11	1.44	12.34	34.14				1.05	68.73	43.02	167.83					4.45			0	0		0					60.17	1.27	0	0	2278.05	6539.03	12037.34				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.2	122.44	25.54	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.2	122.44	0	0	0	10.83	21.67				0	8.59	0.25	2.55	-	1.29	2.82	0.21	1.82	5.03	-	-	-	0.15	9.07	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.74	-	-	-	61.4	8.59	0.25	2.55	-	1.29	2.82	0.21	1.82	5.03	-	-	-	0.15	9.07	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.74	-	-	-	61.4
H1804_066_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1127.24	23.88	1180.09	550.05	8.49	18.48	1.39	11.93	33				1.01	66.44	41.59	162.23					4.45			0	0		0					59.33	1.26	0	0	2246.13	6447.39	11868.66				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.74	122.44	25.69	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.74	122.44	0	0	0	10.9	21.8				0	8.52	0.24	2.53	-	1.26	2.74	0.21	1.77	4.89	-	-	-	0.15	8.79	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.86	21.56	-	-	-	60.47	8.52	0.24	2.53	-	1.26	2.74	0.21	1.77	4.89	-	-	-	0.15	8.79	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.86	21.56	-	-	-	60.47
H1804_067_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1087.24	23.03	569.1	530.54	7.96	17.32	1.3	11.18	30.92				0.95	62.27	38.98	152.04					4.45			0	0		0					57.22	1.21	0	0	2166.42	6218.61	11447.49				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.91	122.44	52.04	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.91	122.44	0	0	0	11.04	22.08				0	8.33	0.23	2.47	-	1.19	2.6	0.2	1.68	4.64	-	-	-	0.14	8.31	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.72	21.06	-	-	-	58.49	8.33	0.23	2.47	-	1.19	2.6	0.2	1.68	4.64	-	-	-	0.14	8.31	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.72	21.06	-	-	-	58.49
H1804_068_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1158.41	24.54	1212.72	565.26	9.16	19.94	1.5	12.87	35.61				1.09	71.71	44.89	175.09					4.45			0	0		0					60.97	1.29	0	0	2308.24	6625.67	12196.84				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.6	122.44	25.37	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.6	122.44	0	0	0	10.76	21.52				0	8.65	0.25	2.56	-	1.34	2.92	0.22	1.88	5.21	-	-	-	0.16	9.42	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.94	21.88	-	-	-	62.45	8.65	0.25	2.56	-	1.34	2.92	0.22	1.88	5.21	-	-	-	0.16	9.42	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.94	21.88	-	-	-	62.45
H1804_070_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1158	24.53	1212.29	565.06	9.17	19.96	1.5	12.88	35.64				1.09	71.77	44.92	175.23					4.45			0	0		0					60.95	1.29	0	0	2307.42	6623.33	12192.52				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.62	122.44	25.37	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.62	122.44	0	0	0	10.76	21.53				0	8.65	0.25	2.56	-	1.34	2.92	0.22	1.89	5.22	-	-	-	0.16	9.44	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.94	21.87	-	-	-	62.46	8.65	0.25	2.56	-	1.34	2.92	0.22	1.89	5.22	-	-	-	0.16	9.44	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.94	21.87	-	-	-	62.46
H1804_075_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1105.55	23.42	578.69	539.47	8.18	17.81	1.34	11.5	31.81				0.98	64.05	40.09	156.39					4.45			0	0		0					58.19	1.23	0	0	2202.92	6323.36	11640.33				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.38	122.44	51.74	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.38	122.44	0	0	0	10.98	21.95				0	8.42	0.24	2.5	-	1.22	2.66	0.2	1.72	4.75	-	-	-	0.15	8.51	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.78	21.29	-	-	-	59.37	8.42	0.24	2.5	-	1.22	2.66	0.2	1.72	4.75	-	-	-	0.15	8.51	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.78	21.29	-	-	-	59.37
H1804_077_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1160.54	24.58	1214.94	566.3	9.2	20.02	1.51	12.92	35.76				1.1	72	45.07	175.81					4.45			0	0		0					61.08	1.29	0	0	2312.47	6637.84	12219.23				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.54	122.44	25.35	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.54	122.44	0	0	0	10.75	21.51				0	8.66	0.25	2.57	-	1.35	2.93	0.22	1.89	5.23	-	-	-	0.16	9.46	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.95	21.9	-	-	-	62.57	8.66	0.25	2.57	-	1.35	2.93	0.22	1.89	5.23	-	-	-	0.16	9.46	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.95	21.9	-	-	-	62.57
H1804_078_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1239.28	26.25	1297.38	604.73	11.02	23.98	1.8	15.48	42.82				1.32	86.22	53.97	210.51					4.45			0	0		0					65.23	1.38	0	0	2469.38	7088.24	13048.35				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					86.78	122.44	24.57	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					86.78	122.44	0	0	0	10.42	20.85				0	8.96	0.27	2.66	-	1.56	3.4	0.26	2.19	6.07	-	-	-	0.19	11.1	0.15	0.6	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.16	22.67	-	-	-	67.61	8.96	0.27	2.66	-	1.56	3.4	0.26	2.19	6.07	-	-	-	0.19	11.1	0.15	0.6	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.16	22.67	-	-	-	67.61
H1804_081_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1098.88	23.28	575.2	536.22	8.09	17.6	1.33	11.36	31.44				0.97	63.3	39.62	154.56					4.45			0	0		0					57.84	1.23	0	0	2189.63	6285.21	11570.1				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.6	122.44	51.87	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.6	122.44	0	0	0	11	22				0	8.39	0.24	2.49	-	1.21	2.63	0.2	1.7	4.7	-	-	-	0.14	8.43	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.76	21.22	-	-	-	59.04	8.39	0.24	2.49	-	1.21	2.63	0.2	1.7	4.7	-	-	-	0.14	8.43	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.76	21.22	-	-	-	59.04
H1804_083_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1201.09	25.44	1257.4	586.09	9.58	20.85	1.57	13.46	37.24				1.14	74.99	46.94	183.1					4.45			0	0		0					63.22	1.34	0	0	2393.29	6869.81	12646.25				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					88.63	122.44	25.09	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					88.63	122.44	0	0	0	10.65	21.29				0	8.87	0.26	2.63	-	1.39	3.02	0.23	1.95	5.39	-	-	-	0.17	9.78	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.09	22.44	-	-	-	64.25	8.87	0.26	2.63	-	1.39	3.02	0.23	1.95	5.39	-	-	-	0.17	9.78	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.09	22.44	-	-	-	64.25
H1804_086_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1113.98	23.6	583.1	543.58	8.33	18.13	1.36	11.7	32.38				0.99	65.2	40.81	159.19					4.45			0	0		0					58.63	1.24	0	0	2219.71	6371.56	11729.06				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.09	122.44	51.58	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.09	122.44	0	0	0	10.94	21.88				0	8.46	0.24	2.51	-	1.24	2.7	0.2	1.74	4.82	-	-	-	0.15	8.65	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.81	21.39	-	-	-	59.84	8.46	0.24	2.51	-	1.24	2.7	0.2	1.74	4.82	-	-	-	0.15	8.65	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.81	21.39	-	-	-	59.84
H1804_087_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1155.69	24.48	1209.87	563.94	9.36	20.38	1.53	13.16	36.4				1.12	73.29	45.88	178.96					4.45			0	0		0					60.83	1.29	0	0	2302.83	6610.15	12168.26				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.45	122.44	25.32	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.45	122.44	0	0	0	10.74	21.49				0	8.61	0.25	2.55	-	1.37	2.98	0.22	1.92	5.32	-	-	-	0.16	9.63	0.13	0.52	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.92	21.79	-	-	-	62.74	8.61	0.25	2.55	-	1.37	2.98	0.22	1.92	5.32	-	-	-	0.16	9.63	0.13	0.52	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.92	21.79	-	-	-	62.74
H1804_088_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1195.9	25.33	1251.96	583.56	10.06	21.9	1.65	14.14	39.11				1.2	78.76	49.3	192.3					4.45			0	0		0					62.94	1.33	0	0	2382.94	6840.11	12591.58				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					88.26	122.44	24.99	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					88.26	122.44	0	0	0	10.6	21.2				0	8.8	0.26	2.61	-	1.45	3.16	0.24	2.04	5.64	-	-	-	0.17	10.26	0.14	0.55	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.04	22.25	-	-	-	64.97	8.8	0.26	2.61	-	1.45	3.16	0.24	2.04	5.64	-	-	-	0.17	10.26	0.14	0.55	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.04	22.25	-	-	-	64.97
H1804_089_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1126.18	23.86	1178.97	549.54	8.5	18.49	1.39	11.94	33.02				1.01	66.49	41.62	162.35					4.45			0	0		0					59.27	1.26	0	0	2244.01	6441.32	11857.47				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.75	122.44	25.69	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.75	122.44	0	0	0	10.9	21.8				0	8.52	0.24	2.52	-	1.26	2.74	0.21	1.77	4.9	-	-	-	0.15	8.8	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.85	21.54	-	-	-	60.46	8.52	0.24	2.52	-	1.26	2.74	0.21	1.77	4.9	-	-	-	0.15	8.8	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.85	21.54	-	-	-	60.46
H1804_090_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1192.08	25.25	1247.97	581.7	9.64	20.97	1.58	13.54	37.46				1.15	75.42	47.21	184.16					4.45			0	0		0					62.74	1.33	0	0	2375.34	6818.29	12551.41				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					88.69	122.44	25.11	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					88.69	122.44	0	0	0	10.65	21.31				0	8.81	0.26	2.61	-	1.4	3.04	0.23	1.96	5.43	-	-	-	0.17	9.85	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.05	22.28	-	-	-	64.12	8.81	0.26	2.61	-	1.4	3.04	0.23	1.96	5.43	-	-	-	0.17	9.85	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.05	22.28	-	-	-	64.12
H1804_091_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1079.59	22.87	565.1	526.81	8.05	17.51	1.32	11.31	31.28				0.96	62.98	39.42	153.78					4.45			0	0		0					56.82	1.2	0	0	2151.19	6174.88	11367				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.93	122.44	52.05	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.93	122.44	0	0	0	11.04	22.08				0	8.27	0.23	2.45	-	1.21	2.63	0.2	1.7	4.7	-	-	-	0.14	8.41	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.68	20.92	-	-	-	58.46	8.27	0.23	2.45	-	1.21	2.63	0.2	1.7	4.7	-	-	-	0.14	8.41	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.68	20.92	-	-	-	58.46
H1804_093_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1218.27	25.81	1275.39	594.48	10.74	23.38	1.76	15.09	41.75				1.28	84.06	52.62	205.24					4.45			0	0		0					64.12	1.36	0	0	2427.52	6968.08	12827.16				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					87.36	122.44	24.73	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					87.36	122.44	0	0	0	10.49	20.98				0	8.87	0.26	2.63	-	1.53	3.34	0.25	2.15	5.96	-	-	-	0.18	10.88	0.15	0.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.09	22.43	-	-	-	66.68	8.87	0.26	2.63	-	1.53	3.34	0.25	2.15	5.96	-	-	-	0.18	10.88	0.15	0.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.09	22.43	-	-	-	66.68
H1804_094_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1093.02	23.15	572.13	533.36	168.2	17.59	1.32	473.98	333.81				20.48	2177.95	6251.68	11508.38					4.45			0	0		0					57.53	1.22	0	0	0	0	0				165 per day (1-5)	165 per day (1-5)	0 per day (1-10) 100 per day (11-100)	0	150	20	20	May-50	25-100				25	0-50	25-May	20-25					20											165 per day (1-5)	165 per day (1-5)	0	0	0	0	0				112.23	112.23	40.75	0	150	0.2	0.2	41.4	49.75				25	29.85	5.39	20.1					20			0	0		0					112.23	112.23	0	0	0	0	0					93.38	112.23	33.9	0	124.8	0.17	0.17	34.44	41.39				20.8	24.83	4.49	16.72					20			0	0		0					93.38	112.23	0	0	0	0	0				0	8.51	0.22	1.62	-	1.75	2.93	0.22	1.36	1.15	-	-	-	0.04	4.51	2.34	16.04	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	-	-	-	-	-	42.01	8.51	0.22	1.62	-	1.75	2.93	0.22	1.36	1.15	-	-	-	0.04	4.51	2.34	16.04	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	-	-	-	-	-	42.01
H1804_095_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1154.03	24.45	1208.13	563.13	177.59	20.05	1.51	500.43	352.44				21.62	2299.51	6600.61	12150.71					4.45			0	0		0					60.74	1.29	0	0	0	0	0				165 per day (1-5)	165 per day (1-5)	0 per day (1-10) 100 per day (11-100)	0	150	20	20	May-50	25-100				25	0-50	25-May	20-25					0.2											165 per day (1-5)	165 per day (1-5)	0	0	0	0	0				112.23	112.23	20.38	0	150	0.2	0.2	41.4	49.75				25	30.11	5.39	20.1					0.2			0	0		0					112.23	112.23	0	0	0	0	0					92.2	112.23	16.74	0	123.22	0.16	0.16	34.01	40.87				20.54	24.73	4.43	16.51					0.2			0	0		0					92.2	112.23	0	0	0	0	0				0	8.87	0.23	1.69	-	1.82	3.29	0.25	1.42	1.2	-	-	-	0.04	4.74	2.44	16.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	-	-	-	-	-	44.06	8.87	0.23	1.69	-	1.82	3.29	0.25	1.42	1.2	-	-	-	0.04	4.74	2.44	16.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	-	-	-	-	-	44.06
H1804_097_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1078.99	22.86	564.79	526.51	7.85	17.09	1.29	11.03	30.52				0.94	61.46	38.47	150.06					4.45			0	0		0					56.79	1.2	0	0	2149.98	6171.42	11360.63				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					92.14	122.44	52.17	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					92.14	122.44	0	0	0	11.07	22.13				0	8.29	0.23	2.46	-	1.18	2.57	0.19	1.66	4.59	-	-	-	0.14	8.21	0.12	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.69	20.96	-	-	-	58.08	8.29	0.23	2.46	-	1.18	2.57	0.19	1.66	4.59	-	-	-	0.14	8.21	0.12	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.69	20.96	-	-	-	58.08
H1804_098_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1159.52	24.56	1213.87	565.8	8.98	19.55	1.47	12.62	34.92				1.07	70.31	44.01	171.68					4.45			0	0		0					61.03	1.29	0	0	2310.44	6632	12208.49				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.76	122.44	25.41	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.76	122.44	0	0	0	10.78	21.56				0	8.67	0.25	2.57	-	1.32	2.87	0.22	1.85	5.12	-	-	-	0.16	9.24	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.96	21.94	-	-	-	62.15	8.67	0.25	2.57	-	1.32	2.87	0.22	1.85	5.12	-	-	-	0.16	9.24	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.96	21.94	-	-	-	62.15
H1804_099_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1146.72	24.29	1200.47	559.56	9.05	19.69	1.48	12.71	35.16				1.08	70.8	44.32	172.87					4.45			0	0		0					60.35	1.28	0	0	2284.94	6558.79	12073.72				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.88	122.44	25.45	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.88	122.44	0	0	0	10.8	21.59				0	8.59	0.25	2.55	-	1.33	2.89	0.22	1.87	5.16	-	-	-	0.16	9.33	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.72	-	-	-	61.95	8.59	0.25	2.55	-	1.33	2.89	0.22	1.87	5.16	-	-	-	0.16	9.33	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.72	-	-	-	61.95
H1804_103_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1092.55	23.14	571.89	533.13	8.14	17.72	1.33	11.44	31.65				0.97	63.73	39.89	155.62					4.45			0	0		0					57.5	1.22	0	0	2177.01	6249.01	11503.46				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.63	122.44	51.89	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.63	122.44	0	0	0	11.01	22.01				0	8.34	0.24	2.47	-	1.22	2.65	0.2	1.71	4.74	-	-	-	0.15	8.49	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.73	21.1	-	-	-	58.97	8.34	0.24	2.47	-	1.22	2.65	0.2	1.71	4.74	-	-	-	0.15	8.49	0.12	0.47	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.73	21.1	-	-	-	58.97
H1804_122_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1139.38	24.14	1192.8	555.98	8.7	18.93	1.42	12.22	33.8				1.04	68.06	42.6	166.18					4.45			0	0		0					59.97	1.27	0	0	2270.33	6516.85	11996.52				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.32	122.44	25.57	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.32	122.44	0	0	0	10.85	21.7				0	8.58	0.25	2.54	-	1.28	2.79	0.21	1.8	4.99	-	-	-	0.15	8.98	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.89	21.69	-	-	-	61.13	8.58	0.25	2.54	-	1.28	2.79	0.21	1.8	4.99	-	-	-	0.15	8.98	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.89	21.69	-	-	-	61.13
H1804_123_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1165.38	24.69	1220.01	568.66	9.1	19.8	1.49	12.78	35.36				1.09	71.2	44.56	173.83					4.45			0	0		0					61.34	1.3	0	0	2322.12	6665.52	12270.19				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.56	122.44	25.36	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.56	122.44	0	0	0	10.76	21.51				0	8.7	0.25	2.58	-	1.33	2.9	0.22	1.87	5.17	-	-	-	0.16	9.35	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.97	22	-	-	-	62.49	8.7	0.25	2.58	-	1.33	2.9	0.22	1.87	5.17	-	-	-	0.16	9.35	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.97	22	-	-	-	62.49
H1804_125_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1227.55	26	1285.1	599	10.08	21.94	1.65	14.16	39.19				1.2	78.91	49.39	192.66					4.45			0	0		0					64.61	1.37	0	0	2446	7021.13	12924.81				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					87.8	122.44	24.86	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					87.8	122.44	0	0	0	10.55	21.09				0	8.98	0.27	2.66	-	1.45	3.15	0.24	2.03	5.62	-	-	-	0.17	10.23	0.14	0.55	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.17	22.72	-	-	-	65.75	8.98	0.27	2.66	-	1.45	3.15	0.24	2.03	5.62	-	-	-	0.17	10.23	0.14	0.55	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.17	22.72	-	-	-	65.75
H1804_126_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1095.2	23.2	573.27	534.42	8.12	17.67	1.33	11.41	31.57				0.97	63.56	39.78	155.19					4.45			0	0		0					57.64	1.22	0	0	2182.29	6264.14	11531.32				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					91.6	122.44	51.87	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					91.6	122.44	0	0	0	11	22				0	8.36	0.24	2.48	-	1.22	2.64	0.2	1.71	4.72	-	-	-	0.15	8.46	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.74	21.14	-	-	-	58.99	8.36	0.24	2.48	-	1.22	2.64	0.2	1.71	4.72	-	-	-	0.15	8.46	0.12	0.46	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.74	21.14	-	-	-	58.99
H1804_127_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1141.93	24.19	1195.47	557.22	8.9	19.37	1.46	12.5	34.6				1.06	69.66	43.6	170.09					4.45			0	0		0					60.1	1.27	0	0	2275.41	6531.44	12023.37				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.12	122.44	25.51	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.12	122.44	0	0	0	10.82	21.65				0	8.58	0.25	2.54	-	1.31	2.85	0.21	1.84	5.09	-	-	-	0.16	9.19	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.89	21.69	-	-	-	61.59	8.58	0.25	2.54	-	1.31	2.85	0.21	1.84	5.09	-	-	-	0.16	9.19	0.13	0.5	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.89	21.69	-	-	-	61.59
H1804_128_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1118.39	23.69	1170.82	545.74	8.46	18.41	1.39	11.88	32.88				1.01	66.2	41.44	161.64					4.45			0	0		0					58.86	1.25	0	0	2228.49	6396.78	11775.48				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.92	122.44	25.74	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.92	122.44	0	0	0	10.92	21.84				0	8.47	0.24	2.51	-	1.26	2.73	0.21	1.76	4.88	-	-	-	0.15	8.78	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.82	21.43	-	-	-	60.2	8.47	0.24	2.51	-	1.26	2.73	0.21	1.76	4.88	-	-	-	0.15	8.78	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.82	21.43	-	-	-	60.2
H1804_129_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1192.59	25.26	1248.5	581.94	9.86	21.47	1.62	13.86	38.34				1.18	77.19	48.32	188.47					4.45			0	0		0					62.77	1.33	0	0	2376.34	6821.16	12556.7				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					88.48	122.44	25.05	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					88.48	122.44	0	0	0	10.63	21.26				0	8.79	0.26	2.61	-	1.43	3.1	0.23	2	5.54	-	-	-	0.17	10.07	0.14	0.54	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.04	22.24	-	-	-	64.53	8.79	0.26	2.61	-	1.43	3.1	0.23	2	5.54	-	-	-	0.17	10.07	0.14	0.54	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.04	22.24	-	-	-	64.53
H1804_130_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1078.67	22.85	564.62	526.35	7.9	17.2	1.29	11.1	30.71				0.94	61.84	38.71	150.98					4.45			0	0		0					56.77	1.2	0	0	2149.35	6169.6	11357.28				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					92.1	122.44	52.15	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					92.1	122.44	0	0	0	11.06	22.12				0	8.28	0.23	2.45	-	1.19	2.59	0.19	1.67	4.62	-	-	-	0.14	8.26	0.12	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.69	20.94	-	-	-	58.16	8.28	0.23	2.45	-	1.19	2.59	0.19	1.67	4.62	-	-	-	0.14	8.26	0.12	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.69	20.94	-	-	-	58.16
H1804_131_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1162.44	24.62	1216.94	567.23	9.18	19.97	1.5	12.89	35.67				1.1	71.82	44.96	175.37					4.45			0	0		0					61.18	1.3	0	0	2316.27	6648.75	12239.31				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					89.54	122.44	25.35	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					89.54	122.44	0	0	0	10.76	21.51				0	8.67	0.25	2.57	-	1.34	2.92	0.22	1.89	5.22	-	-	-	0.16	9.43	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.96	21.94	-	-	-	62.58	8.67	0.25	2.57	-	1.34	2.92	0.22	1.89	5.22	-	-	-	0.16	9.43	0.13	0.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	5.96	21.94	-	-	-	62.58
H1804_132_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1139.24	24.13	1192.64	555.91	8.74	19.02	1.43	12.28	33.97				1.04	68.41	42.82	167.03					4.45			0	0		0					59.96	1.27	0	0	2270.03	6516.01	11994.97				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.33	122.44	25.57	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.33	122.44	0	0	0	10.85	21.7				0	8.58	0.25	2.54	-	1.29	2.81	0.21	1.81	5.01	-	-	-	0.15	9.03	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.89	21.69	-	-	-	61.24	8.58	0.25	2.54	-	1.29	2.81	0.21	1.81	5.01	-	-	-	0.15	9.03	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.89	21.69	-	-	-	61.24
H1804_133_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1271.53	26.94	1331.14	620.46	10.97	23.87	1.8	15.41	42.63				1.31	85.84	53.73	209.58					4.45			0	0		0					66.92	1.42	0	0	2533.65	7272.7	13387.92				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					86.44	122.44	24.47	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					86.44	122.44	0	0	0	10.38	20.76				0	9.16	0.27	2.71	-	1.55	3.37	0.25	2.18	6.02	-	-	-	0.18	11.01	0.15	0.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.48	0.01	-	-	-	6.29	23.17	-	-	-	68.3	9.16	0.27	2.71	-	1.55	3.37	0.25	2.18	6.02	-	-	-	0.18	11.01	0.15	0.59	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.48	0.01	-	-	-	6.29	23.17	-	-	-	68.3
H1804_137_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1078.02	22.84	564.28	526.04	7.82	17.01	1.28	10.98	30.38				0.93	61.18	38.29	149.37					4.45			0	0		0					56.74	1.2	0	0	2148.05	6165.88	11350.42				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					20											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	69.33	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					20			0	0		0					122.44	122.44	0	0	0	14.71	29.41					92.2	122.44	52.21	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					20			0	0		0					92.2	122.44	0	0	0	11.07	22.15				0	8.28	0.23	2.46	-	1.18	2.56	0.19	1.65	4.58	-	-	-	0.14	8.18	0.12	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.69	20.95	-	-	-	57.99	8.28	0.23	2.46	-	1.18	2.56	0.19	1.65	4.58	-	-	-	0.14	8.18	0.12	0.45	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.44	0.01	-	-	-	5.69	20.95	-	-	-	57.99
H1804_138_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1136.33	24.07	1189.6	554.49	8.7	18.94	1.43	12.22	33.82				1.04	68.09	42.62	166.26					4.45			0	0		0					59.81	1.27	0	0	2264.24	6499.4	11964.38				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.37	122.44	25.58	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.37	122.44	0	0	0	10.85	21.71				0	8.56	0.25	2.54	-	1.28	2.8	0.21	1.8	4.99	-	-	-	0.15	8.99	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.88	21.64	-	-	-	61.06	8.56	0.25	2.54	-	1.28	2.8	0.21	1.8	4.99	-	-	-	0.15	8.99	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.88	21.64	-	-	-	61.06
H1804_143_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1190.99	25.23	1246.82	581.16	9.49	20.65	1.55	13.33	36.87				1.13	74.25	46.47	181.29					4.45			0	0		0					62.68	1.33	0	0	2373.15	6812.02	12539.87				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					88.83	122.44	25.15	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					88.83	122.44	0	0	0	10.67	21.34				0	8.82	0.26	2.61	-	1.38	3	0.23	1.93	5.35	-	-	-	0.16	9.7	0.13	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.06	22.3	-	-	-	63.82	8.82	0.26	2.61	-	1.38	3	0.23	1.93	5.35	-	-	-	0.16	9.7	0.13	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.06	22.3	-	-	-	63.82
H1804_144_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1192.14	25.25	1248.03	581.72	9.5	20.69	1.56	13.35	36.94				1.13	74.38	46.56	181.62					4.45			0	0		0					62.74	1.33	0	0	2375.45	6818.6	12551.98				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					88.8	122.44	25.14	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					88.8	122.44	0	0	0	10.67	21.33				0	8.82	0.26	2.61	-	1.38	3	0.23	1.94	5.36	-	-	-	0.16	9.71	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.06	22.31	-	-	-	63.87	8.82	0.26	2.61	-	1.38	3	0.23	1.94	5.36	-	-	-	0.16	9.71	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.06	22.31	-	-	-	63.87
H1804_145_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1241.79	26.31	1300.01	605.95	10.61	23.08	1.74	14.9	41.22				1.27	83	51.95	202.66					4.45			0	0		0					65.36	1.38	0	0	2474.38	7102.6	13074.78				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					87.2	122.44	24.69	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					87.2	122.44	0	0	0	10.47	20.95				0	9.02	0.27	2.67	-	1.51	3.29	0.25	2.12	5.87	-	-	-	0.18	10.72	0.15	0.58	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.2	22.82	-	-	-	67.03	9.02	0.27	2.67	-	1.51	3.29	0.25	2.12	5.87	-	-	-	0.18	10.72	0.15	0.58	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.2	22.82	-	-	-	67.03
H1804_146_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1216.82	25.78	1273.87	593.77	10.15	22.09	1.66	14.26	39.46				1.21	79.45	49.73	193.98					4.45			0	0		0					64.04	1.36	0	0	2424.63	6959.79	12811.9				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					87.88	122.44	24.88	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					87.88	122.44	0	0	0	10.55	21.11				0	8.91	0.26	2.64	-	1.46	3.17	0.24	2.05	5.66	-	-	-	0.17	10.31	0.14	0.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.12	22.54	-	-	-	65.61	8.91	0.26	2.64	-	1.46	3.17	0.24	2.05	5.66	-	-	-	0.17	10.31	0.14	0.56	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.12	22.54	-	-	-	65.61
H1804_147_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	261.98	5.95	1178.29	549.22	173.21	18.33	1.38	488.07	343.73				21.08	2242.72	6437.6	11850.63					4.45			0	0		0					13.79	0.31	0	0	0	0	0				300 per admit (0-0)	812 per admit (0-0)	0 per day (1-6) 125 per day (7-100)	0	80	20	20	May-50	25-150				25	0-100	25-May	25-30					0.2											300 per admit (0-0)	812 per admit (0-0)	0	0	0	0	0				300	812	36.36	0	80	0.2	0.2	41.4	66.25				25	53.49	5.39	29.9					0.2			0	0		0					300	812	0	0	0	0	0					237.45	812	28.78	0	63.32	0.16	0.16	32.77	52.44				19.79	42.34	4.27	23.67					0.2			0	0		0					237.45	812	0	0	0	0	0				0	5.18	0.4	2.83	-	0.91	2.9	0.22	1.33	1.5	-	-	-	0.03	7.91	2.29	23.37	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.27	0.02	-	-	-	-	-	-	-	-	50.07	5.18	0.4	2.83	-	0.91	2.9	0.22	1.33	1.5	-	-	-	0.03	7.91	2.29	23.37	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.27	0.02	-	-	-	-	-	-	-	-	50.07
H1804_148_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1143.28	24.22	1196.88	557.88	8.78	19.12	1.44	12.34	34.14				1.05	68.74	43.03	167.83					4.45			0	0		0					60.17	1.27	0	0	2278.1	6539.16	12037.58				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2			0 - 0	0		0					180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.2	122.44	25.54	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.2	122.44	0	0	0	10.83	21.67				0	8.59	0.25	2.55	-	1.29	2.82	0.21	1.82	5.03	-	-	-	0.15	9.07	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.74	-	-	-	61.4	8.59	0.25	2.55	-	1.29	2.82	0.21	1.82	5.03	-	-	-	0.15	9.07	0.13	0.49	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.9	21.74	-	-	-	61.4
H1804_149_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1127.24	23.88	1180.09	550.06	8.49	18.48	1.39	11.93	33				1.01	66.44	41.59	162.23					4.45			0	0		0					59.33	1.26	0	0	2246.13	6447.41	11868.69				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2			0 - 0	0		0					180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.74	122.44	25.69	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.74	122.44	0	0	0	10.9	21.8				0	8.52	0.24	2.53	-	1.26	2.74	0.21	1.77	4.89	-	-	-	0.15	8.79	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.86	21.56	-	-	-	60.47	8.52	0.24	2.53	-	1.26	2.74	0.21	1.77	4.89	-	-	-	0.15	8.79	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.86	21.56	-	-	-	60.47
H1804_150_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1200.86	25.44	1257.15	585.98	9.58	20.85	1.57	13.46	37.23				1.14	74.96	46.92	183.03					4.45			0	0		0					63.2	1.34	0	0	2392.82	6868.46	12643.77				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					88.64	122.44	25.09	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					88.64	122.44	0	0	0	10.65	21.29				0	8.87	0.26	2.63	-	1.39	3.02	0.23	1.95	5.39	-	-	-	0.17	9.78	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.09	22.43	-	-	-	64.24	8.87	0.26	2.63	-	1.39	3.02	0.23	1.95	5.39	-	-	-	0.17	9.78	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.47	0.01	-	-	-	6.09	22.43	-	-	-	64.24
H1804_151_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1126.15	23.86	1178.94	549.52	8.49	18.49	1.39	11.93	33.02				1.01	66.49	41.62	162.34					4.45			0	0		0					59.27	1.26	0	0	2243.95	6441.14	11857.14				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					90.76	122.44	25.69	0	0.15	0.15	0.15	0.15	0.15				0.15	0.13	0	0					0.2			0	0		0					90.76	122.44	0	0	0	10.9	21.8				0	8.52	0.24	2.52	-	1.26	2.74	0.21	1.77	4.9	-	-	-	0.15	8.8	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.85	21.54	-	-	-	60.46	8.52	0.24	2.52	-	1.26	2.74	0.21	1.77	4.9	-	-	-	0.15	8.8	0.12	0.48	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.45	0.01	-	-	-	5.85	21.54	-	-	-	60.46
H1804_152_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1192.05	25.25	1247.93	581.68	9.64	20.97	1.58	13.54	37.45				1.15	75.42	47.21	184.14					4.45			0	0		0					62.74	1.33	0	0	2375.26	6818.07	12551.02				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					88.69	122.44	25.11	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					88.69	122.44	0	0	0	10.65	21.31				0	8.81	0.26	2.61	-	1.4	3.04	0.23	1.96	5.43	-	-	-	0.17	9.84	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.05	22.28	-	-	-	64.12	8.81	0.26	2.61	-	1.4	3.04	0.23	1.96	5.43	-	-	-	0.17	9.84	0.14	0.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.05	22.28	-	-	-	64.12
H1804_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1259.65	26.68	1318.7	651.36	200.54	19.1	1.44	565.11	397.99				25.01	2596.69	7634.89	14054.66					4.45			0	0		0					66.3	1.4	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	100 per day (1-20) 100 per day (21-100)	0	100	25	25	30-50	50-200				0	30-100	20-50	30-50					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	8.8	0	100	0.25	0.25	40.6	99.5				0	27.99	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	8.8	0	100	0.25	0.25	40.6	99.5				0	27.99	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0				0	21.42	0.45	0.97	-	1.67	4.78	0.36	1.91	3.3	-	-	-	-	6.06	13.1	35.6	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.13	0.02	-	-	-	-	-	-	-	-	91.65	21.42	0.45	0.97	-	1.67	4.78	0.36	1.91	3.3	-	-	-	-	6.06	13.1	35.6	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.13	0.02	-	-	-	-	-	-	-	-	91.65
H1804_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1259.6	26.68	1318.65	651.4	200.55	19.1	1.44	565.12	398				25.01	2596.74	7635.34	14055.49					4.45			0	0		0					66.29	1.4	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	100 per day (1-20) 100 per day (21-100)	0	100	25	25	30-50	50-200				0	30-100	20-50	30-50					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.99	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.99	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0				0	21.42	0.45	0.97	-	1.67	4.77	0.36	1.91	3.3	-	-	-	-	6.06	13.1	35.6	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.13	0.02	-	-	-	-	-	-	-	-	91.65	21.42	0.45	0.97	-	1.67	4.77	0.36	1.91	3.3	-	-	-	-	6.06	13.1	35.6	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.13	0.02	-	-	-	-	-	-	-	-	91.65
H1806_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	986.84	20.9	516.55	481.54	134.99	17.82	1.34	380.39	301.38				16.43	1857.13	5957.94	10390.39					4.45			7.01	0		0					51.94	1.1	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-75	Oct-50	35-50					20			25								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.4	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.4	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0				0	9.79	0.21	1.02	0.4	1.12	3.56	0.27	1.29	2.93	-	-	-	-	7.65	5.35	30.56	-	-	-	-	0.89	-	-	2.47	-	-	-	-	-	-	-	0.52	0.01	-	-	-	-	-	-	-	-	68.03	9.79	0.21	1.02	0.4	1.12	3.56	0.27	1.29	2.93	-	-	-	-	7.65	5.35	30.56	-	-	-	-	0.89	-	-	2.47	-	-	-	-	-	-	-	0.52	0.01	-	-	-	-	-	-	-	-	68.03
H1806_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	979.97	20.76	512.95	478.19	134.05	15.84	1.19	377.74	299.28				16.32	1844.19	5916.45	10318.04					4.45			7.01	0		0					51.58	1.09	0	0	0	0	0				150 per day (1-5)	150 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	50	20	20	35-50	100-150				0	0-75	Oct-50	35-50					20			25								150 per day (1-5)	150 per day (1-5)	0	0	0	0	0				102.03	102.03	23.59	10	50	0.2	0.2	40.7	116.5				0	49.36	10.78	35.29					20			0.35	0		0					102.03	102.03	0	0	0	0	0					102.03	102.03	23.59	10	50	0.2	0.2	40.7	116.5				0	49.36	10.78	35.29					20			0.35	0		0					102.03	102.03	0	0	0	0	0				0	8.33	0.18	1.01	0.4	0.56	3.17	0.24	1.28	2.91	-	-	-	-	7.59	5.32	30.35	-	-	-	-	0.89	-	-	2.47	-	-	-	-	-	-	-	0.44	0.01	-	-	-	-	-	-	-	-	65.13	8.33	0.18	1.01	0.4	0.56	3.17	0.24	1.28	2.91	-	-	-	-	7.59	5.32	30.35	-	-	-	-	0.89	-	-	2.47	-	-	-	-	-	-	-	0.44	0.01	-	-	-	-	-	-	-	-	65.13
H1806_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	235.15	5.34	1020.4	475.62	133.33	17.6	1.32	375.71	297.67				16.23	1834.29	5884.68	10262.65					4.45			0	0		0					12.38	0.28	0	0	0	0	0				600 per admit	600 per admit	100 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35-50					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.18	25.2	35.29					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.18	25.2	35.29					20			0	0		0					600	600	0	0	0	0	0				0	11.76	0.27	0.75	0.4	1.11	4.4	0.33	1.42	4.96	-	-	-	-	5.22	12.36	30.18	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.68	11.76	0.27	0.75	0.4	1.11	4.4	0.33	1.42	4.96	-	-	-	-	5.22	12.36	30.18	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.68
H1806_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	235.15	5.34	1020.41	475.63	133.33	17.6	1.32	375.71	297.68				16.23	1834.3	5884.71	10262.68					4.45			0	0		0					12.38	0.28	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.18	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.18	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	11.76	0.27	0.75	0.4	1.11	4.4	0.33	1.42	4.96	-	-	-	-	5.22	12.36	29.93	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.42	11.76	0.27	0.75	0.4	1.11	4.4	0.33	1.42	4.96	-	-	-	-	5.22	12.36	29.93	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.42
H1806_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	235.15	5.34	1020.4	475.62	133.33	17.6	1.32	375.71	297.67				16.23	1834.29	5884.68	10262.65					4.45			0	0		0					12.38	0.28	0	0	0	0	0				600 per admit	600 per admit	100 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35-50					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.18	25.2	35.29					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.18	25.2	35.29					20			0	0		0					600	600	0	0	0	0	0				0	11.76	0.27	0.75	0.4	1.11	4.4	0.33	1.42	4.96	-	-	-	-	5.22	12.36	30.18	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.68	11.76	0.27	0.75	0.4	1.11	4.4	0.33	1.42	4.96	-	-	-	-	5.22	12.36	30.18	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.68
H1806_805_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	235.15	5.34	1020.41	475.63	133.33	17.6	1.32	375.71	297.68				16.23	1834.3	5884.71	10262.68					4.45			0	0		0					12.38	0.28	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.18	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.18	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	11.76	0.27	0.75	0.4	1.11	4.4	0.33	1.42	4.96	-	-	-	-	5.22	12.36	29.93	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.42	11.76	0.27	0.75	0.4	1.11	4.4	0.33	1.42	4.96	-	-	-	-	5.22	12.36	29.93	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.42
H1807_001_0	2006																						A	A	D		Coin	Coin	Coin	Coin	Coin		Coin		Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0		0	0	0	0	0		0		0	0			0	0	0	0	0	0																				-	417.03	5	526.42		16.12	38.12	1.79	25.98	36.14		21.45		0.68	62.73			6.87	1.37	23.14	197.47	11.02	18.9																				Days 1-60 initial deductible of 956; days 61-90 239/day; days 91-150 478/day	Days 1-60 initial deductible of 956; days 61-90 239/day; days 91-150 478/day	Days 1-20 0/day; days 21-100 119.50/day		20 coinsurance	20 coinsurance	20 coinsurance	20-50 coinsurance depending on APC	20-50 coinsurance depending on APC		20-50 coinsurance depending on APC		20 coinsurance	20-50 coinsurance depending on APC	Combined in i.6. Professional Other	Combined in i.6. Professional Other	50 coinsurance	20 coinsurance	20 coinsurance	20 coinsurance	20 coinsurance	20 coinsurance																				762.31	762.31	28.48		0.2	0.2	0.2	0.25	0.21		0.27		0.2	0.24			0.5	0.2	0.2	0.2	0.2	0.2																					762.31	762.31	28.48		0.2	0.2	0.2	0.25	0.21		0.27		0.2	0.24			0.5	0.2	0.2	0.2	0.2	0.2																				0	26.49	0.32	1.25	-	3.22	7.62	0.36	6.6	7.59	-	5.82	-	0.14	14.76	-	-	3.43	0.27	4.63	39.38	2.2	3.78	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	127.88	26.49	0.32	1.25	-	3.22	7.62	0.36	6.6	7.59	-	5.82	-	0.14	14.76	-	-	3.43	0.27	4.63	39.38	2.2	3.78	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	127.88
H1849_005_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	359.61	6.39	364.4		289.3	10.82	3.72	329.6	415.65	806.84	1103.83	50.32	34.22	0.61	5958.2	1761	6.82	400.86			245.81				23.72		174.24					862.61	22.81	62.78	389.83	113.09	0.04	859.6	3.7			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/40/30/80 copay levels				50 max		50 max					30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			750	750	75		75	0.2	0.2	50	250	51.31	59.45	250	34.28	30	15	30	30	30			26.22				50		50					30	50	30	30	15	0.2	30	30			3500	576.83	638.01	69.18		69.18	0.2	0.2	46.12	230.6	47.33	54.84	230.6	31.62	27.67	13.84	27.67	27.67	27.67			24.18				46.12		46.12					27.67	46.12	27.67	27.67	13.84	0.18	27.67	27.67				17.29	0.34	2.1	-	1.67	2.16	0.74	1.27	7.99	3.18	5.04	0.97	0.09	0	6.87	4.06	0.02	0.92	-	-	0.5	-	-	-	0.09	-	0.67	-	-	-	-	1.99	0.09	0.14	0.9	0.13	0.01	1.98	0.01	-	-	61.22	17.29	0.34	2.1	-	1.67	2.16	0.74	1.27	7.99	3.18	5.04	0.97	0.09	0	6.87	4.06	0.02	0.92	-	-	0.5	-	-	-	0.09	-	0.67	-	-	-	-	1.99	0.09	0.14	0.9	0.13	0.01	1.98	0.01	-	-	61.22
H1849_014_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			D	D	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	2095.59	50.03	362.96		288.16	10.75	3.7	328.29	414.01	803.65	1099.46	50.12	34.08	0.61	5934.59	1754.02	6.79	399.28			244.84				23.63		173.55					859.19	22.72	62.53	388.29	112.64	0.04	856.2	3.68			175/day with 1750 yearly max	175/day with 1750 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	175 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	175 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/40/30/80 copay levels				50 max		50 max					30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			175	175	75		75	0.2	0.2	50	175	51.31	59.45	175	34.28	30	15	30	30	30			26.22				50		50					30	50	30	30	15	0.2	30	30			3500	103.78	122.42	69		69	0.2	0.2	46	161.01	47.21	54.7	161.01	31.54	27.6	13.8	27.6	27.6	27.6			24.12				46		46					27.6	46	27.6	27.6	13.8	0.2	27.6	27.6				18.12	0.51	2.09	-	1.66	2.15	0.74	1.26	5.55	3.16	5.01	0.67	0.09	0	6.83	4.03	0.02	0.92	-	-	0.49	-	-	-	0.09	-	0.67	-	-	-	-	1.98	0.09	0.14	0.89	0.13	0.01	1.97	0.01	-	-	59.28	18.12	0.51	2.09	-	1.66	2.15	0.74	1.26	5.55	3.16	5.01	0.67	0.09	0	6.83	4.03	0.02	0.92	-	-	0.49	-	-	-	0.09	-	0.67	-	-	-	-	1.98	0.09	0.14	0.89	0.13	0.01	1.97	0.01	-	-	59.28
H1849_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			none																																										-	352.37	3.93	374.14		301.93	10.52	4.55	278.47	519.29	780.99	1357.12	47.73	73.35	0	6633.51	2144.76	1.02	767.76			275.73											886.04	28.9	98.59	483.76	149.56	0.03	958.55	5.89			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/30/40/80 copay levels											30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			750	750	75		75	0.2	0.2	50	250	51.72	59.66	250	35	30	15	30	30	30			30.66											30	50	30	30	15	0.2	30	30			4000	601.18	699.98	72.26		72.26	0.2	0.2	48.17	240.85	49.83	57.48	240.85	33.72	28.9	14.45	28.9	28.9	28.9			29.54											28.9	48.17	28.9	28.9	14.45	0.19	28.9	28.9				17.65	0.23	2.25	-	1.82	2.1	0.91	1.12	10.42	3.24	6.5	0.96	0.21	-	7.99	5.17	0	1.85	-	-	0.68	-	-	-	-	-	-	-	-	-	-	2.13	0.12	0.24	1.17	0.18	0.01	2.31	0.01	-	-	69.26	17.65	0.23	2.25	-	1.82	2.1	0.91	1.12	10.42	3.24	6.5	0.96	0.21	-	7.99	5.17	0	1.85	-	-	0.68	-	-	-	-	-	-	-	-	-	-	2.13	0.12	0.24	1.17	0.18	0.01	2.31	0.01	-	-	69.26
H1903_001_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1823.8	36.65	803.57	2842.58	374.59	20762.77	21398.33	272.59	245.55	2159.62	872.23	0	48.05	545.1	8254.76	11404.79	199.1	252.62	4847.32	12950.02	380.62	863.92	0	381	399.48	300.93	171.2	18.42	0	100	28.49											50 days 1 to 5	50 days 1 to 5	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	25	Eff. copay 0 to 15	Eff. copay 0 to 75	0	0	0	Eff. copay 0 to 15	Eff. copay 0 to 20	15	20		Eff. copay 20 coins. 0 to 20 copay	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											32.49	32.37	37.93	0	100	0.97	1.27	50	25	3	17.63	0	0	0	0.65	11.37	15	20	0	3.45	27.68	3.92	0	21.1	5	5	5	0	0	0	1.7											N/A	32.49	32.37	37.93	0	100	0.97	1.27	50	25	3	17.63	0	0	0	0.65	11.37	15	20	0	3.45	27.68	3.92	0	21.1	5	5	5	0	0	0	1.7												4.94	0.1	2.54	-	3.12	1.68	2.27	1.14	0.51	0.54	1.28	-	-	-	0.45	10.81	0.25	0.42	-	3.73	0.88	0.28	-	0.67	0.17	0.13	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	35.97	4.94	0.1	2.54	-	3.12	1.68	2.27	1.14	0.51	0.54	1.28	-	-	-	0.45	10.81	0.25	0.42	-	3.73	0.88	0.28	-	0.67	0.17	0.13	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	35.97
H1903_002_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1595.9	31.34	877.27	2523.93	339.73	18732.17	19360.76	280.31	251.44	2126.95	854.42	0	49.54	560.98	7228.28	10370.49	181.15	231.05	3729.17	10199.71	392.46	806.46	0	381	363.93	268.75	155.97	16.65	0	100	26.42											200 days 1 to 5	200 days 1 to 5	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	100	Eff. copay 0 to 25	Eff. copay 0 to 75	0	0	Eff. copay 0 to 50	Eff. copay 0 to 10	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 copay	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											129.98	129.5	75.87	0	100	0.98	1.33	50	100	5.24	17.75	0	0	2.49	6.49	15.69	24	30	0	4.32	30.08	3.8	0	21.1	5	5	5	0	0	0	1.64											N/A	129.98	129.5	75.87	0	100	0.98	1.33	50	100	5.24	17.75	0	0	2.49	6.49	15.69	24	30	0	4.32	30.08	3.8	0	21.1	5	5	5	0	0	0	1.64												17.29	0.34	5.55	-	2.83	1.54	2.15	1.17	2.1	0.93	1.26	-	-	0.12	3.91	13.56	0.36	0.58	-	3.67	0.98	0.26	-	0.67	0.15	0.11	0.06	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.59	17.29	0.34	5.55	-	2.83	1.54	2.15	1.17	2.1	0.93	1.26	-	-	0.12	3.91	13.56	0.36	0.58	-	3.67	0.98	0.26	-	0.67	0.15	0.11	0.06	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.59
H1903_003_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1640.11	32.22	920.6	2582.93	347.67	19170.11	19813.39	286.87	257.32	2207.18	888.99	0	50.7	574.09	7498	10709.12	188.77	240.71	3882.27	10565.99	401.64	825.32	0	381	372.43	275.03	159.61	17.04	0	100	27.04											150 days 1 to 5	150 days 1 to 5	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	50	Eff. copay 0 to 20	Eff. copay 0 to 75	0	0	0	Eff. copay 0 to 05	Eff. copay 0 to 20	Eff. copay 10 to 20	20		Eff. copay 20 coins. 0 to 20 copay	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											97.48	97.12	37.93	0	100	0.99	1.35	50	50	4.13	17.7	0	0	0	3.52	10.79	19	20	0	3.35	30.31	3.8	0	21.1	5	5	5	0	0	0	1.64											N/A	97.48	97.12	37.93	0	100	0.99	1.35	50	50	4.13	17.7	0	0	0	3.52	10.79	19	20	0	3.35	30.31	3.8	0	21.1	5	5	5	0	0	0	1.64												13.32	0.26	2.91	-	2.9	1.59	2.22	1.2	1.07	0.76	1.31	-	-	-	2.2	9.63	0.3	0.4	-	2.95	1.01	0.26	-	0.67	0.16	0.11	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	45.31	13.32	0.26	2.91	-	2.9	1.59	2.22	1.2	1.07	0.76	1.31	-	-	-	2.2	9.63	0.3	0.4	-	2.95	1.01	0.26	-	0.67	0.16	0.11	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	45.31
H1903_005_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1806.2	36.3	793.44	2806.76	369.87	20501.12	21128.67	269.15	242.46	2221.98	902.11	0	47.44	538.23	8493.12	11707.82	223.67	283.43	5041.27	13393.75	375.83	853.04	0	381	394.44	297.14	169.05	18.19	0	100	28.13											0	0	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	0		Eff. copay 0 to 50	0	0	0	Eff. copay 0 to 25	Eff. copay 0 to 25	0			Eff. copay 20 coins. 0 to 5 coins.	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											0	0	37.93	0	50	0.96	1.27	50	0	0	11.59	0	0	0	0.13	0.28	0	0	0	1.74	27.56	3.92	0	21.1	5	5	5	0	0	0	1.7											N/A	0	0	37.93	0	50	0.96	1.27	50	0	0	11.59	0	0	0	0.13	0.28	0	0	0	1.74	27.56	3.92	0	21.1	5	5	5	0	0	0	1.7												-	-	2.51	-	1.54	1.65	2.23	1.12	-	-	0.87	-	-	-	0.09	0.28	-	-	-	1.94	0.86	0.28	-	0.67	0.16	0.12	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	14.4	-	-	2.51	-	1.54	1.65	2.23	1.12	-	-	0.87	-	-	-	0.09	0.28	-	-	-	1.94	0.86	0.28	-	0.67	0.16	0.12	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	14.4
H1903_006_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1808.41	36	1025.17	2929.17	368.34	20372.15	21050.83	303.04	272.86	2314.87	928.37	0	53.43	606.05	7825.09	11236.01	195.56	248.64	4044.71	11029.84	423.27	864.35	0	381	388.22	285.27	166.38	17.57	0	100	27.9											100 days 1 to 5	100 days 1 to 5	75 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	50	Eff. copay 0 to 25	Eff. copay 0 to 75	0	0	Eff. copay 0 to 25	Eff. copay 0 to 5	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											60.84	60.53	56.9	0	100	1.02	1.38	50	50	5.19	17.71	0	0	1.25	3.56	16.23	24	30	0	4.63	30.86	3.79	0	21.1	5	5	5	0	0	0	1.65											N/A	60.84	60.53	56.9	0	100	1.02	1.38	50	50	5.19	17.71	0	0	1.25	3.56	16.23	24	30	0	4.63	30.86	3.79	0	21.1	5	5	5	0	0	0	1.65												9.17	0.18	4.86	-	3.07	1.73	2.41	1.26	1.14	1	1.37	-	-	0.06	2.32	15.2	0.39	0.62	-	4.26	1.09	0.27	-	0.67	0.16	0.12	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	51.43	9.17	0.18	4.86	-	3.07	1.73	2.41	1.26	1.14	1	1.37	-	-	0.06	2.32	15.2	0.39	0.62	-	4.26	1.09	0.27	-	0.67	0.16	0.12	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	51.43
H1903_007_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1792.95	35.56	1045.79	2900.89	365.75	20210.38	20885.06	301.13	270.84	2378.04	961	0	53.13	602.35	8029.05	11413.22	209	265.76	4193.43	11330.54	420.9	861.18	0	381	387.35	285.05	166.01	17.59	0	100	27.92											25 days 1 to 4	25 days 1 to 4	25 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 50	Eff. copay 0 to 10	Eff. copay 0 to 75	0	0	Eff. copay 0 to 10	Eff. copay 0 to 05	Eff. copay 0 to 10	10	10		Eff. copay 20 coins. 0 to 10 copay	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											14.38	14.31	18.97	0	100	1.02	1.38	50	41.67	2.01	17.64	0	0	0.5	3.29	5.63	10	10	0	2.78	30.91	3.8	0	21.1	5	5	5	0	0	0	1.65											N/A	14.38	14.31	18.97	0	100	1.02	1.38	50	41.67	2.01	17.64	0	0	0.5	3.29	5.63	10	10	0	2.78	30.91	3.8	0	21.1	5	5	5	0	0	0	1.65												2.15	0.04	1.65	-	3.05	1.72	2.4	1.25	0.94	0.4	1.41	-	-	0.03	2.2	5.35	0.17	0.22	-	2.63	1.08	0.27	-	0.67	0.16	0.12	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	27.99	2.15	0.04	1.65	-	3.05	1.72	2.4	1.25	0.94	0.4	1.41	-	-	0.03	2.2	5.35	0.17	0.22	-	2.63	1.08	0.27	-	0.67	0.16	0.12	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	27.99
H1903_009_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2108.55	42.48	1064.47	3118.72	435.31	24146.29	24945.04	357.08	322.68	2745.09	1099.17	0	62.81	713.64	9231.61	13255.69	230.16	291.75	4781.74	13002.59	497.59	1010.14	0	381	451.63	330.23	193.56	20.22	0	100	32.13											100 days 1 to 4	100 days 1 to 4	75 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	50	Eff. copay 0 to 25	Eff. copay 0 to 75	0	0	Eff. copay 0 to 25	Eff. copay 0 to 5	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 copay	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											57.52	57.23	56.9	0	100	1.14	1.53	50	50	5.15	17.68	0	0	1.26	3.52	15.51	24	30	0	4.76	34.43	3.79	0	21.1	5	5	5	0	0	0	1.65											N/A	57.52	57.23	56.9	0	100	1.14	1.53	50	50	5.15	17.68	0	0	1.26	3.52	15.51	24	30	0	4.76	34.43	3.79	0	21.1	5	5	5	0	0	0	1.65												10.11	0.2	5.05	-	3.63	2.29	3.19	1.49	1.34	1.18	1.62	-	-	0.07	2.71	17.14	0.46	0.73	-	5.16	1.43	0.32	-	0.67	0.19	0.14	0.08	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.19	10.11	0.2	5.05	-	3.63	2.29	3.19	1.49	1.34	1.18	1.62	-	-	0.07	2.71	17.14	0.46	0.73	-	5.16	1.43	0.32	-	0.67	0.19	0.14	0.08	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.19
H1903_010_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2072.69	41.77	1070.97	3053.49	426.2	23641.25	24423.3	349.61	315.93	2788.04	1124.71	0	61.5	698.71	9346.5	13280.96	243.04	307.87	4897.87	13180.89	487.18	989.01	0	381	442.18	323.32	189.51	19.79	0	100	31.46											25 days 1 to 4	25 days 1 to 4	25 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 50	Eff. copay 0 to 10	Eff. copay 0 to 75	0	0	Eff. copay 0 to 10	Eff. copay 0 to 05	Eff. copay 0 to 10	10	10		Eff. copay 20 coins. 0 to 10 coins.	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											14.38	14.31	18.97	0	100	1.13	1.52	50	41.67	1.99	17.6	0	0	0.5	3.24	5.54	10	10	0	2.98	34.19	3.79	0	21.1	5	5	5	0	0	0	1.65											N/A	14.38	14.31	18.97	0	100	1.13	1.52	50	41.67	1.99	17.6	0	0	0.5	3.24	5.54	10	10	0	2.98	34.19	3.79	0	21.1	5	5	5	0	0	0	1.65												2.48	0.05	1.69	-	3.55	2.23	3.1	1.46	1.1	0.46	1.65	-	-	0.03	2.52	6.13	0.2	0.26	-	3.28	1.39	0.31	-	0.67	0.18	0.13	0.08	-	-	-	0	-	-	-	-	-	-	-	-	-	-	32.96	2.48	0.05	1.69	-	3.55	2.23	3.1	1.46	1.1	0.46	1.65	-	-	0.03	2.52	6.13	0.2	0.26	-	3.28	1.39	0.31	-	0.67	0.18	0.13	0.08	-	-	-	0	-	-	-	-	-	-	-	-	-	-	32.96
H1903_011_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2898.66	58.9	1472.44	5232.82	1765.77	32719.46	33715.19	460.38	387.08	3567.42	1337.84	0	75.24	855.19	13550.11	18693.27	302.48	449.63	8087.19	21470.14	596.06	1416.97	0	381	0	0	0	0	0	100	163.66											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.			21.1					0	0	Eff. copay 20 coins.											180.13	175.1	54.11	0	13.36	0	0	34.15	176.23	0	56.09	0	3.03	35.1	0	0	17.57	0	0	1.5	27.61	0	0	21.1	0	0	0	0	0	0	0.31											N/A	180.13	175.1	54.11	0	13.36	0	0	34.15	176.23	0	56.09	0	3.03	35.1	0	0	17.57	0	0	1.5	27.61	0	0	21.1	0	0	0	0	0	0	0.31												43.51	0.86	6.64	-	1.97	-	-	1.31	5.68	-	6.25	-	0.02	2.5	-	-	0.44	-	-	2.68	1.37	-	-	0.67	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	73.91	43.51	0.86	6.64	-	1.97	-	-	1.31	5.68	-	6.25	-	0.02	2.5	-	-	0.44	-	-	2.68	1.37	-	-	0.67	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	73.91
H1903_012_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2493.82	48.96	1499.19	4216.56	1629.34	29946.16	30956.93	475.14	405.56	3694.53	1396.57	0	79.91	904.82	12402.47	17585.9	302.8	435.55	6526.57	17573.43	633.02	1352.43	0	381	0	0	0	0	0	100	162.24											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.			21.1					0	0	Eff. copay 20 coins.											180.11	175.1	54.11	0	13.85	0	0	38.47	198.37	0	62.47	0	3.39	39.06	0	0	17.23	0	0	1.78	30.84	0	0	21.1	0	0	0	0	0	0	0.33											N/A	180.11	175.1	54.11	0	13.85	0	0	38.47	198.37	0	62.47	0	3.39	39.06	0	0	17.23	0	0	1.78	30.84	0	0	21.1	0	0	0	0	0	0	0.33												37.43	0.71	6.76	-	1.88	-	-	1.52	6.7	-	7.27	-	0.02	2.95	-	-	0.43	-	-	2.61	1.63	-	-	0.67	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	70.6	37.43	0.71	6.76	-	1.88	-	-	1.52	6.7	-	7.27	-	0.02	2.95	-	-	0.43	-	-	2.61	1.63	-	-	0.67	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	70.6
H1903_013_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2925.41	57.9	1848.22	5155.27	1864.54	34332.79	35485.49	533.75	463.7	4237.96	1598.42	0	91.02	1031.74	14193.12	20115.23	336.71	498.09	7484.56	20113.32	721.06	1538.2	0	381	0	0	0	0	0	100	167.57											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.			21.1					0	0	Eff. copay 20 coins.											180.12	175.1	54.11	0	15.43	0	0	42.28	219.67	0	69.28	0	3.75	43.36	0	0	19.19	0	0	1.97	34.2	0	0	21.1	0	0	0	0	0	0	0.4											N/A	180.12	175.1	54.11	0	15.43	0	0	42.28	219.67	0	69.28	0	3.75	43.36	0	0	19.19	0	0	1.97	34.2	0	0	21.1	0	0	0	0	0	0	0.4												43.91	0.84	8.33	-	2.4	-	-	1.88	8.49	-	9.23	-	0.03	3.73	-	-	0.54	-	-	3.31	2.05	-	-	0.67	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	85.42	43.91	0.84	8.33	-	2.4	-	-	1.88	8.49	-	9.23	-	0.03	3.73	-	-	0.54	-	-	3.31	2.05	-	-	0.67	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	85.42
H1903_014_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2571.3	51.68	1366.24	4580.52	520.68	28859.92	29747.79	381.9	344.03	3152.83	1280.03	0	67.31	763.7	11967.38	16516.15	314.86	398.99	7096.71	18887.16	533.27	1202.91	0	381	555.27	418.29	237.97	25.61	0	100	39.6											0	0	0		50		Eff. copay 20 coins.	50	0		Eff. copay 0 to 50	0	0	0			0			Eff. copay 20 coins. 0 to 5 copay	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											0	0	0	0	50	0	1.27	50	0	0	11.59	0	0	0	0	0	0	0	0	1.56	27.71	3.91	0	21.1	5	5	5	0	0	0	0.42											N/A	0	0	0	0	50	0	1.27	50	0	0	11.59	0	0	0	0	0	0	0	0	1.56	27.71	3.91	0	21.1	5	5	5	0	0	0	0.42												-	-	-	-	2.17	-	3.14	1.59	-	-	1.24	-	-	-	-	-	-	-	-	2.45	1.23	0.39	-	0.67	0.23	0.17	0.1	-	-	-	0	-	-	-	-	-	-	-	-	-	-	13.39	-	-	-	-	2.17	-	3.14	1.59	-	-	1.24	-	-	-	-	-	-	-	-	2.45	1.23	0.39	-	0.67	0.23	0.17	0.1	-	-	-	0	-	-	-	-	-	-	-	-	-	-	13.39
H1903_015_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2160.48	42.45	1325.1	3665.48	457.83	25243.68	26096.13	381.4	342.12	2934.56	1181.96	0	67.41	763.29	9878.24	14123.06	255.25	325.38	5112.27	13944.59	534	1089.31	0	381	490.43	362.17	210.18	22.44	0	100	35.61											50 days 1 to 5	50 days 1 to 5	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	50	Eff. copay 0 to 15	Eff. copay 0 to 50	0	Eff. copay 20 coins.		Eff. copay 0 to 05	Eff. copay 0 to 15	Eff. copay 05 to 15	15		Eff. copay 20 coins. 0 to 15 coins.	Eff. copay 20 coins.	Eff. copay 0 to 5		21.102362	5	5	5		0	0	Eff. copay 0 to 50											32.49	32.37	37.93	0	50	0.99	1.34	50	50	3.1	11.8	0	0	0	3.42	8.23	14	15	0	3.07	30.5	3.79	0	21.1	5	5	5	0	0	0	0.38											N/A	32.49	32.37	37.93	0	50	0.99	1.34	50	50	3.1	11.8	0	0	0	3.42	8.23	14	15	0	3.07	30.5	3.79	0	21.1	5	5	5	0	0	0	0.38												5.85	0.11	4.19	-	1.91	2.08	2.92	1.59	1.43	0.76	1.16	-	-	-	2.82	9.69	0.3	0.41	-	3.56	1.36	0.34	-	0.67	0.2	0.15	0.09	-	-	-	0	-	-	-	-	-	-	-	-	-	-	41.59	5.85	0.11	4.19	-	1.91	2.08	2.92	1.59	1.43	0.76	1.16	-	-	-	2.82	9.69	0.3	0.41	-	3.56	1.36	0.34	-	0.67	0.2	0.15	0.09	-	-	-	0	-	-	-	-	-	-	-	-	-	-	41.59
H1903_016_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2214.39	43.52	1353.87	3673.62	473.18	26090.24	26970.86	393.91	353.34	3218.82	1308.65	0	69.62	788.32	10798.53	15300.22	298.15	379.46	5686.2	15303.08	551.51	1125.65	0	381	506.88	374.32	217.23	23.2	0	100	36.8											0	0	0	0	50		Eff. copay 20 coins.	50	0	0	Eff. copay 0 to 50	0	0	0			0			Eff. copay 20 coins. 0 to 5 copay	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											0	0	0	0	50	0	1.34	50	0	0	11.62	0	0	0	0	0	0	0	0	1.81	30.56	3.79	0	21.1	5	5	5	0	0	0	0.39											N/A	0	0	0	0	50	0	1.34	50	0	0	11.62	0	0	0	0	0	0	0	0	1.81	30.56	3.79	0	21.1	5	5	5	0	0	0	0.39												-	-	-	-	1.97	-	3.02	1.64	-	-	1.27	-	-	-	-	-	-	-	-	2.3	1.4	0.36	-	0.67	0.21	0.16	0.09	-	-	-	0	-	-	-	-	-	-	-	-	-	-	13.09	-	-	-	-	1.97	-	3.02	1.64	-	-	1.27	-	-	-	-	-	-	-	-	2.3	1.4	0.36	-	0.67	0.21	0.16	0.09	-	-	-	0	-	-	-	-	-	-	-	-	-	-	13.09
H1903_017_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2661.88	52.8	1707.84	4596.98	553.71	30596.88	31623.44	459.38	413.17	3778.15	1534.69	0	81.05	918.9	12639.72	17903.82	349.34	443.71	6670.41	17910.65	642.09	1306.16	0	381	586.41	431.54	251.32	26.63	0	100	42.27											0	0	0		50		Eff. copay 20 coins.	50	0		Eff. copay 0 to 50	0	0	0			0			Eff. copay 20 coins. 0 to 5 copay	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5		0	0	Eff. copay 0 to 50											0	0	0	0	50	0	1.51	50	0	0	11.6	0	0	0	0	0	0	0	0	2.01	34.18	3.79	0	21.1	5	5	5	0	0	0	0.43											N/A	0	0	0	0	50	0	1.51	50	0	0	11.6	0	0	0	0	0	0	0	0	2.01	34.18	3.79	0	21.1	5	5	5	0	0	0	0.43												-	-	-	-	2.31	-	3.97	1.91	-	-	1.48	-	-	-	-	-	-	-	-	3	1.83	0.41	-	0.67	0.24	0.18	0.1	-	-	-	0	-	-	-	-	-	-	-	-	-	-	16.12	-	-	-	-	2.31	-	3.97	1.91	-	-	1.48	-	-	-	-	-	-	-	-	3	1.83	0.41	-	0.67	0.24	0.18	0.1	-	-	-	0	-	-	-	-	-	-	-	-	-	-	16.12
H1903_018_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1678.97	33.24	763.62	2632.35	351.56	19414.82	20017.25	258.61	231.81	2109.5	857.85	0	45.73	517.62	8066.44	11141.88	212.66	270.45	4743.1	12670.92	362.25	822.66	0	381	381.71	288.63	163.59	17.8	0	100	27.56													50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff Copay 0 to 35	Eff. Copay 0 to 15	Eff. copay 0 to 50			Eff. Copay 0 to 35	Eff. Copay 0 to 25			15		Eff. copay 20 coins. 0 to 15	Eff. copay 20 coins.	Eff. copay 0 to 5		21.1	5	5	5				Eff. copay 0 to 50											0	0	37.93	0	50	0.96	2.36	50	28.58	0.19	11.63	0	0	0.94	0.13	0.29	0	15	0	3.29	27.44	3.92	0	21.1	5	5	5	0	0	0	1.69											N/A	0	0	37.93	0	50	0.96	2.36	50	28.58	0.19	11.63	0	0	0.94	0.13	0.29	0	15	0	3.29	27.44	3.92	0	21.1	5	5	5	0	0	0	1.69												-	-	2.41	-	1.46	1.55	3.93	1.08	0.55	0.03	0.83	-	-	0.04	0.09	0.27	-	0.34	-	3.48	0.83	0.27	-	0.67	0.16	0.12	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	18.19	-	-	2.41	-	1.46	1.55	3.93	1.08	0.55	0.03	0.83	-	-	0.04	0.09	0.27	-	0.34	-	3.48	0.83	0.27	-	0.67	0.16	0.12	0.07	-	-	-	0	-	-	-	-	-	-	-	-	-	-	18.19
H1903_019_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1585.41	31.05	886.14	2507.15	1014.29	18630.31	19256.38	294.19	250.17	2100.16	800.94	0	49.35	558.65	7131.21	10336.53	188.6	230.29	3679.12	10126.77	390.97	841.83	0	0	0	0	0	0	0	0	26.44											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0		Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											128.18	127.53	54.11	0	13.69	0.98	1.34	37.66	193.81	0	61.01	0	0	38.14	5.79	16.13	17.03	35	0	4.12	30.11	0	0	0	0	0	0	0	0	0	1.24											N/A	128.18	127.53	54.11	0	13.69	0.98	1.34	37.66	193.81	0	61.01	0	0	38.14	5.79	16.13	17.03	35	0	4.12	30.11	0	0	0	0	0	0	0	0	0	1.24												16.93	0.33	4	-	1.16	1.53	2.14	0.92	4.04	-	4.07	-	-	1.78	3.44	13.9	0.27	0.67	-	3.48	0.98	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.64	16.93	0.33	4	-	1.16	1.53	2.14	0.92	4.04	-	4.07	-	-	1.78	3.44	13.9	0.27	0.67	-	3.48	0.98	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.64
H1905_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1117.07	23.66	584.72	545.09	152.8	21.93	1.65	430.58	341.15				18.6	2102.2	6744.18	11761.58					4.45			0	0		0					58.79	1.25	0	0	0	0	0				100 per day (1-7)	150 per day (1-7)	0 per day (1-6) 75 per day (7-100)	0	125	10	10	30-50	50				0	0-100	10-100	30-100					20											100 per day (1-7)	150 per day (1-7)	0	0	0	0	0				77.96	116.94	43.64	0	125	0.1	0.1	40.6	50				0	27.52	11.77	31.37					20			0	0		0					77.96	116.94	0	0	0	0	0					77.96	116.94	43.64	0	125	0.1	0.1	40.6	50				0	27.52	11.77	31.37					20			0	0		0					77.96	116.94	0	0	0	0	0				0	7.26	0.23	2.13	-	1.59	2.19	0.17	1.46	1.42	-	-	-	-	4.82	6.61	30.75	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.38	0.01	-	-	-	-	-	-	-	-	59.91	7.26	0.23	2.13	-	1.59	2.19	0.17	1.46	1.42	-	-	-	-	4.82	6.61	30.75	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.38	0.01	-	-	-	-	-	-	-	-	59.91
H1905_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1142.26	24.2	597.9	557.38	156.25	22.51	1.69	440.29	348.84				19.02	2149.61	6896.26	12026.8					4.45			0	0		0					60.12	1.27	0	0	0	0	0				100 per day (1-7)	150 per day (1-7)	0 per day (1-6) 75 per day (7-100)	0	125	10	10	30-50	75				0	0-100	10-100	30-100					20											100 per day (1-7)	150 per day (1-7)	0	0	0	0	0				77.96	116.94	43.64	0	125	0.1	0.1	40.6	75				0	20.43	11.77	31.37					20			0	0		0					77.96	116.94	0	0	0	0	0					77.96	116.94	43.64	0	125	0.1	0.1	40.6	75				0	20.43	11.77	31.37					20			0	0		0					77.96	116.94	0	0	0	0	0				0	7.42	0.24	2.17	-	1.63	2.25	0.17	1.49	2.18	-	-	-	-	3.66	6.76	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.39	0.01	-	-	-	-	-	-	-	-	60.71	7.42	0.24	2.17	-	1.63	2.25	0.17	1.49	2.18	-	-	-	-	3.66	6.76	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.39	0.01	-	-	-	-	-	-	-	-	60.71
H1905_003_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1170.28	24.79	612.57	571.06	160.08	21.26	1.6	451.09	357.4				19.49	2202.34	7065.42	12321.81					4.45			0	0		0					61.59	1.3	0	0	0	0	0				150 per day (1-7)	150 per day (1-7)	0 per day (1-6) 50 per day (7-100)	0	100	20	20	35-50	125				0	0-150	10-100	35-100					20											150 per day (1-7)	150 per day (1-7)	0	0	0	0	0				116.94	116.94	29.09	0	100	0.2	0.2	40.7	125				0	31.05	11.77	36.28					20			0	0		0					116.94	116.94	0	0	0	0	0					116.94	116.94	29.09	0	100	0.2	0.2	40.7	125				0	31.05	11.77	36.28					20			0	0		0					116.94	116.94	0	0	0	0	0				0	11.4	0.24	1.48	-	1.33	4.25	0.32	1.53	3.72	-	-	-	-	5.7	6.93	37.25	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.6	0.01	-	-	-	-	-	-	-	-	75.67	11.4	0.24	1.48	-	1.33	4.25	0.32	1.53	3.72	-	-	-	-	5.7	6.93	37.25	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.6	0.01	-	-	-	-	-	-	-	-	75.67
H1905_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	273.93	6.22	1214.84	566.25	158.74	23.72	1.79	447.3	354.4				19.32	2183.82	7006.02	12218.21					4.45			0	0		0					14.42	0.33	0	0	0	0	0				600 per admit	600 per admit	100 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35-50					20											600 per admit	600 per admit	0	0	0	0	0				408.12	408.12	8.81	10	100	0.25	0.25	45.2	200				0	35.11	25.2	35.29					20			0	0		0					408.12	408.12	0	0	0	0	0					408.12	408.12	8.81	10	100	0.25	0.25	45.2	200				0	35.11	25.2	35.29					20			0	0		0					408.12	408.12	0	0	0	0	0				0	9.32	0.21	0.89	0.47	1.32	5.93	0.45	1.68	5.91	-	-	-	-	6.39	14.71	35.94	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.49	0.01	-	-	-	-	-	-	-	-	84.61	9.32	0.21	0.89	0.47	1.32	5.93	0.45	1.68	5.91	-	-	-	-	6.39	14.71	35.94	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.49	0.01	-	-	-	-	-	-	-	-	84.61
H1905_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	273.93	6.22	1214.81	566.24	158.73	23.72	1.79	447.29	354.39				19.32	2183.77	7005.87	12217.95					4.45			0	0		0					14.42	0.33	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.11	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.11	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13.7	0.31	0.89	0.47	1.32	5.93	0.45	1.68	5.91	-	-	-	-	6.39	14.71	35.64	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	89.02	13.7	0.31	0.89	0.47	1.32	5.93	0.45	1.68	5.91	-	-	-	-	6.39	14.71	35.64	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	89.02
H1905_805_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	273.93	6.22	1214.84	566.25	158.74	23.72	1.79	447.3	354.4				19.32	2183.82	7006.02	12218.21					4.45			0	0		0					14.42	0.33	0	0	0	0	0				600 per admit	600 per admit	100 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35-50					20											600 per admit	600 per admit	0	0	0	0	0				408.12	408.12	8.81	10	100	0.25	0.25	45.2	200				0	35.11	25.2	35.29					20			0	0		0					408.12	408.12	0	0	0	0	0					408.12	408.12	8.81	10	100	0.25	0.25	45.2	200				0	35.11	25.2	35.29					20			0	0		0					408.12	408.12	0	0	0	0	0				0	9.32	0.21	0.89	0.47	1.32	5.93	0.45	1.68	5.91	-	-	-	-	6.39	14.71	35.94	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.49	0.01	-	-	-	-	-	-	-	-	84.61	9.32	0.21	0.89	0.47	1.32	5.93	0.45	1.68	5.91	-	-	-	-	6.39	14.71	35.94	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.49	0.01	-	-	-	-	-	-	-	-	84.61
H1905_806_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	273.93	6.22	1214.81	566.24	158.73	23.72	1.79	447.29	354.39				19.32	2183.77	7005.87	12217.95					4.45			0	0		0					14.42	0.33	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.11	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.11	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13.7	0.31	0.89	0.47	1.32	5.93	0.45	1.68	5.91	-	-	-	-	6.39	14.71	35.64	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	89.02	13.7	0.31	0.89	0.47	1.32	5.93	0.45	1.68	5.91	-	-	-	-	6.39	14.71	35.64	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	89.02
H1906_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1199.29	25.41	1255.51	585.21	9.91	21.57	1.62	13.92	38.51				1.18	77.55	48.54	189.35					4.45			0	0		0					63.12	1.34	0	0	2389.69	6859.49	12627.25				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					88.34	122.44	25.01	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					88.34	122.44	0	0	0	10.61	21.22				0	8.83	0.26	2.62	-	1.43	3.11	0.23	2.01	5.56	-	-	-	0.17	10.1	0.14	0.55	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.07	22.33	-	-	-	64.77	8.83	0.26	2.62	-	1.43	3.11	0.23	2.01	5.56	-	-	-	0.17	10.1	0.14	0.55	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	6.07	22.33	-	-	-	64.77
H1906_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1313.22	27.82	1374.79	640.81	11.71	25.48	1.92	16.45	45.51				1.4	91.63	57.36	223.74					4.45			0	0		0					69.12	1.46	0	0	2616.71	7511.14	13826.84				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					85.28	122.44	24.14	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					85.28	122.44	0	0	0	10.24	20.49				0	9.33	0.28	2.77	-	1.63	3.55	0.27	2.29	6.34	-	-	-	0.19	11.63	0.16	0.62	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.49	0.01	-	-	-	6.41	23.6	-	-	-	70.48	9.33	0.28	2.77	-	1.63	3.55	0.27	2.29	6.34	-	-	-	0.19	11.63	0.16	0.62	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.49	0.01	-	-	-	6.41	23.6	-	-	-	70.48
H1906_003_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1290.3	27.33	1350.8	629.62	11.69	25.45	1.92	16.43	45.46				1.4	91.53	57.29	223.49					4.45			0	0		0					67.91	1.44	0	0	2571.05	7380.07	13585.57				180 per day (1-5)	180 per day (1-5)	0 per day (1-3) 90 per day (4-100)	0	20	20	20	20	20				20	0-20	20	20					0.2											180 per day (1-5)	180 per day (1-5)	0	0	0	15	30				122.44	122.44	34.66	0	0.2	0.2	0.2	0.2	0.2				0.2	0.18	0	0					0.2			0	0		0					122.44	122.44	0	0	0	14.71	29.41					85.57	122.44	24.23	0	0.14	0.14	0.14	0.14	0.14				0.14	0.13	0	0					0.2			0	0		0					85.57	122.44	0	0	0	10.28	20.56				0	9.2	0.28	2.73	-	1.63	3.56	0.27	2.3	6.35	-	-	-	0.2	11.66	0.16	0.62	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.48	0.01	-	-	-	6.32	23.27	-	-	-	69.94	9.2	0.28	2.73	-	1.63	3.56	0.27	2.3	6.35	-	-	-	0.2	11.66	0.16	0.62	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.48	0.01	-	-	-	6.32	23.27	-	-	-	69.94
H1906_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1246.54	26.41	1304.98	608.27	191.83	22.94	1.73	540.55	380.69				23.35	2483.85	7129.76	13124.78					4.45			0	0		0					65.61	1.39	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	100 per day (1-20) 100 per day (21-100)	0	100	25	25	30-50	50-200				0	30-100	20-50	30-50					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.8	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.8	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0				0	21.2	0.45	0.96	-	1.6	5.73	0.43	1.83	3.16	-	-	-	-	5.75	12.23	33.24	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.12	0.02	-	-	-	-	-	-	-	-	88.61	21.2	0.45	0.96	-	1.6	5.73	0.43	1.83	3.16	-	-	-	-	5.75	12.23	33.24	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.12	0.02	-	-	-	-	-	-	-	-	88.61
H1906_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1246.54	26.41	1304.98	608.27	191.83	22.94	1.73	540.55	380.69				23.35	2483.85	7129.76	13124.78					4.45			0	0		0					65.61	1.39	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	100 per day (1-20) 100 per day (21-100)	0	100	25	25	30-50	50-200				0	30-100	20-50	30-50					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.8	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.8	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0				0	21.2	0.45	0.96	-	1.6	5.73	0.43	1.83	3.16	-	-	-	-	5.75	12.23	33.24	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.12	0.02	-	-	-	-	-	-	-	-	88.61	21.2	0.45	0.96	-	1.6	5.73	0.43	1.83	3.16	-	-	-	-	5.75	12.23	33.24	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.12	0.02	-	-	-	-	-	-	-	-	88.61
H1951_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2801.15	58.03	612.7	2066.65	499.22	15.91	1.2	560.07	437.72				522.33	1744.77	5791.59	6734.96					4.45			0	390		210					147.43	3.05	0	0	0	0	0				25 per day (1-5)	25 per day (1-5)	0 per day (1-20) 25 per day (21-100)	0	100	20	20	Oct-50	100				0	0-100	5-100	20-100					20			0	5		5					25 per day (1-5)	25 per day (1-5)	0	0	0	0	0				17.01	17.01	4.4	0	100	0.2	0.2	41.8	100				0	23.53	6.86	21.57					20			0	1.23		5.14					17.01	17.01	0	0	0	0	0					17.01	17.01	4.4	0	100	0.2	0.2	41.8	100				0	23.53	6.86	21.57					20			0	1.23		5.14					17.01	17.01	0	0	0	0	0				0	3.97	0.08	0.22	-	4.16	3.18	0.24	1.95	3.65	-	-	-	-	3.42	3.31	12.11	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	0.21	0	-	-	-	-	-	-	-	-	37.53	3.97	0.08	0.22	-	4.16	3.18	0.24	1.95	3.65	-	-	-	-	3.42	3.31	12.11	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	0.21	0	-	-	-	-	-	-	-	-	37.53
H1951_005_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2564.96	53.14	561.04	1892.39	457.12	14.59	1.1	512.84	400.81				478.29	1597.66	5303.25	6167.08					4.45			0	390		310					135	2.8	0	0	0	0	0				25 per day (1-5)	25 per day (1-5)	0 per day (1-20) 25 per day (21-100)	0	100	20	20	Oct-50	100				0	0-100	5-100	20-100					20			0	5		5					25 per day (1-5)	25 per day (1-5)	0	0	0	0	0				17.01	17.01	4.4	0	100	0.2	0.2	41.8	100				0	22.97	6.86	21.57					20			0	1.23		3.48					17.01	17.01	0	0	0	0	0					17.01	17.01	4.4	0	100	0.2	0.2	41.8	100				0	22.97	6.86	21.57					20			0	1.23		3.48					17.01	17.01	0	0	0	0	0				0	3.63	0.08	0.21	-	3.81	2.92	0.22	1.79	3.34	-	-	-	-	3.06	3.03	11.08	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	0.19	0	-	-	-	-	-	-	-	-	34.38	3.63	0.08	0.21	-	3.81	2.92	0.22	1.79	3.34	-	-	-	-	3.06	3.03	11.08	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	0.19	0	-	-	-	-	-	-	-	-	34.38
H1951_008_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2094.61	43.39	916.31	1537.44	383.86	14.28	1.07	430.65	336.58				388.57	1341.61	4308.53	5010.33					4.45			0	390		310					110.24	2.28	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-6) 150 per day (7-100)	0	150	20	20	30-50	100				0	0-300	10-100	30-100					0.2			0 - 0	5		5					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	43.64	0	150	0.2	0.2	45.4	100				0	21.44	11.77	31.37					0.2			0	1.23		3.48					204.06	204.06	0	0	0	0	0					204.06	204.06	43.64	0	150	0.2	0.2	45.4	100				0	21.44	11.77	31.37					0.2			0	1.23		3.48					204.06	204.06	0	0	0	0	0				0	35.62	0.74	3.33	-	4.8	2.86	0.21	1.63	2.8	-	-	-	-	2.4	4.22	13.1	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	1.87	0.04	-	-	-	-	-	-	-	-	74.65	35.62	0.74	3.33	-	4.8	2.86	0.21	1.63	2.8	-	-	-	-	2.4	4.22	13.1	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	1.87	0.04	-	-	-	-	-	-	-	-	74.65
H1951_009_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2065.08	42.78	903.39	1515.76	378.45	13.88	1.04	424.58	331.83				383.1	1322.69	4247.78	4939.69					4.45			0	390		310					108.69	2.25	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-6) 150 per day (7-100)	0	150	20	20	30-50	100				0	0-300	10-100	30-100					0.2			0 - 0	5		5					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	43.64	0	150	0.2	0.2	45.4	100				0	21.33	11.77	31.37					0.2			0	1.23		3.48					204.06	204.06	0	0	0	0	0					204.06	204.06	43.64	0	150	0.2	0.2	45.4	100				0	21.33	11.77	31.37					0.2			0	1.23		3.48					204.06	204.06	0	0	0	0	0				0	35.12	0.73	3.28	-	4.73	2.78	0.21	1.61	2.77	-	-	-	-	2.35	4.16	12.91	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	1.85	0.04	-	-	-	-	-	-	-	-	73.55	35.12	0.73	3.28	-	4.73	2.78	0.21	1.61	2.77	-	-	-	-	2.35	4.16	12.91	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	1.85	0.04	-	-	-	-	-	-	-	-	73.55
H1951_013_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2013.71	41.72	440.46	1478.06	369.04	13.2	0.99	414.02	323.58				373.57	1289.79	4142.11	4816.81					4.45			0	390		310					105.98	2.2	0	0	0	0	0				100 per day (1-5)	100 per day (1-5)	0 per day (1-20) 100 per day (21-100)	0	100	20	20	Oct-50	100				0	0-100	10-100	25-100					20			0	5		5					100 per day (1-5)	100 per day (1-5)	0	0	0	0	0				68.02	68.02	17.61	0	100	0.2	0.2	42.3	100				0	33.97	11.77	26.47					20			0	1.23		3.48					68.02	68.02	0	0	0	0	0					68.02	68.02	17.61	0	100	0.2	0.2	42.3	100				0	33.97	11.77	26.47					20			0	1.23		3.48					68.02	68.02	0	0	0	0	0				0	11.41	0.24	0.65	-	3.08	2.64	0.2	1.46	2.7	-	-	-	-	3.65	4.06	10.63	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	0.6	0.01	-	-	-	-	-	-	-	-	42.34	11.41	0.24	0.65	-	3.08	2.64	0.2	1.46	2.7	-	-	-	-	3.65	4.06	10.63	-	-	-	-	0.89	-	-	-	0.04	-	0.09	-	-	-	-	0.6	0.01	-	-	-	-	-	-	-	-	42.34
H1951_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2775.58	57.5	607.11	2047.79	494.66	16.19	1.22	554.96	433.73				517.56	1728.85	5738.72	6673.49					4.45			0	0		0					146.08	3.03	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	22.01	0	100	0.2	0.2	46.3	200				0	53.92	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	22.01	0	100	0.2	0.2	46.3	200				0	53.92	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	47.2	0.98	1.11	-	4.12	3.24	0.24	2.14	7.23	-	-	-	-	7.77	10.78	20.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.48	0.05	-	-	-	-	-	-	-	-	108.96	47.2	0.98	1.11	-	4.12	3.24	0.24	2.14	7.23	-	-	-	-	7.77	10.78	20.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.48	0.05	-	-	-	-	-	-	-	-	108.96
H1951_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2775.6	57.5	1214.22	2047.8	494.66	16.19	1.22	554.96	433.73				517.56	1728.86	5738.76	6673.53					4.45			0	0		0					146.08	3.03	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	53.92	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	53.92	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	47.2	0.98	1.11	-	4.12	3.24	0.24	2.14	7.23	-	-	-	-	7.77	10.78	20.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.48	0.05	-	-	-	-	-	-	-	-	108.96	47.2	0.98	1.11	-	4.12	3.24	0.24	2.14	7.23	-	-	-	-	7.77	10.78	20.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.48	0.05	-	-	-	-	-	-	-	-	108.96
H1951_805_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2775.58	57.5	607.11	2047.79	494.66	16.19	1.22	554.96	433.73				517.56	1728.85	5738.72	6673.49					4.45			0	0		0					146.08	3.03	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	22.01	0	100	0.2	0.2	46.3	200				0	53.92	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	22.01	0	100	0.2	0.2	46.3	200				0	53.92	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	47.2	0.98	1.11	-	4.12	3.24	0.24	2.14	7.23	-	-	-	-	7.77	10.78	20.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.48	0.05	-	-	-	-	-	-	-	-	108.96	47.2	0.98	1.11	-	4.12	3.24	0.24	2.14	7.23	-	-	-	-	7.77	10.78	20.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.48	0.05	-	-	-	-	-	-	-	-	108.96
H1951_806_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2775.6	57.5	1214.22	2047.8	494.66	16.19	1.22	554.96	433.73				517.56	1728.86	5738.76	6673.53					4.45			0	0		0					146.08	3.03	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	53.92	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	53.92	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	47.2	0.98	1.11	-	4.12	3.24	0.24	2.14	7.23	-	-	-	-	7.77	10.78	20.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.48	0.05	-	-	-	-	-	-	-	-	108.96	47.2	0.98	1.11	-	4.12	3.24	0.24	2.14	7.23	-	-	-	-	7.77	10.78	20.72	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	2.48	0.05	-	-	-	-	-	-	-	-	108.96
H1961_001_0	2006	Professional	Professional	Professional	Other Medicare Part B								PCP - Other Procedures	Specialist - Other Procedures	Other	Blood							D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	P	P	P	P	P	P	S	O	T		V	V	P				O	P	P	P	O																																																	-	1693.75	29.6	725.89	1669.06	773.97	8.26	15.42	382.48	285.02	329.96	1095.42	0	0.47	1625.76	4280.18	4539.66	237.12	280.8	4385.92	6488.05	96.84	3.52	600	0	1101.22	255.56	0	0	0	0	421.51	2969.75	15578.32	763.61	9.62							Choice 1: 0 Choice 2: 150 copay days 1-3 0 Copay afterwards		0 Copay days 1-20 50 Copay 21+	Choice 2: 10 for MC services 500 max OOP		5 of MA	0 for Infusion Supplies 5 otherwise		Choice 2: 150 Copay per visit				20 Coins for OOA services		Office Visit:  Choice 1: 5 Copay Choice 2: 25 Copay Urgent Care: 25 Copay Worldwide: 50 Copay Routine Physical Choice 1: 10 Copay Choice 2: NA	Office Visit:  Choice 1: 10 Copay Choice 2: 25 Copay Urgent Care: 25 Copay WorldWide: 50 Copay						Vision Exams: 10 Copay	5 Copay 12 one-way trips											Chiropractor & Podiatrist: Choice 1: 10 Copay Choice 2: 25 Copay Hearing Exams: 10 Copay																																																		9.48	0	8.37	0.14	0	0.05	0.05	50	22.5	0	0	0	0	0	7.72	12.25	10	0	0	0	0	10	5	0	10	0	0	0	0	0	0	0	0	11.95	0								1.34	-	0.51	0.02	-	0.41	0.75	1.59	0.53	-	-	-	0	-	2.75	4.63	0.2	-	-	-	-	0	0.25	-	0.92	-	-	-	-	-	-	-	-	0.76	-	-	-	-	-	-	-	14.67	1.34	-	0.51	0.02	-	0.41	0.75	1.59	0.53	-	-	-	0	-	2.75	4.63	0.2	-	-	-	-	0	0.25	-	0.92	-	-	-	-	-	-	-	-	0.76	-	-	-	-	-	-	-	14.67
H1961_002_0	2006	Professional	Professional	Professional	Other Medicare Part B								PCP - Other Procedures	Specialist - Other Procedures	Other	Blood							D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	P	P	P	P	P	P	S	O			V	V	P				O	P	P	O	O																																																	-	1742.06	26.05	746.6	1377.65	796.04	8.4	15.69	393.39	293.14	339.37	1125.02	0	0.48	1672.13	4209.25	4515.32	208.67	284.45	4511.02	6673.11	99.61	3.62	0	0	1132.63	262.85	0	0	0	0	433.53	3054.45	16022.66	784.93	9.89							Choice 1: 0 Choice 2: 150 copay days 1-3 0 Copay afterwards		0 Copay days 1-20 50 Copay 21+	Choice 2: 10 for MC services 500 max OOP		5 of MA	0 for Infusion Supplies 5 otherwise		Choice 2: 150 Copay per visit				Choice 2: 20 Coins		Office Visit:  Choice 1: 5 Copay Choice 2: 25 Copay Urgent Care: 25 Copay Worldwide: 50 Copay Routine Physical Choice 1: 10 Copay Choice 2: NA	Office Visit:  Choice 1: 10 Copay Choice 2: 25 Copay Urgent Care: 25 Copay WorldWide: 50 Copay	10 Copay days 1 - 20 50 coins afterwards					Vision Exams: 10 Copay												Chiropractor & Podiatrist: Choice 1: 10 Copay Choice 2: 25 Copay Hearing Exams: 10 Copay																																																		9.48	0	8.37	0.14	0	0.05	0.05	50	22.5	0	0	0	0.03	0	7.71	12.25	10	0	0	0	0	10	0	0	10	0	0	0	0	0	0	0	0	11.95	0								1.38	-	0.52	0.02	-	0.42	0.76	1.64	0.55	-	-	-	0.01	-	2.7	4.61	0.17	-	-	-	-	0	-	-	0.94	-	-	-	-	-	-	-	-	0.78	-	-	-	-	-	-	-	14.51	1.38	-	0.52	0.02	-	0.42	0.76	1.64	0.55	-	-	-	0.01	-	2.7	4.61	0.17	-	-	-	-	0	-	-	0.94	-	-	-	-	-	-	-	-	0.78	-	-	-	-	-	-	-	14.51
H1961_003_0	2006	Professional	Professional	Professional	Other Medicare Part B								PCP - Other Procedures	Specialist - Other Procedures	Other	Blood							D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	P	P	P	P	P	P	S	O	T		V	V	P				O	P	P	P	O																																																	-	2253.52	39.38	971.33	2220.67	1029.75	10.98	20.52	508.88	379.21	439	1457.44	0	10.5	2163.05	5691.17	6486.65	315.49	373.6	5835.42	8632.27	128.85	5.17	798.29	0	1620.84	340.02	0	0	0	0	560.81	4272.35	20726.77	1111.88	12.79							Choice 1: 0 Choice 2: 150 copay days 1-3 0 Copay afterwards		Choice 2: 0 Copay days 1-20 50 Copay 21+	Choice 2: 10 for MC services 500 max OOP		Choice 2: 5 of MA	Choice 2: 0 for Infusion Supplies 5 otherwise		Choice 2: 150 Copay per visit						Office Visit:  Choice 2: 25 Copay Urgent Care: 25 Copay Worldwide: 50 Copay	Office Visit:  Choice 2: 25 Copay Urgent Care: 25 Copay WorldWide: 50 Copay	10 Copay Days 1-20 50 coins after					Vision Exams: Choice 2: 10 Copay												Chiropractor & Podiatrist: Choice 2: 25 Copay Hearing Exams: Choice 2: 10 Copay																																																		9.48	0	1.26	0.14	0	0.01	0.01	50	22.5	0	0	0	0	0	3.75	3.75	10	0	0	0	0	1.5	0	0	1.5	0	0	0	0	0	0	0	0	3.44	0								1.78	-	0.1	0.03	-	0.08	0.15	2.12	0.71	-	-	-	-	-	1.78	2.03	0.26	-	-	-	-	0	-	-	0.2	-	-	-	-	-	-	-	-	0.32	-	-	-	-	-	-	-	9.56	1.78	-	0.1	0.03	-	0.08	0.15	2.12	0.71	-	-	-	-	-	1.78	2.03	0.26	-	-	-	-	0	-	-	0.2	-	-	-	-	-	-	-	-	0.32	-	-	-	-	-	-	-	9.56
H2001_001_0	2006											3200											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1361.72	75.28	873.93		218.27	7.06	10.69	410.36	31.97		19.57	3.5	0.45	23.48	3395.01	4094.8	263.34	2.66	13.48	370.06	15.59				117.8		210.9															295	175	150		150	30	30	50	30		0/30	30	30	30/40/30	15/0	25	40/30	30	0/30	0/25	30				25		25															295	175	150		150	0.3	0.3	50	0.2		0.16	0.2	0.3	0.2	15	23.4	37.5	0.2	0.11	0.26	0.3				25		25																184.14	105.52	90.45		90.45	0.18	0.18	30.15	0.12		0.1	0.12	0.18	0.12	15	23.4	37.5	0.14	0.06	0.26	0.18				25		25																20.9	0.66	6.59	-	1.65	1.28	1.93	1.03	3.86	-	1.94	0.42	0.08	2.84	4.24	7.98	0.82	0.36	0.87	0.01	2.82	-	-	-	0.25	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.96	20.9	0.66	6.59	-	1.65	1.28	1.93	1.03	3.86	-	1.94	0.42	0.08	2.84	4.24	7.98	0.82	0.36	0.87	0.01	2.82	-	-	-	0.25	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.96
H2001_003_0	2006											2400											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1471.81	81.36	944.56		235.92	7.63	11.57	443.48	34.58		21.17	3.78	0.49	25.4	3663.9	4420.03	284.64	2.88	14.58	399.98	16.86				117.8		210.9															150	150	75		150	30	30	50	15		0/15	15	30	15/40/20/10	Oct-00	20	20/10	15	0/15	0/20	30				20		20															150	150	75		150	0.3	0.3	50	0.15		0.12	0.15	0.3	0.15	10	18.72	17.5	0.15	0.08	0.3	0.3				20		20																95.27	92.18	46.09		92.18	0.18	0.18	30.73	0.09		0.08	0.09	0.18	0.09	10	18.72	17.5	0.1	0.05	0.3	0.18				20		20																11.68	0.62	3.63	-	1.81	1.41	2.13	1.14	3.19	-	1.6	0.35	0.09	2.33	3.05	6.89	0.42	0.3	0.72	0.01	3.11	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.03	11.68	0.62	3.63	-	1.81	1.41	2.13	1.14	3.19	-	1.6	0.35	0.09	2.33	3.05	6.89	0.42	0.3	0.72	0.01	3.11	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.03
H2001_005_0	2006											2650											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1361.72	75.28	873.93	0	218.27	7.06	10.69	410.36	31.97	0	19.57	3.5	0.45	23.48	3395.03	4094.83	263.35	2.66	13.48	370.06	15.59	0	0	0	117.8	0	210.9	0	0	0	0											265	175	125	0	150	20	20	50	20	0	0/20	20	20	20/40/30	Oct-00	20	40/30	20	0/20	0/20	20	0			20		20															265	175	125	0	150	0.2	0.2	50	0.2	0	0.16	0.2	0.2	0.2	10	18.72	37.5	0.2	0.11	0.25	0.2	0	0	0	20	0	20	0	0	0	0												161.09	102.5	73.22	0	87.86	0.12	0.12	29.29	0.12	0	0.1	0.12	0.12	0.12	10	18.72	37.5	0.13	0.06	0.25	0.12	0	0	0	20	0	20	0	0	0	0												18.28	0.64	5.33	-	1.6	0.83	1.25	1	3.74	-	1.88	0.41	0.05	2.75	2.83	6.39	0.82	0.35	0.85	0.01	1.83	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.4	18.28	0.64	5.33	-	1.6	0.83	1.25	1	3.74	-	1.88	0.41	0.05	2.75	2.83	6.39	0.82	0.35	0.85	0.01	1.83	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.4
H2001_006_0	2006											1500											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1471.81	81.36	944.56	0	235.92	7.63	11.57	443.48	34.58	0	21.17	3.78	0.49	25.4	3663.9	4420.03	284.64	2.88	14.58	399.98	16.86	0	0	0	117.8	0	210.9	0	0	0	0											75	75	25	0	150	20	20	50	5	0	0/5	5	20	5/40/20/10	May-00	10	20/10	5	0/5	0/10	20	0			10		10															75	75	25	0	150	0.2	0.2	50	0.05	0	0.04	0.05	0.2	0.05	5	9.36	17.5	0.05	0.03	0.3	0.2	0	0	0	10	0	10	0	0	0	0												50.92	49.56	16.52	0	99.12	0.13	0.13	33.04	0.03	0	0.03	0.03	0.13	0.03	5	9.36	17.5	0.04	0.02	0.3	0.13	0	0	0	10	0	10	0	0	0	0												6.25	0.34	1.3	-	1.95	1.01	1.53	1.22	1.14	-	0.57	0.13	0.06	0.87	1.53	3.45	0.42	0.1	0.26	0.01	2.23	-	-	-	0.1	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.62	6.25	0.34	1.3	-	1.95	1.01	1.53	1.22	1.14	-	0.57	0.13	0.06	0.87	1.53	3.45	0.42	0.1	0.26	0.01	2.23	-	-	-	0.1	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.62
H2001_007_0	2006											600											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1639.41	91.58	859.63		300.88	9.73	14.75	659.54	51.43		33.43	5.63	0.73	37.87	8750.56	5386.25	384.14	3.43	19.6	485.82	20.47				117.8		307.52															25	25	15		100	20	20	40	15		0/10	15	20	15/10/8/4	Feb-00	4	04-Aug	10	0/10	0/4	20				4.00/5.00		4															25	25	15		100	0.2	0.2	40	0.01		0.02	0.05	0.2	0.1	1.08	3.74	7	0.12	0.1	0.15	0.2				4		4																16.1	15.6	9.36		62.38	0.12	0.12	24.95	0.01		0.01	0.03	0.12	0.06	1.08	3.74	7	0.08	0.06	0.15	0.12				4		4																2.2	0.12	0.67	-	1.56	1.21	1.84	1.37	0.4	-	0.48	0.18	0.09	2.26	0.78	1.68	0.22	0.27	1.19	0.01	2.55	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.25	2.2	0.12	0.67	-	1.56	1.21	1.84	1.37	0.4	-	0.48	0.18	0.09	2.26	0.78	1.68	0.22	0.27	1.19	0.01	2.55	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.25
H2001_801_0	2006											3300											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1440.7	74.02	916.87		226.8	7.21	11.21	423.83	34.4		21.15	3.71	0.5	24.82	3640.32	4415.08	255.62	2.86	14.49	394.75	17.02				126.64		226.72															265	175	150		150	30	30	50	30	20	20/30	30	30	30/40/30	25/0	35	40/30	30	0/30	0/35	30				35		35															265	175	150		150	0.3	0.3	50	0.3		0.25	0.3	0.3	0.3	25.2	32.77	10.5	0.3	0.16	0.45	0.3				35		35																159.67	101.45	86.96		86.96	0.17	0.17	28.99	0.17		0.14	0.17	0.17	0.17	25.2	32.77	10.5	0.2	0.09	0.45	0.17				35		35																19.17	0.63	6.64	-	1.64	1.25	1.95	1.02	5.98	-	3.02	0.65	0.09	4.26	7.65	12.06	0.22	0.56	1.35	0.01	2.96	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.15	19.17	0.63	6.64	-	1.64	1.25	1.95	1.02	5.98	-	3.02	0.65	0.09	4.26	7.65	12.06	0.22	0.56	1.35	0.01	2.96	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.15
H2003_001_0	2006	OP Facility - Emergency										1000											D	D	D	P	P	P	P	V	V	P	P	V	P	V	P	V	P	V		V	S	V	P		P	P	P					V																																																				-	2171.39	154.38			1731.95			173.82								1240.29		0.33		116.74												96.33										75	7500			15 per trip			30								15		15		15												20										75	75			5			30								15		15		15												20											70.38	70.38			4.69			28.15								14.08		14.08		14.08												18.77											12.73	0.91	-	-	0.68	-	-	0.41	-	-	-	-	-	-	-	1.45	-	0	-	0.14	-	-	-	-	-	-	-	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	16.47	12.73	0.91	-	-	0.68	-	-	0.41	-	-	-	-	-	-	-	1.45	-	0	-	0.14	-	-	-	-	-	-	-	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	16.47
H2108_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P						0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	458.62	15.6	90.27	0	16.73	23.41	5.72	909.36	31.04	23.08	13.29	0.31	0.86	22.35	6.52	167.04	4.61	11.42	33.19	3.99	27.35	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	0 for ER/mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	0 for NP/mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	27.91	0.95	14.28	-	3.9	5.45	1.33	3.79	7.23	5.38	3.1	0.07	0.2	5.21	1.52	38.92	1.07	2.66	7.73	0.93	6.37	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	138.02	27.91	0.95	14.28	-	3.9	5.45	1.33	3.79	7.23	5.38	3.1	0.07	0.2	5.21	1.52	38.92	1.07	2.66	7.73	0.93	6.37	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	138.02
H2108_002_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P					0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	330.12	8.64	54.23	0	8.9	12.07	2.71	692.48	18.27	15.45	6.35	0.15	0.22	9.92	6.51	109.71	2.32	6.4	19.61	2.41	18.86	0.09	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	0 for ER/mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	0 for NP /mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	20.54	0.54	8.46	-	2.07	2.81	0.63	2.89	4.26	3.6	1.48	0.04	0.05	2.31	1.52	25.56	0.54	1.49	4.57	0.56	4.39	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.33	20.54	0.54	8.46	0	2.07	2.81	0.63	2.89	4.26	3.6	1.48	0.04	0.05	2.31	1.52	25.56	0.54	1.49	4.57	0.56	4.39	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.33
H2108_005_0	2006																						A	A	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	436.76	13.37	54.23	0	8.9	12.07	2.71	692.48	18.27	15.45	6.35	0.15	0.22	9.92	6.51	109.71	2.32	6.4	19.61	2.41	18.86	0.09	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	175	175	20	20	20	20	20	50	20/APC	20/APC	20/APC	20/APC	20/APC	20/APC	20	0 for ER/20 for other	20	20	20	0 for NP /20 for other	20	20																				175	175	0.16	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		175	175	0.16	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		6.37	0.19	8.46	-	1.78	2.42	0.54	2.89	3.66	3.1	1.27	0.03	0.04	1.99	1.31	21.99	0.47	1.28	3.93	0.48	3.78	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66	6.37	0.19	8.46	-	1.78	2.42	0.54	2.89	3.66	3.1	1.27	0.03	0.04	1.99	1.31	21.99	0.47	1.28	3.93	0.48	3.78	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66
H2108_017_0	2006																						A	A	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P					0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	436.76	13.37	54.23	0	8.9	12.07	2.71	692.48	18.27	15.45	6.35	0.15	0.22	9.92	6.51	109.71	2.32	6.4	19.61	2.41	18.86	0.09	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	200	200	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	0 for ER/mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	0 for NP /mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				200	200	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		200	200	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	7.28	0.22	8.46	-	2.07	2.81	0.63	2.89	4.26	3.6	1.48	0.04	0.05	2.31	1.52	25.56	0.54	1.49	4.57	0.56	4.39	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.76	7.28	0.22	8.46	0	2.07	2.81	0.63	2.89	4.26	3.6	1.48	0.04	0.05	2.31	1.52	25.56	0.54	1.49	4.57	0.56	4.39	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.76
H2111_001_0	2006											200											D	D	D	P	P	P	P	V	V	P	P	V	P	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	1797.24				1871.28																																					25 first 8 days				15 per Trip																																					25				5																																						13.17				2.63																																						1.97	-	-	-	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.38	1.97	-	-	-	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.38
H2111_002_0	2006											200											D	D	D	P	P	P	P	V	V	P	P	V	P	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	2695.86				1871.28																																					25 first 8 days				15 per Trip																																					25				5																																						10.36				2.07																																						2.33	-	-	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.65	2.33	-	-	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.65
H2111_003_0	2006											1200											D	D	D	P	P	P	P	V	V	P	P	V	P	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	2421.1	82.79			1738.51			139.21																																		150 first 8 days	150 first 8 days			75 per Trip			50																																		150	150			25			50																																			66.83	66.83			11.14			50																																			13.48	0.46	-	-	1.61	-	-	0.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.14	13.48	0.46	-	-	1.61	-	-	0.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.14
H2112_001_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1721.4	17.39	1296.53	1611.16	138.81	4.36	0.04	216.76	47.88	301.41	193.17	0	37.69	50.39	523.54	8253.22	0.37	559.3	2.22	0	285.6	523.22			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-10 75/d 11-100 days																																							122.35	122.35	47.6	20	100	0.2	0.2	48	100	30	50	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	47.6	20	100	0.2	0.2	48	100	30	50	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	17.55	0.18	5.14	2.69	1.16	0.87	0.01	0.87	0.4	0.75	0.8	-	0.09	0.13	0.65	20.63	0	1.4	0.01	-	1.07	1.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.71	17.55	0.18	5.14	2.69	1.16	0.87	0.01	0.87	0.4	0.75	0.8	-	0.09	0.13	0.65	20.63	0	1.4	0.01	-	1.07	1.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.71
H2112_002_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1737.58	17.55	1296.53	1611.16	138.81	4.36	0.04	216.76	47.88	304.81	195.74	0	38.11	50.96	530.42	8432.63	0.38	571.46	2.26	0	285.6	523.22			0	0	0	0	0	0	0											250/admission	250/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0												40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0											0	5.9	0.06	7.65	2.69	1.16	0.87	0.01	0.87	0.4	0.51	0.98	-	0.06	0.08	0.44	14.05	0	0.95	0	-	1.07	0.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.64	5.9	0.06	7.65	2.69	1.16	0.87	0.01	0.87	0.4	0.51	0.98	-	0.06	0.08	0.44	14.05	0	0.95	0	-	1.07	0.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.64
H2112_003_0	2006											4000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1701.08	17.18	1296.53	1611.16	138.81	4.36	0.04	216.76	47.75	304.81	195.69	0	38.11	50.96	530.42	8432.63	0.38	571.46	2.26	0	285.6	523.22			0	0	0	0	0	0	0											15 per Stay	15 per Stay	0/d 1-9 75/d 10-19 125 20-100 days																																							277.5	277.5	70.85	20	100	0.2	0.2	48	112.5	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0												217.62	217.62	55.56	15.68	78.42	0.16	0.16	37.64	88.22	15.68	47.05	0	15.68	15.68	7.84	15.68	15.68	15.68	15.68	0	45	15.68			0	0	0	0	0	0	0											500	30.85	0.31	6	2.11	0.91	0.68	0.01	0.68	0.35	0.4	0.77	-	0.05	0.07	0.35	11.02	0	0.75	0	-	1.07	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.05	30.85	0.31	6	2.11	0.91	0.68	0.01	0.68	0.35	0.4	0.77	-	0.05	0.07	0.35	11.02	0	0.75	0	-	1.07	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.05
H2112_007_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1721.4	17.39	1296.53	1611.16	138.81	4.36	0.04	216.76	47.88	301.41	193.17	0	37.69	50.39	523.54	8253.22	0.37	559.3	2.22	0	285.6	523.22			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	17.55	0.18	7.65	2.69	1.16	0.87	0.01	0.87	0.4	0.75	1.05	-	0.09	0.13	0.65	20.63	0	1.4	0.01	-	1.07	1.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.46	17.55	0.18	7.65	2.69	1.16	0.87	0.01	0.87	0.4	0.75	1.05	-	0.09	0.13	0.65	20.63	0	1.4	0.01	-	1.07	1.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.46
H2112_008_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1744.69	17.62	1296.53	1611.16	138.81	4.36	0.04	216.76	47.88	313.33	196.41	0	39.18	52.38	596.72	8701.76	0.39	589.7	2.34	0	285.6	523.22			0	0	0	0	0	0	0											0 Copay	0 Copay	0/d 1-10 75/d 11-100 days																																							0	0	47.6	20	100	0.2	0.2	48	100	10	40	0	10	10	0	10	10	10	10	0	45	10			0	0	0	0	0	0	0												0	0	47.6	20	100	0.2	0.2	48	100	10	40	0	10	10	0	10	10	10	10	0	45	10			0	0	0	0	0	0	0											0	-	-	5.14	2.69	1.16	0.87	0.01	0.87	0.4	0.26	0.65	-	0.03	0.04	-	7.25	0	0.49	0	-	1.07	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.38	-	-	5.14	2.69	1.16	0.87	0.01	0.87	0.4	0.26	0.65	-	0.03	0.04	-	7.25	0	0.49	0	-	1.07	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.38
H2112_009_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1744.69	17.62	1296.53	1611.16	138.81	4.36	0.04	216.76	47.88	313.33	195.83	0	39.18	52.38	596.72	8701.76	0.39	589.7	2.34	0	285.6	523.22			0	0	0	0	0	0	0											0 copay	0 copay	0/d 1-9 75/d 10-19 125 20-100 days																																							0	0	70.85	20	100	0.2	0.2	48	100	10	55	0	10	10	0	10	10	10	10	0	45	10			0	0	0	0	0	0	0												0	0	70.85	20	100	0.2	0.2	48	100	10	55	0	10	10	0	10	10	10	10	0	45	10			0	0	0	0	0	0	0											0	-	-	7.65	2.69	1.16	0.87	0.01	0.87	0.4	0.26	0.9	-	0.03	0.04	-	7.25	0	0.49	0	-	1.07	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.13	-	-	7.65	2.69	1.16	0.87	0.01	0.87	0.4	0.26	0.9	-	0.03	0.04	-	7.25	0	0.49	0	-	1.07	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.13
H2112_011_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1739.4	17.57	1296.53	1611.16	138.81	4.36	0.04	216.76	47.88	309.07	195.83	0	38.64	51.67	596.72	8522.34	0.38	577.54	2.29	0	285.6	523.22			0	0	0	0	0	0	0											50/day for days 1-5	50/day for days 1-5	0/d 1-9 75/d 10-19 125 20-100 days																																							30.34	30.34	70.85	20	100	0.2	0.2	48	100	15	57.5	0	15	15	0	15	15	15	15	0	45	15			0	0	0	0	0	0	0												30.34	30.34	70.85	20	100	0.2	0.2	48	100	15	57.5	0	15	15	0	15	15	15	15	0	45	15			0	0	0	0	0	0	0											0	4.4	0.04	7.65	2.69	1.16	0.87	0.01	0.87	0.4	0.39	0.94	-	0.05	0.06	-	10.65	0	0.72	0	-	1.07	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.63	4.4	0.04	7.65	2.69	1.16	0.87	0.01	0.87	0.4	0.39	0.94	-	0.05	0.06	-	10.65	0	0.72	0	-	1.07	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.63
H2112_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1840.4	18.59	1273.72	1673	148.89	4.68	0.05	229.99	47.38	337.61	207.2		40.41	54.04	497.82	8756.27	0.39	593.4	2.35		285.6	561.21																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																				0	22.04	0.22	10.61	4.88	1.86	1.4	0.01	0.96	0.59	0.24	1.6	-	0.12	0.16	1.45	25.54	0	1.73	0.01	-	1.61	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.68	22.04	0.22	10.61	4.88	1.86	1.4	0.01	0.96	0.59	0.24	1.6	-	0.12	0.16	1.45	25.54	0	1.73	0.01	-	1.61	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.68
H2112_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1840.4	18.59	1273.72	1673	148.89	4.68	0.05	229.99	47.38	337.61	207.2		40.41	54.04	497.82	8756.27	0.39	593.4	2.35		285.6	561.21																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																				0	22.04	0.22	10.61	4.88	1.86	1.4	0.01	0.96	0.59	0.24	1.6	-	0.12	0.16	1.45	25.54	0	1.73	0.01	-	1.61	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.68	22.04	0.22	10.61	4.88	1.86	1.4	0.01	0.96	0.59	0.24	1.6	-	0.12	0.16	1.45	25.54	0	1.73	0.01	-	1.61	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.68
H2112_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1840.4	18.59	1273.72	1673	148.89	4.68	0.05	229.99	47.38	337.61	207.2		40.41	54.04	497.82	8756.27	0.39	593.4	2.35		285.6	561.21																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																				0	22.04	0.22	10.61	4.88	1.86	1.4	0.01	0.96	0.59	0.24	1.6	-	0.12	0.16	1.45	25.54	0	1.73	0.01	-	1.61	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.68	22.04	0.22	10.61	4.88	1.86	1.4	0.01	0.96	0.59	0.24	1.6	-	0.12	0.16	1.45	25.54	0	1.73	0.01	-	1.61	1.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.68
H2204_007_0	2006																						A							V							V	V	V	V		V					V		V			V																																																						-	271.61							718.39							5513.91	4537.23	617.97	2531.06				618.22			357.96		37.96			162.9												300 per Stay up to Max of 600 per Year																15 for each individual therapy visit 1-8; 25 for each individual therapy visit 9-20; 50 for each individual therapy visit 21+; 5 for each group therapy visist 1-20; 50 for each group therapy visit 21+					15 for each Medicare Covered Hearing Exam and Vision Exam																				273.21							50							15	15	17.25	15				15			15		15			15													273.21							50							15	15	17.25	15				15			15		15			15													6.18	-	-	-	-	-	-	2.99	-	-	-	-	-	-	6.89	5.67	0.89	3.16	-	-	-	0.77	-	-	0.45	-	0.05	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	27.26	6.18	-	-	-	-	-	-	2.99	-	-	-	-	-	-	6.89	5.67	0.89	3.16	-	-	-	0.77	-	-	0.45	-	0.05	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	27.26
H2204_008_0	2006																						A							V							V	V	V	V				V			V		V			V																																																						-	271.61							718.39							5513.91	4537.23	617.97	2531.06				618.22			357.96		37.96			162.9												300 per Stay up to Max of 600 per Year																15 for each individual therapy visit 1-8; 25 for each individual therapy visit 9-20; 50 for each individual therapy visit 21+; 5 for each group therapy visist 1-20; 50 for each group therapy visit 21+					15 for each Medicare Covered Hearing Exam and Vision Exam																				273.21							50							15	15	17.25	15				15			15		15			15													273.21							50							15	15	17.25	15				15			15		15			15													6.18	-	-	-	-	-	-	2.99	-	-	-	-	-	-	6.89	5.67	0.89	3.16	-	-	-	0.77	-	-	0.45	-	0.05	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	27.26	6.18	-	-	-	-	-	-	2.99	-	-	-	-	-	-	6.89	5.67	0.89	3.16	-	-	-	0.77	-	-	0.45	-	0.05	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	27.26
H2204_801_0	2006																						A							V							V	V	V	V				V			V		V			V																																																						-	183.88							561.95							4752.52	3849.59	473.43	2311.83				550			321.72		34.97			136.36												300 per Stay up to Max of 600 per Year																15 for each individual therapy visit 1-8; 25 for each individual therapy visit 9-20; 50 for each individual therapy visit 21+; 5 for each group therapy visist 1-20; 50 for each group therapy visit 21+					15 for each Medicare Covered Hearing Exam and Vision Exam																				267.69							50							15	15	17.25	15				15			15		15			15													267.69							50							15	15	17.25	15				15			15		15			15													4.1	-	-	-	-	-	-	2.34	-	-	-	-	-	-	5.94	4.81	0.68	2.89	-	-	-	0.69	-	-	0.4	-	0.04	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	22.07	4.1	-	-	-	-	-	-	2.34	-	-	-	-	-	-	5.94	4.81	0.68	2.89	-	-	-	0.69	-	-	0.4	-	0.04	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	22.07
H2204_802_0	2006																						A							V							V	V	V	V				V			V		V			V																																																						-	183.88							561.95							4752.52	3849.59	473.43	2311.83				550			321.72		34.97			136.36												300 per Stay up to Max of 600 per Year																15 for each individual therapy visit 1-8; 25 for each individual therapy visit 9-20; 50 for each individual therapy visit 21+; 5 for each group therapy visist 1-20; 50 for each group therapy visit 21+					15 for each Medicare Covered Hearing Exam and Vision Exam																				267.69							50							15	15	17.25	15				15			15		15			15													267.69							50							15	15	17.25	15				15			15		15			15													4.1	-	-	-	-	-	-	2.34	-	-	-	-	-	-	5.94	4.81	0.68	2.89	-	-	-	0.69	-	-	0.4	-	0.04	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	22.07	4.1	-	-	-	-	-	-	2.34	-	-	-	-	-	-	5.94	4.81	0.68	2.89	-	-	-	0.69	-	-	0.4	-	0.04	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	22.07
H2206_003_0	2006																						A							V							V	V	V	V				V			V		V			V																																																						-	322.38							749.57							4333.07	4555.14	549.47	1718.49				651.93			381.1		56.24			53.1												300 per Stay up to Max of 600 per Year																15 for each individual therapy visit 1-8; 25 for each individual therapy visit 9-20; 50 for each individual therapy visit 21+; 5 for each group therapy visist 1-20; 50 for each group therapy visit 21+					15 for each Medicare Covered Hearing Exam and Vision Exam																				258.54							50							15	15	17.25	15				15			15		15			15													258.54							50							15	15	17.25	15				15			15		15			15													6.95	-	-	-	-	-	-	3.12	-	-	-	-	-	-	5.42	5.69	0.79	2.15	-	-	-	0.81	-	-	0.48	-	0.07	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	25.55	6.95	-	-	-	-	-	-	3.12	-	-	-	-	-	-	5.42	5.69	0.79	2.15	-	-	-	0.81	-	-	0.48	-	0.07	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	25.55
H2206_013_0	2006																						A							V							V	V	V	V				V			V		V			V																																																						-	322.38							749.57							4333.07	4555.14	549.47	1718.49				651.93			381.1		56.24			53.1												300 per Stay up to Max of 600 per Year																15 for each individual therapy visit 1-8; 25 for each individual therapy visit 9-20; 50 for each individual therapy visit 21+; 5 for each group therapy visist 1-20; 50 for each group therapy visit 21+					15 for each Medicare Covered Hearing Exam and Vision Exam																				258.54							50							15	15	17.25	15				15			15		15			15													258.54							50							15	15	17.25	15				15			15		15			15													6.95	-	-	-	-	-	-	3.12	-	-	-	-	-	-	5.42	5.69	0.79	2.15	-	-	-	0.81	-	-	0.48	-	0.07	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	25.55	6.95	-	-	-	-	-	-	3.12	-	-	-	-	-	-	5.42	5.69	0.79	2.15	-	-	-	0.81	-	-	0.48	-	0.07	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	25.55
H2206_014_0	2006																						A							V							V	V	V	V				V			V		V			V																																																						-	322.38							749.57							4333.07	4555.14	549.47	1718.49				651.93			381.1		56.24			53.1												300 per Stay up to Max of 600 per Year																15 for each individual therapy visit 1-8; 25 for each individual therapy visit 9-20; 50 for each individual therapy visit 21+; 5 for each group therapy visist 1-20; 50 for each group therapy visit 21+					15 for each Medicare Covered Hearing Exam and Vision Exam																				258.54							50							15	15	17.25	15				15			15		15			15													258.54							50							15	15	17.25	15				15			15		15			15													6.95	-	-	-	-	-	-	3.12	-	-	-	-	-	-	5.42	5.69	0.79	2.15	-	-	-	0.81	-	-	0.48	-	0.07	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	25.55	6.95	-	-	-	-	-	-	3.12	-	-	-	-	-	-	5.42	5.69	0.79	2.15	-	-	-	0.81	-	-	0.48	-	0.07	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	25.55
H2206_801_0	2006																						A							V							V	V	V	V				V			V		V			V																																																						-	275.16							622.35							4105.73	4830.32	490	2056.6				671.4			392.17		58.83			63.03												300 per Stay up to Max of 600 per Year																15 for each individual therapy visit 1-8; 25 for each individual therapy visit 9-20; 50 for each individual therapy visit 21+; 5 for each group therapy visist 1-20; 50 for each group therapy visit 21+					15 for each Medicare Covered Hearing Exam and Vision Exam																				264.17							50							15	15	17.25	15				15			15		15			15													264.17							50							15	15	17.25	15				15			15		15			15													6.06	-	-	-	-	-	-	2.59	-	-	-	-	-	-	5.13	6.04	0.7	2.57	-	-	-	0.84	-	-	0.49	-	0.07	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	24.58	6.06	-	-	-	-	-	-	2.59	-	-	-	-	-	-	5.13	6.04	0.7	2.57	-	-	-	0.84	-	-	0.49	-	0.07	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	24.58
H2206_802_0	2006																						A							V							V	V	V	V				V			V		V			V																																																						-	275.16							622.35							4105.73	4830.32	490	2056.6				671.4			392.17		58.83			63.03												300 per Stay up to Max of 600 per Year																15 for each individual therapy visit 1-8; 25 for each individual therapy visit 9-20; 50 for each individual therapy visit 21+; 5 for each group therapy visist 1-20; 50 for each group therapy visit 21+					15 for each Medicare Covered Hearing Exam and Vision Exam																				264.17							50							15	15	17.25	15				15			15		15			15													264.17							50							15	15	17.25	15				15			15		15			15													6.06	-	-	-	-	-	-	2.59	-	-	-	-	-	-	5.13	6.04	0.7	2.57	-	-	-	0.84	-	-	0.49	-	0.07	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	24.58	6.06	-	-	-	-	-	-	2.59	-	-	-	-	-	-	5.13	6.04	0.7	2.57	-	-	-	0.84	-	-	0.49	-	0.07	-	-	0.08	-	-	-	-	-	-	-	-	-	-	-	24.58
H2224_001_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H2225_001_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																															-	1		1		1	1		1	1	1					1						1																																																																																																								27.46		21.94		6.28	17.44		3.54	6.54	10.67					113.64						0.62																						27.46	-	21.94	-	6.28	17.44	-	3.54	6.54	10.67	-	-	-	-	113.64	-	-	-	-	-	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	208.13	27.46	-	21.94	-	6.28	17.44	-	3.54	6.54	10.67	-	-	-	-	113.64	-	-	-	-	-	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	208.13
H2226_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	443.44	16.28	111.92		22.39	40.33	36.75	25.05	37.44	29.94	25.91	2.9	4.61	53.43	35.17	40.35	7.27	8.27	30.2	164.96	27.97	0.39																				FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co	FFS Ded/Co																				0.07	0.07	0.17		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.17		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				110	29.61	1.09	19.03	-	5.22	9.4	8.56	5.84	8.72	6.98	6.04	0.68	1.07	12.45	8.2	9.4	1.69	1.93	7.04	38.44	6.52	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	187.97	29.61	1.09	19.03	-	5.22	9.4	8.56	5.84	8.72	6.98	6.04	0.68	1.07	12.45	8.2	9.4	1.69	1.93	7.04	38.44	6.52	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	187.97
H2228_001_0	2006	OP Facility - Emergency										1000											D	D	D	P	P	Coin	Coin	V	V	P	P	V	P	V	P	V	V	V		V	S	V	P		P	P	P					V																																																				-	1747.45	201.95			1876.56	22.85	10.82	252.22																								201.5										250 first 5 days	250 first 5 days			50/trip	20	20	50																								25										250	250			16.67	0.2	0.2	50																								25											68.23	68.23			4.55	0.05	0.05	13.65																								6.82											9.94	1.15	-	-	0.71	1.25	0.59	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.11	-	-	-	-	-	-	-	-	-	14.03	9.94	1.15	-	-	0.71	1.25	0.59	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.11	-	-	-	-	-	-	-	-	-	14.03
H2228_002_0	2006											1500											D	D	D	P	P	Coin	Coin	V	V	P	P	V	Coin	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	1802.71				1759.91	20.1	9.52	236.54					0.1																													200 first 8 days				75/trip	20	20	50					20																													200				25	0.2	0.2	50					0.2																														103.9				12.99	0.2	0.2	25.97					0.2																														15.61	-	-	-	1.9	4.02	1.9	0.51	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.97	15.61	-	-	-	1.9	4.02	1.9	0.51	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.97
H2228_004_0	2006											600	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		P			T	V	V	P	V	P																																																								-	2199.76	505.16	872.06		325.44	33.7	29.68	868.46	348.27	1764.4	868.19	59.46	3.15	2259.28		3903.66	1122.47	721.19		878.22																						75 1st 20 days	75 1st 20 days	114 days 21-62		100	20	20	35	25	10	10	50	20	50		25	35 indiv/25 group	10		25																						75	75	60.08		100	0.2	0.2	35	25	10	10	50	0.2	46.38		25	32.5	13.53		25																							26.41	26.41	21.15		35.21	0.07	0.07	12.32	8.8	3.52	3.52	17.6	0.07	16.33		8.8	11.44	4.76		8.8																							4.84	1.11	1.54	-	0.95	2.37	2.09	0.89	0.26	0.52	0.25	0.09	0.22	3.07	-	2.86	1.07	0.29	-	0.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.08	4.84	1.11	1.54	-	0.95	2.37	2.09	0.89	0.26	0.52	0.25	0.09	0.22	3.07	-	2.86	1.07	0.29	-	0.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.08
H2229_001_1	2006											3000											D		D					V	Coin						V	V	V				Coin				V		V															3000																																										-	862.95	0	920.24	0	0	0	0	351.52	19.09	0	0	0	0	0	2997.64	4098.16	174.56	0	0	0	2.89	0	0	0	314.66	0	134.85	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	93.85	0	23.45	0	0	0	0	46.93	0.19	0	0	0	0	0	14.08	18.77	18.77	0	0	0	0.19	0	0	0	18.77	0	18.77	0	0	0	0												6.75	-	1.8	-	-	-	-	1.37	3.58	-	-	-	-	-	3.52	6.41	0.27	-	-	-	0.54	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.95	6.75	-	1.8	-	-	-	-	1.37	3.58	-	-	-	-	-	3.52	6.41	0.27	-	-	-	0.54	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.95
H2229_001_2	2006											3000											D		D					V	coin						V	V	V				Coin				V		V															3000																																										-	811.68	0	861.46	0	0	0	0	360.11	18.66	0	0	0	0	0	3030.99	4118.12	171.22	0	0	0	2.79	0	0	0	331.55	0	142.09	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	94.13	0	23.54	0	0	0	0	47.05	0.19	0	0	0	0	0	14.12	18.83	18.83	0	0	0	0.19	0	0	0	18.83	0	18.83	0	0	0	0												6.37	-	1.69	-	-	-	-	1.41	3.51	-	-	-	-	-	3.57	6.46	0.27	-	-	-	0.53	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.55	6.37	-	1.69	-	-	-	-	1.41	3.51	-	-	-	-	-	3.57	6.46	0.27	-	-	-	0.53	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.55
H2229_001_3	2006											3000											D		D					V	Coin						V	V	V				Coin				V		V															3000																																										-	745.15	0	795.73	0	0	0	0	361	15.48	0	0	0	0	0	2771.98	3605.12	121.65	0	0	0	2.13	0	0	0	324.18	0	138.94	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	95.32	0	23.83	0	0	0	0	47.66	0.19	0	0	0	0	0	14.3	19.06	19.06	0	0	0	0.19	0	0	0	19.06	0	19.06	0	0	0	0												5.92	-	1.58	-	-	-	-	1.43	2.95	-	-	-	-	-	3.3	5.73	0.19	-	-	-	0.41	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.25	5.92	-	1.58	-	-	-	-	1.43	2.95	-	-	-	-	-	3.3	5.73	0.19	-	-	-	0.41	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.25
H2229_010_1	2006											3000											D		D					V	Coin						V	V	V				Coin				V		V															3000																																										-	862.95	0	920.24	0	0	0	0	351.52	19.09	0	0	0	0	0	2997.64	4098.16	174.56	0	0	0	2.89	0	0	0	314.66	0	134.85	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	93.85	0	23.45	0	0	0	0	46.93	0.19	0	0	0	0	0	14.08	18.77	18.77	0	0	0	0.19	0	0	0	18.77	0	18.77	0	0	0	0												6.75	-	1.8	-	-	-	-	1.37	3.58	-	-	-	-	-	3.52	6.41	0.27	-	-	-	0.54	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.95	6.75	-	1.8	-	-	-	-	1.37	3.58	-	-	-	-	-	3.52	6.41	0.27	-	-	-	0.54	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.95
H2229_010_2	2006											3000											D		D					V	coin						V	V	V				Coin				V		V															3000																																										-	811.68	0	861.46	0	0	0	0	360.11	18.66	0	0	0	0	0	3030.99	4118.12	171.22	0	0	0	2.79	0	0	0	331.55	0	142.09	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	94.13	0	23.54	0	0	0	0	47.05	0.19	0	0	0	0	0	14.12	18.83	18.83	0	0	0	0.19	0	0	0	18.83	0	18.83	0	0	0	0												6.37	-	1.69	-	-	-	-	1.41	3.51	-	-	-	-	-	3.57	6.46	0.27	-	-	-	0.53	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.55	6.37	-	1.69	-	-	-	-	1.41	3.51	-	-	-	-	-	3.57	6.46	0.27	-	-	-	0.53	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.55
H2229_010_3	2006											3000											D		D					V	Coin						V	V	V				Coin				V		V															3000																																										-	745.15	0	795.73	0	0	0	0	361	15.48	0	0	0	0	0	2771.98	3605.12	121.65	0	0	0	2.13	0	0	0	324.18	0	138.94	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	95.32	0	23.83	0	0	0	0	47.66	0.19	0	0	0	0	0	14.3	19.06	19.06	0	0	0	0.19	0	0	0	19.06	0	19.06	0	0	0	0												5.92	-	1.58	-	-	-	-	1.43	2.95	-	-	-	-	-	3.3	5.73	0.19	-	-	-	0.41	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.25	5.92	-	1.58	-	-	-	-	1.43	2.95	-	-	-	-	-	3.3	5.73	0.19	-	-	-	0.41	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.25
H2229_011_1	2006											3000											D		D					V	Coin						V	V	V				Coin				V		V															3000																																										-	862.95	0	920.24	0	0	0	0	351.52	19.09	0	0	0	0	0	2997.64	4098.16	174.56	0	0	0	2.89	0	0	0	314.66	0	134.85	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	93.85	0	23.45	0	0	0	0	46.93	0.19	0	0	0	0	0	14.08	18.77	18.77	0	0	0	0.19	0	0	0	18.77	0	18.77	0	0	0	0												6.75	-	1.8	-	-	-	-	1.37	3.58	-	-	-	-	-	3.52	6.41	0.27	-	-	-	0.54	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.95	6.75	-	1.8	-	-	-	-	1.37	3.58	-	-	-	-	-	3.52	6.41	0.27	-	-	-	0.54	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.95
H2229_011_2	2006											3000											D		D					V	coin						V	V	V				Coin				V		V															3000																																										-	811.68	0	861.46	0	0	0	0	360.11	18.66	0	0	0	0	0	3030.99	4118.12	171.22	0	0	0	2.79	0	0	0	331.55	0	142.09	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	94.13	0	23.54	0	0	0	0	47.05	0.19	0	0	0	0	0	14.12	18.83	18.83	0	0	0	0.19	0	0	0	18.83	0	18.83	0	0	0	0												6.37	-	1.69	-	-	-	-	1.41	3.51	-	-	-	-	-	3.57	6.46	0.27	-	-	-	0.53	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.55	6.37	-	1.69	-	-	-	-	1.41	3.51	-	-	-	-	-	3.57	6.46	0.27	-	-	-	0.53	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.55
H2229_011_3	2006											3000											D		D					V	Coin						V	V	V				Coin				V		V															3000																																										-	745.15	0	795.73	0	0	0	0	361	15.48	0	0	0	0	0	2771.98	3605.12	121.65	0	0	0	2.13	0	0	0	324.18	0	138.94	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	95.32	0	23.83	0	0	0	0	47.66	0.19	0	0	0	0	0	14.3	19.06	19.06	0	0	0	0.19	0	0	0	19.06	0	19.06	0	0	0	0												5.92	-	1.58	-	-	-	-	1.43	2.95	-	-	-	-	-	3.3	5.73	0.19	-	-	-	0.41	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.25	5.92	-	1.58	-	-	-	-	1.43	2.95	-	-	-	-	-	3.3	5.73	0.19	-	-	-	0.41	-	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.25
H2229_801_0	2006											3000											D		D					V	coin						V	V	V				Coin				V		V															3000																																										-	823.99	0	876.65	0	0	0	0	357	18.49	0	0	0	0	0	2992.14	4058.34	167.41	0	0	0	2.76	0	0	0	324.51	0	139.07	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	94.13	0	23.54	0	0	0	0	47.07	0.19	0	0	0	0	0	14.12	18.83	18.82	0	0	0	0.19	0	0	0	18.83	0	18.83	0	0	0	0												6.46	-	1.72	-	-	-	-	1.4	3.48	-	-	-	-	-	3.52	6.37	0.26	-	-	-	0.52	-	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.46	6.46	-	1.72	-	-	-	-	1.4	3.48	-	-	-	-	-	3.52	6.37	0.26	-	-	-	0.52	-	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.46
H2229_802_0	2006											3000											D		D					V	coin						V	V	V				Coin				V		V															3000																																										-	823.99	0	876.65	0	0	0	0	357	18.49	0	0	0	0	0	2992.14	4058.34	167.41	0	0	0	2.76	0	0	0	324.51	0	139.07	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	94.13	0	23.54	0	0	0	0	47.07	0.19	0	0	0	0	0	14.12	18.83	18.82	0	0	0	0.19	0	0	0	18.83	0	18.83	0	0	0	0												6.46	-	1.72	-	-	-	-	1.4	3.48	-	-	-	-	-	3.52	6.37	0.26	-	-	-	0.52	-	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.46	6.46	-	1.72	-	-	-	-	1.4	3.48	-	-	-	-	-	3.52	6.37	0.26	-	-	-	0.52	-	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.46
H2229_803_0	2006											3000											D		D					V	coin						V	V	V				Coin				V		V															3000																																										-	823.99	0	876.65	0	0	0	0	357	18.49	0	0	0	0	0	2992.14	4058.34	167.41	0	0	0	2.76	0	0	0	324.51	0	139.07	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	94.13	0	23.54	0	0	0	0	47.07	0.19	0	0	0	0	0	14.12	18.83	18.82	0	0	0	0.19	0	0	0	18.83	0	18.83	0	0	0	0												6.46	-	1.72	-	-	-	-	1.4	3.48	-	-	-	-	-	3.52	6.37	0.26	-	-	-	0.52	-	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.46	6.46	-	1.72	-	-	-	-	1.4	3.48	-	-	-	-	-	3.52	6.37	0.26	-	-	-	0.52	-	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.46
H2229_804_0	2006											3000											D		D					V	coin						V	V	V				Coin				V		V															3000																																										-	823.99	0	876.65	0	0	0	0	357	18.49	0	0	0	0	0	2992.14	4058.34	167.41	0	0	0	2.76	0	0	0	324.51	0	139.07	0	0	0	0											Days 1-5		Days 11-100																																							100	0	25	0	0	0	0	50	0.2	0	0	0	0	0	15	20	20	0	0	0	0.2	0	0	0	20	0	20	0	0	0	0											3000	94.13	0	23.54	0	0	0	0	47.07	0.19	0	0	0	0	0	14.12	18.83	18.82	0	0	0	0.19	0	0	0	18.83	0	18.83	0	0	0	0												6.46	-	1.72	-	-	-	-	1.4	3.48	-	-	-	-	-	3.52	6.37	0.26	-	-	-	0.52	-	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.46	6.46	-	1.72	-	-	-	-	1.4	3.48	-	-	-	-	-	3.52	6.37	0.26	-	-	-	0.52	-	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.46
H2230_002_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	1538.77	57.94	2417.97	1960.05	384.29	1289.47	352.66	667.03	311.69	2496.63	1332.66	60.94	24.58	3264.13	4320.64	8570.57	303.43	572.42	4072.57	9523.71	404.22	110.56	0	306.03	1044.47	179.54	49.46	17.3	0	40.33	385.87																																																				48.31	39.45	10.45	0.07	37.68	11.38	7.46	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51											6000	48.31	39.45	10.45	0.07	37.68	11.15	6.44	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51												6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69	6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69
H2230_003_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V											4000																																										-	1985.08	123.85	2921.79	2814.98	437.23	1270.11	327.49	836.22	397.63	2639.22	1953.85	188.89	14.44	4179.71	5158.97	8897.45	347.65	950.29	3749.99	10113.42	860.59	111.41	0	264.23	978.6	127.64	51.49	11.54	0	36.2	381.26																																																				45.63	36.65	9.98	0.07	29.36	11.6	7.11	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99											6000	45.63	36.65	9.98	0.07	29.36	11.32	6.93	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99												7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11	7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11
H2230_004_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				41.8	25.8	10.22	0.07	30.37	13.71	9.62	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36											6000	41.8	25.8	10.22	0.07	30.37	13.38	9.37	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36												6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98	6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98
H2230_005_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				38.63	26.13	11.51	0.19	45.02	13.71	9.62	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04											6000	38.63	26.13	11.51	0.19	45.02	13.38	9.37	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04												6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85	6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85
H2230_006_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	1538.77	57.94	2417.97	1960.05	384.29	1289.47	352.66	667.03	311.69	2496.63	1332.66	60.94	24.58	3264.13	4320.64	8570.57	303.43	572.42	4072.57	9523.71	404.22	110.56	0	306.03	1044.47	179.54	49.46	17.3	0	40.33	385.87																																																				48.31	39.45	10.45	0.07	37.68	11.38	7.46	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51											6000	48.31	39.45	10.45	0.07	37.68	11.15	6.44	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51												6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69	6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69
H2230_007_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V											4000																																										-	1985.08	123.85	2921.79	2814.98	437.23	1270.11	327.49	836.22	397.63	2639.22	1953.85	188.89	14.44	4179.71	5158.97	8897.45	347.65	950.29	3749.99	10113.42	860.59	111.41	0	264.23	978.6	127.64	51.49	11.54	0	36.2	381.26																																																				45.63	36.65	9.98	0.07	29.36	11.6	7.11	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99											6000	45.63	36.65	9.98	0.07	29.36	11.32	6.93	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99												7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11	7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11
H2230_008_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				41.8	25.8	10.22	0.07	30.37	13.71	9.62	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36											6000	41.8	25.8	10.22	0.07	30.37	13.38	9.37	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36												6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98	6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98
H2230_009_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				38.63	26.13	11.51	0.19	45.02	13.71	9.62	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04											6000	38.63	26.13	11.51	0.19	45.02	13.38	9.37	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04												6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85	6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85
H2230_010_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	1538.77	57.94	2417.97	1960.05	384.29	1289.47	352.66	667.03	311.69	2496.63	1332.66	60.94	24.58	3264.13	4320.64	8570.57	303.43	572.42	4072.57	9523.71	404.22	110.56	0	306.03	1044.47	179.54	49.46	17.3	0	40.33	385.87																																																				48.31	39.45	10.45	0.07	37.68	11.38	7.46	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51											6000	48.31	39.45	10.45	0.07	37.68	11.15	6.44	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51												6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69	6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69
H2230_011_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V											4000																																										-	1985.08	123.85	2921.79	2814.98	437.23	1270.11	327.49	836.22	397.63	2639.22	1953.85	188.89	14.44	4179.71	5158.97	8897.45	347.65	950.29	3749.99	10113.42	860.59	111.41	0	264.23	978.6	127.64	51.49	11.54	0	36.2	381.26																																																				45.63	36.65	9.98	0.07	29.36	11.6	7.11	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99											6000	45.63	36.65	9.98	0.07	29.36	11.32	6.93	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99												7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11	7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11
H2230_012_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				41.8	25.8	10.22	0.07	30.37	13.71	9.62	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36											6000	41.8	25.8	10.22	0.07	30.37	13.38	9.37	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36												6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98	6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98
H2230_013_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				38.63	26.13	11.51	0.19	45.02	13.71	9.62	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04											6000	38.63	26.13	11.51	0.19	45.02	13.38	9.37	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04												6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85	6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85
H2230_801_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	1538.77	57.94	2417.97	1960.05	384.29	1289.47	352.66	667.03	311.69	2496.63	1332.66	60.94	24.58	3264.13	4320.64	8570.57	303.43	572.42	4072.57	9523.71	404.22	110.56	0	306.03	1044.47	179.54	49.46	17.3	0	40.33	385.87																																																				48.31	39.45	10.45	0.07	37.68	11.38	7.46	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51											6000	48.31	39.45	10.45	0.07	37.68	11.15	6.44	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51												6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69	6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69
H2230_802_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	1985.08	123.85	2921.79	2814.98	437.23	1270.11	327.49	836.22	397.63	2639.22	1953.85	188.89	14.44	4179.71	5158.97	8897.45	347.65	950.29	3749.99	10113.42	860.59	111.41	0	264.23	978.6	127.64	51.49	11.54	0	36.2	381.26																																																				45.63	36.65	9.98	0.07	29.36	11.6	7.11	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99											6000	45.63	36.65	9.98	0.07	29.36	11.32	6.93	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99												7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11	7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11
H2230_803_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				41.8	25.8	10.22	0.07	30.37	13.71	9.62	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36											6000	41.8	25.8	10.22	0.07	30.37	13.38	9.37	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36												6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98	6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98
H2230_804_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				38.63	26.13	11.51	0.19	45.02	13.71	9.62	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04											6000	38.63	26.13	11.51	0.19	45.02	13.38	9.37	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04												6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85	6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85
H2230_809_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	1538.77	57.94	2417.97	1960.05	384.29	1289.47	352.66	667.03	311.69	2496.63	1332.66	60.94	24.58	3264.13	4320.64	8570.57	303.43	572.42	4072.57	9523.71	404.22	110.56	0	306.03	1044.47	179.54	49.46	17.3	0	40.33	385.87																																																				48.31	39.45	10.45	0.07	37.68	11.38	7.46	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51											6000	48.31	39.45	10.45	0.07	37.68	11.15	6.44	5.55	69.5	0.76	0.72	1.25	0	2.56	10.02	12.5	24.74	14.86	0.04	3.42	7.08	21.97	0	24.99	19.71	96.79	1.49	1455.53	0	0	18.51												6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69	6.2	0.19	2.11	0.01	1.21	1.2	0.19	0.31	1.81	0.16	0.08	0.01	-	0.7	3.61	8.93	0.63	0.71	0.01	2.71	0.24	0.2	-	0.64	1.72	1.45	0.01	2.1	-	-	0.6	-	-	-	-	-	-	-	-	-	-	37.69
H2230_810_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	1985.08	123.85	2921.79	2814.98	437.23	1270.11	327.49	836.22	397.63	2639.22	1953.85	188.89	14.44	4179.71	5158.97	8897.45	347.65	950.29	3749.99	10113.42	860.59	111.41	0	264.23	978.6	127.64	51.49	11.54	0	36.2	381.26																																																				45.63	36.65	9.98	0.07	29.36	11.6	7.11	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99											6000	45.63	36.65	9.98	0.07	29.36	11.32	6.93	5.64	59.77	0.55	0.52	0.09	0	2.72	10.03	12.91	24.42	8.38	0.01	2.86	4.3	10.16	0	25.05	19.51	93.12	0.5	2124.24	0	0	15.99												7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11	7.55	0.38	2.43	0.02	1.07	1.2	0.19	0.39	1.98	0.12	0.08	0	-	0.95	4.31	9.57	0.71	0.66	0	2.41	0.31	0.09	-	0.55	1.59	0.99	0	2.04	-	-	0.51	-	-	-	-	-	-	-	-	-	-	40.11
H2230_811_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				41.8	25.8	10.22	0.07	30.37	13.71	9.62	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36											6000	41.8	25.8	10.22	0.07	30.37	13.38	9.37	6.5	70.6	0.88	0.74	0.04	0	2.08	9.89	13.67	25.46	12.84	0.02	3.21	5.37	24.58	0	25	20.56	97.59	0.27	1720.37	0	0	17.36												6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98	6.98	0.21	2.01	0.01	0.91	1.2	0.19	0.37	2.32	0.16	0.11	0	-	0.56	4.07	8.69	0.64	0.8	0.01	2.7	0.37	0.11	-	0.68	1.58	1.19	0	1.58	-	-	0.54	-	-	-	-	-	-	-	-	-	-	37.98
H2230_812_0	2006											2000											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V											4000																																										-	2003.15	97.53	2359.68	2244.31	360.77	1074.77	242.2	687.07	393.95	2185.22	1824.46	79.86	11.43	3226.48	4935.97	7627.18	299.61	747.94	3925.94	10116.18	832.8	54.65	0	325.1	922.16	146.7	56.9	11.02	0	35.72	370.54																																																				38.63	26.13	11.51	0.19	45.02	13.71	9.62	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04											6000	38.63	26.13	11.51	0.19	45.02	13.38	9.37	5.49	65.77	0.68	0.46	0.18	0	3.2	9.2	16.67	18.52	8.58	0.03	2.99	3.96	16.08	0	20.02	18.71	87.46	0.73	1870.92	0	0	19.04												6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85	6.45	0.21	2.26	0.04	1.35	1.2	0.19	0.31	2.16	0.12	0.07	0	-	0.86	3.78	10.6	0.46	0.53	0.01	2.52	0.27	0.07	-	0.54	1.44	1.07	0	1.72	-	-	0.59	-	-	-	-	-	-	-	-	-	-	38.85
H2256_001_1	2006																						A							V	V						V	V	V				S				V		V																																																									-	193.43	0	0	0	0	0	0	242.86	404	0	0	0	0	0	5237.89	4185.16	141.09	0	0	0	47.07	0	0	0	448.77	0	42.57	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.22	-	-	-	-	-	-	1.01	1.45	-	-	-	-	-	4.36	5.23	0.18	-	-	-	0.08	-	-	-	0.56	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.15	3.22	-	-	-	-	-	-	1.01	1.45	-	-	-	-	-	4.36	5.23	0.18	-	-	-	0.08	-	-	-	0.56	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.15
H2256_001_2	2006																						A							V	V						V	V	V				S				V		V																																																									-	133.72	0	0	0	0	0	0	320.02	359	0	0	0	0	0	4352.15	5092.74	139.2	0	0	0	41.77	0	0	0	403.15	0	23.48	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																2.23	-	-	-	-	-	-	1.33	1.29	-	-	-	-	-	3.63	6.37	0.17	-	-	-	0.07	-	-	-	0.5	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.62	2.23	-	-	-	-	-	-	1.33	1.29	-	-	-	-	-	3.63	6.37	0.17	-	-	-	0.07	-	-	-	0.5	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.62
H2256_001_3	2006																						A							V	V						V	V	V				S				V		V																																																									-	206.06	0	0	0	0	0	0	263.73	433	0	0	0	0	0	5330.95	4100.54	198.51	0	0	0	43.95	0	0	0	534.74	0	35.81	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.43	-	-	-	-	-	-	1.1	1.55	-	-	-	-	-	4.44	5.13	0.25	-	-	-	0.07	-	-	-	0.67	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.69	3.43	-	-	-	-	-	-	1.1	1.55	-	-	-	-	-	4.44	5.13	0.25	-	-	-	0.07	-	-	-	0.67	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.69
H2256_001_4	2006																						A							V	V						V	V	V				S				V		V																																																									-	204.86	0	0	0	0	0	0	358.49	365	0	0	0	0	0	4092.1	4704.75	199.76	0	0	0	72.35	0	0	0	502.97	0	20	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.41	-	-	-	-	-	-	1.49	1.31	-	-	-	-	-	3.41	5.88	0.25	-	-	-	0.12	-	-	-	0.63	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.53	3.41	-	-	-	-	-	-	1.49	1.31	-	-	-	-	-	3.41	5.88	0.25	-	-	-	0.12	-	-	-	0.63	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.53
H2256_001_5	2006																						A							V	V						V	V	V				S				V		V																																																									-	201.23	0	0	0	0	0	0	294.23	394	0	0	0	0	0	4618.34	4445.03	212.09	0	0	0	51.43	0	0	0	425.95	0	59.93	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.35	-	-	-	-	-	-	1.23	1.41	-	-	-	-	-	3.85	5.56	0.27	-	-	-	0.09	-	-	-	0.53	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.35	3.35	-	-	-	-	-	-	1.23	1.41	-	-	-	-	-	3.85	5.56	0.27	-	-	-	0.09	-	-	-	0.53	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.35
H2256_015_1	2006																						A							V	V						V	V	V				S				V		V																																																									-	193.43	0	0	0	0	0	0	242.86	404	0	0	0	0	0	5237.89	4185.16	141.09	0	0	0	47.07	0	0	0	448.77	0	42.57	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.22	-	-	-	-	-	-	1.01	1.45	-	-	-	-	-	4.36	5.23	0.18	-	-	-	0.08	-	-	-	0.56	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.15	3.22	-	-	-	-	-	-	1.01	1.45	-	-	-	-	-	4.36	5.23	0.18	-	-	-	0.08	-	-	-	0.56	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.15
H2256_015_2	2006																						A							V	V						V	V	V				S				V		V																																																									-	133.72	0	0	0	0	0	0	320.02	359	0	0	0	0	0	4352.15	5092.74	139.2	0	0	0	41.77	0	0	0	403.15	0	23.48	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																2.23	-	-	-	-	-	-	1.33	1.29	-	-	-	-	-	3.63	6.37	0.17	-	-	-	0.07	-	-	-	0.5	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.62	2.23	-	-	-	-	-	-	1.33	1.29	-	-	-	-	-	3.63	6.37	0.17	-	-	-	0.07	-	-	-	0.5	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.62
H2256_015_3	2006																						A							V	V						V	V	V				S				V		V																																																									-	206.06	0	0	0	0	0	0	263.73	433	0	0	0	0	0	5330.95	4100.54	198.51	0	0	0	43.95	0	0	0	534.74	0	35.81	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.43	-	-	-	-	-	-	1.1	1.55	-	-	-	-	-	4.44	5.13	0.25	-	-	-	0.07	-	-	-	0.67	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.69	3.43	-	-	-	-	-	-	1.1	1.55	-	-	-	-	-	4.44	5.13	0.25	-	-	-	0.07	-	-	-	0.67	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.69
H2256_015_4	2006																						A							V	V						V	V	V				S				V		V																																																									-	204.86	0	0	0	0	0	0	358.49	365	0	0	0	0	0	4092.1	4704.75	199.76	0	0	0	72.35	0	0	0	502.97	0	20	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.41	-	-	-	-	-	-	1.49	1.31	-	-	-	-	-	3.41	5.88	0.25	-	-	-	0.12	-	-	-	0.63	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.53	3.41	-	-	-	-	-	-	1.49	1.31	-	-	-	-	-	3.41	5.88	0.25	-	-	-	0.12	-	-	-	0.63	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.53
H2256_015_5	2006																						A							V	V						V	V	V				S				V		V																																																									-	201.23	0	0	0	0	0	0	294.23	394	0	0	0	0	0	4618.34	4445.03	212.09	0	0	0	51.43	0	0	0	425.95	0	59.93	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.35	-	-	-	-	-	-	1.23	1.41	-	-	-	-	-	3.85	5.56	0.27	-	-	-	0.09	-	-	-	0.53	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.35	3.35	-	-	-	-	-	-	1.23	1.41	-	-	-	-	-	3.85	5.56	0.27	-	-	-	0.09	-	-	-	0.53	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.35
H2256_016_1	2006																						A							V	V						V	V	V				S				V		V																																																									-	193.43	0	0	0	0	0	0	242.86	404	0	0	0	0	0	5237.89	4185.16	141.09	0	0	0	47.07	0	0	0	448.77	0	42.57	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.22	-	-	-	-	-	-	1.01	1.45	-	-	-	-	-	4.36	5.23	0.18	-	-	-	0.08	-	-	-	0.56	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.15	3.22	-	-	-	-	-	-	1.01	1.45	-	-	-	-	-	4.36	5.23	0.18	-	-	-	0.08	-	-	-	0.56	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.15
H2256_016_2	2006																						A							V	V						V	V	V				S				V		V																																																									-	133.72	0	0	0	0	0	0	320.02	359	0	0	0	0	0	4352.15	5092.74	139.2	0	0	0	41.77	0	0	0	403.15	0	23.48	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																2.23	-	-	-	-	-	-	1.33	1.29	-	-	-	-	-	3.63	6.37	0.17	-	-	-	0.07	-	-	-	0.5	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.62	2.23	-	-	-	-	-	-	1.33	1.29	-	-	-	-	-	3.63	6.37	0.17	-	-	-	0.07	-	-	-	0.5	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.62
H2256_016_3	2006																						A							V	V						V	V	V				S				V		V																																																									-	206.06	0	0	0	0	0	0	263.73	433	0	0	0	0	0	5330.95	4100.54	198.51	0	0	0	43.95	0	0	0	534.74	0	35.81	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.43	-	-	-	-	-	-	1.1	1.55	-	-	-	-	-	4.44	5.13	0.25	-	-	-	0.07	-	-	-	0.67	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.69	3.43	-	-	-	-	-	-	1.1	1.55	-	-	-	-	-	4.44	5.13	0.25	-	-	-	0.07	-	-	-	0.67	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.69
H2256_016_4	2006																						A							V	V						V	V	V				S				V		V																																																									-	204.86	0	0	0	0	0	0	358.49	365	0	0	0	0	0	4092.1	4704.75	199.76	0	0	0	72.35	0	0	0	502.97	0	20	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.41	-	-	-	-	-	-	1.49	1.31	-	-	-	-	-	3.41	5.88	0.25	-	-	-	0.12	-	-	-	0.63	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.53	3.41	-	-	-	-	-	-	1.49	1.31	-	-	-	-	-	3.41	5.88	0.25	-	-	-	0.12	-	-	-	0.63	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.53
H2256_016_5	2006																						A							V	V						V	V	V				S				V		V																																																									-	201.23	0	0	0	0	0	0	294.23	394	0	0	0	0	0	4618.34	4445.03	212.09	0	0	0	51.43	0	0	0	425.95	0	59.93	0	0	0	0																			50 or 20																																	200							50	43						10	15	15				20				15		15																200							50	43						10	15	15				20				15		15																3.35	-	-	-	-	-	-	1.23	1.41	-	-	-	-	-	3.85	5.56	0.27	-	-	-	0.09	-	-	-	0.53	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.35	3.35	-	-	-	-	-	-	1.23	1.41	-	-	-	-	-	3.85	5.56	0.27	-	-	-	0.09	-	-	-	0.53	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.35
H2256_017_1	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	949.41	32.08	1225.65	0	0	0	0	256.79	315	0	0	0	0	0	4306.83	4144.73	196.85	0	0	0	47.97	0	0	0	384.95	0	32.41	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.43	0.25	2.4	-	-	-	-	1.07	3.22	-	-	-	-	-	5.05	6.48	0.31	-	-	-	0.08	-	-	-	0.6	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.94	7.43	0.25	2.4	-	-	-	-	1.07	3.22	-	-	-	-	-	5.05	6.48	0.31	-	-	-	0.08	-	-	-	0.6	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.94
H2256_017_2	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	945.57	32.09	1226.07	0	0	0	0	188.05	315	0	0	0	0	0	4814.96	4003.53	117.42	0	0	0	38.39	0	0	0	230.12	0	26.16	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.4	0.25	2.4	-	-	-	-	0.78	3.22	-	-	-	-	-	5.65	6.26	0.18	-	-	-	0.06	-	-	-	0.36	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.6	7.4	0.25	2.4	-	-	-	-	0.78	3.22	-	-	-	-	-	5.65	6.26	0.18	-	-	-	0.06	-	-	-	0.36	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.6
H2256_017_3	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	838.49	32.12	1227.34	0	0	0	0	294.14	301	0	0	0	0	0	4012.51	4703.2	156.97	0	0	0	38.43	0	0	0	278.1	0	16.2	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																6.56	0.25	2.4	-	-	-	-	1.23	3.07	-	-	-	-	-	4.71	7.36	0.25	-	-	-	0.06	-	-	-	0.43	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.34	6.56	0.25	2.4	-	-	-	-	1.23	3.07	-	-	-	-	-	4.71	7.36	0.25	-	-	-	0.06	-	-	-	0.43	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.34
H2256_017_4	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	970.73	32.09	1225.9	0	0	0	0	242.47	324	0	0	0	0	0	4611.37	4017.8	197.82	0	0	0	40.44	0	0	0	368.95	0	24.71	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.59	0.25	2.4	-	-	-	-	1.01	3.31	-	-	-	-	-	5.41	6.28	0.31	-	-	-	0.07	-	-	-	0.58	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.25	7.59	0.25	2.4	-	-	-	-	1.01	3.31	-	-	-	-	-	5.41	6.28	0.31	-	-	-	0.07	-	-	-	0.58	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.25
H2256_017_5	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	967.95	32.04	1224.33	0	0	0	0	329.65	303	0	0	0	0	0	3850.26	4433.69	198.61	0	0	0	66.52	0	0	0	347.05	0	13.8	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.57	0.25	2.39	-	-	-	-	1.37	3.09	-	-	-	-	-	4.52	6.94	0.31	-	-	-	0.11	-	-	-	0.54	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.12	7.57	0.25	2.39	-	-	-	-	1.37	3.09	-	-	-	-	-	4.52	6.94	0.31	-	-	-	0.11	-	-	-	0.54	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.12
H2256_017_6	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	962.08	32.09	1226.24	0	0	0	0	270.41	312	0	0	0	0	0	4174.85	4255.75	207.21	0	0	0	47.32	0	0	0	293.86	0	41.34	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.52	0.25	2.4	-	-	-	-	1.13	3.19	-	-	-	-	-	4.9	6.66	0.32	-	-	-	0.08	-	-	-	0.46	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.97	7.52	0.25	2.4	-	-	-	-	1.13	3.19	-	-	-	-	-	4.9	6.66	0.32	-	-	-	0.08	-	-	-	0.46	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.97
H2256_018_1	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	949.41	32.08	1225.65	0	0	0	0	256.79	315	0	0	0	0	0	4306.83	4144.73	196.85	0	0	0	47.97	0	0	0	384.95	0	32.41	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.43	0.25	2.4	-	-	-	-	1.07	3.22	-	-	-	-	-	5.05	6.48	0.31	-	-	-	0.08	-	-	-	0.6	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.94	7.43	0.25	2.4	-	-	-	-	1.07	3.22	-	-	-	-	-	5.05	6.48	0.31	-	-	-	0.08	-	-	-	0.6	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.94
H2256_018_2	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	945.57	32.09	1226.07	0	0	0	0	188.05	315	0	0	0	0	0	4814.96	4003.53	117.42	0	0	0	38.39	0	0	0	230.12	0	26.16	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.4	0.25	2.4	-	-	-	-	0.78	3.22	-	-	-	-	-	5.65	6.26	0.18	-	-	-	0.06	-	-	-	0.36	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.6	7.4	0.25	2.4	-	-	-	-	0.78	3.22	-	-	-	-	-	5.65	6.26	0.18	-	-	-	0.06	-	-	-	0.36	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.6
H2256_018_3	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	838.49	32.12	1227.34	0	0	0	0	294.14	301	0	0	0	0	0	4012.51	4703.2	156.97	0	0	0	38.43	0	0	0	278.1	0	16.2	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																6.56	0.25	2.4	-	-	-	-	1.23	3.07	-	-	-	-	-	4.71	7.36	0.25	-	-	-	0.06	-	-	-	0.43	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.34	6.56	0.25	2.4	-	-	-	-	1.23	3.07	-	-	-	-	-	4.71	7.36	0.25	-	-	-	0.06	-	-	-	0.43	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.34
H2256_018_4	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	970.73	32.09	1225.9	0	0	0	0	242.47	324	0	0	0	0	0	4611.37	4017.8	197.82	0	0	0	40.44	0	0	0	368.95	0	24.71	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.59	0.25	2.4	-	-	-	-	1.01	3.31	-	-	-	-	-	5.41	6.28	0.31	-	-	-	0.07	-	-	-	0.58	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.25	7.59	0.25	2.4	-	-	-	-	1.01	3.31	-	-	-	-	-	5.41	6.28	0.31	-	-	-	0.07	-	-	-	0.58	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.25
H2256_018_5	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	967.95	32.04	1224.33	0	0	0	0	329.65	303	0	0	0	0	0	3850.26	4433.69	198.61	0	0	0	66.52	0	0	0	347.05	0	13.8	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.57	0.25	2.39	-	-	-	-	1.37	3.09	-	-	-	-	-	4.52	6.94	0.31	-	-	-	0.11	-	-	-	0.54	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.12	7.57	0.25	2.39	-	-	-	-	1.37	3.09	-	-	-	-	-	4.52	6.94	0.31	-	-	-	0.11	-	-	-	0.54	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.12
H2256_018_6	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	962.08	32.09	1226.24	0	0	0	0	270.41	312	0	0	0	0	0	4174.85	4255.75	207.21	0	0	0	47.32	0	0	0	293.86	0	41.34	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.52	0.25	2.4	-	-	-	-	1.13	3.19	-	-	-	-	-	4.9	6.66	0.32	-	-	-	0.08	-	-	-	0.46	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.97	7.52	0.25	2.4	-	-	-	-	1.13	3.19	-	-	-	-	-	4.9	6.66	0.32	-	-	-	0.08	-	-	-	0.46	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.97
H2256_019_1	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	949.41	32.08	1225.65	0	0	0	0	256.79	315	0	0	0	0	0	4306.83	4144.73	196.85	0	0	0	47.97	0	0	0	384.95	0	32.41	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.43	0.25	2.4	-	-	-	-	1.07	3.22	-	-	-	-	-	5.05	6.48	0.31	-	-	-	0.08	-	-	-	0.6	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.94	7.43	0.25	2.4	-	-	-	-	1.07	3.22	-	-	-	-	-	5.05	6.48	0.31	-	-	-	0.08	-	-	-	0.6	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.94
H2256_019_2	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	945.57	32.09	1226.07	0	0	0	0	188.05	315	0	0	0	0	0	4814.96	4003.53	117.42	0	0	0	38.39	0	0	0	230.12	0	26.16	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.4	0.25	2.4	-	-	-	-	0.78	3.22	-	-	-	-	-	5.65	6.26	0.18	-	-	-	0.06	-	-	-	0.36	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.6	7.4	0.25	2.4	-	-	-	-	0.78	3.22	-	-	-	-	-	5.65	6.26	0.18	-	-	-	0.06	-	-	-	0.36	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.6
H2256_019_3	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	838.49	32.12	1227.34	0	0	0	0	294.14	301	0	0	0	0	0	4012.51	4703.2	156.97	0	0	0	38.43	0	0	0	278.1	0	16.2	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																6.56	0.25	2.4	-	-	-	-	1.23	3.07	-	-	-	-	-	4.71	7.36	0.25	-	-	-	0.06	-	-	-	0.43	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.34	6.56	0.25	2.4	-	-	-	-	1.23	3.07	-	-	-	-	-	4.71	7.36	0.25	-	-	-	0.06	-	-	-	0.43	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.34
H2256_019_4	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	970.73	32.09	1225.9	0	0	0	0	242.47	324	0	0	0	0	0	4611.37	4017.8	197.82	0	0	0	40.44	0	0	0	368.95	0	24.71	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.59	0.25	2.4	-	-	-	-	1.01	3.31	-	-	-	-	-	5.41	6.28	0.31	-	-	-	0.07	-	-	-	0.58	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.25	7.59	0.25	2.4	-	-	-	-	1.01	3.31	-	-	-	-	-	5.41	6.28	0.31	-	-	-	0.07	-	-	-	0.58	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.25
H2256_019_5	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	967.95	32.04	1224.33	0	0	0	0	329.65	303	0	0	0	0	0	3850.26	4433.69	198.61	0	0	0	66.52	0	0	0	347.05	0	13.8	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.57	0.25	2.39	-	-	-	-	1.37	3.09	-	-	-	-	-	4.52	6.94	0.31	-	-	-	0.11	-	-	-	0.54	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.12	7.57	0.25	2.39	-	-	-	-	1.37	3.09	-	-	-	-	-	4.52	6.94	0.31	-	-	-	0.11	-	-	-	0.54	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.12
H2256_019_6	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	962.08	32.09	1226.24	0	0	0	0	270.41	312	0	0	0	0	0	4174.85	4255.75	207.21	0	0	0	47.32	0	0	0	293.86	0	41.34	0	0	0	0											Days 1-5		Days 11-100						20 or 150																																	100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																7.52	0.25	2.4	-	-	-	-	1.13	3.19	-	-	-	-	-	4.9	6.66	0.32	-	-	-	0.08	-	-	-	0.46	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.97	7.52	0.25	2.4	-	-	-	-	1.13	3.19	-	-	-	-	-	4.9	6.66	0.32	-	-	-	0.08	-	-	-	0.46	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.97
H2256_801_0	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	1030.91	34.88	1332.68	0	0	0	0	286.35	340.91	0	0	0	0	0	4676.83	4601.33	206.89	0	0	0	49.43	0	0	0	345.69	0	32.64	0	0	0	0																																																				100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																8.06	0.27	2.6	-	-	-	-	1.19	3.48	-	-	-	-	-	5.49	7.2	0.32	-	-	-	0.08	-	-	-	0.54	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.3	8.06	0.27	2.6	-	-	-	-	1.19	3.48	-	-	-	-	-	5.49	7.2	0.32	-	-	-	0.08	-	-	-	0.54	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.3
H2256_802_0	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	1030.91	34.88	1332.68	0	0	0	0	286.35	340.91	0	0	0	0	0	4676.83	4601.33	206.89	0	0	0	49.43	0	0	0	345.69	0	32.64	0	0	0	0																																																				100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																8.06	0.27	2.6	-	-	-	-	1.19	3.48	-	-	-	-	-	5.49	7.2	0.32	-	-	-	0.08	-	-	-	0.54	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.3	8.06	0.27	2.6	-	-	-	-	1.19	3.48	-	-	-	-	-	5.49	7.2	0.32	-	-	-	0.08	-	-	-	0.54	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.3
H2256_803_0	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	1030.91	34.88	1332.68	0	0	0	0	286.35	340.91	0	0	0	0	0	4676.83	4601.33	206.89	0	0	0	49.43	0	0	0	345.69	0	32.64	0	0	0	0																																																				100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																8.06	0.27	2.6	-	-	-	-	1.19	3.48	-	-	-	-	-	5.49	7.2	0.32	-	-	-	0.08	-	-	-	0.54	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.3	8.06	0.27	2.6	-	-	-	-	1.19	3.48	-	-	-	-	-	5.49	7.2	0.32	-	-	-	0.08	-	-	-	0.54	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.3
H2256_804_0	2006											3000											D	D	D					V	V						V	V	V				S				V		V																																																									-	1030.91	34.88	1332.68	0	0	0	0	286.35	340.91	0	0	0	0	0	4676.83	4601.33	206.89	0	0	0	49.43	0	0	0	345.69	0	32.64	0	0	0	0																																																				100	100	25					50	129						15	20	20				20				20		20																93.85	93.85	23.45					50	122.55						14.08	18.77	18.77				20				18.77		18.77																8.06	0.27	2.6	-	-	-	-	1.19	3.48	-	-	-	-	-	5.49	7.2	0.32	-	-	-	0.08	-	-	-	0.54	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.3	8.06	0.27	2.6	-	-	-	-	1.19	3.48	-	-	-	-	-	5.49	7.2	0.32	-	-	-	0.08	-	-	-	0.54	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.3
H2261_005_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	1619.75	68.23	2171.87	2007.99	393.69	1321	361.29	683.35	319.32	2557.69	1365.26	62.43	25.18	3343.97	4426.32	8780.19	310.85	586.42	4172.18	9756.64	414.11	113.27	0	322.13	1099.44	188.99	52.06	18.21	0	42.45	406.18																																																																																													0	48.31	35.26	11.92	0.08	19.58	0	0.03	5.55	46.18	1.54	1.46	2.52	0	5.18	7.41	9.24	18.29	10.99	0.03	2.53	6.24	22.2	0	19.76	16.76	82.29	1.48	1445.07	0	0.78	13.04												6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03	6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03
H2261_008_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	2089.56	145.85	2624.42	2883.83	447.92	1301.18	335.5	856.68	407.35	2703.77	2001.64	193.51	14.79	4281.94	5285.15	9115.07	356.16	973.53	3841.71	10360.78	881.64	114.14	0	278.13	1030.11	134.36	54.2	12.15	0	0	401.32																																																																																													0	45.63	32.76	11.39	0.07	15.25	0.03	1.98	5.64	39.72	1.11	1.05	0.18	0	5.52	7.42	9.55	18.06	6.2	0.01	2.11	3.79	10.27	0	19.81	16.59	79.17	0.49	2108.99	0	0	11.26											0	7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67	7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67
H2261_009_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	2108.58	114.85	2119.52	2299.2	369.59	1101.06	248.12	703.88	403.59	2238.67	1869.09	81.81	11.71	3305.39	5056.69	7813.73	306.94	766.23	4021.97	10363.61	853.17	55.98	0	342.21	970.7	154.42	59.89	11.6	0	37.6	390.04																																																																																													0	41.8	23.06	11.66	0.07	15.78	0.01	0.11	6.5	46.91	1.79	1.5	0.08	0	4.21	7.31	10.11	18.83	9.49	0.01	2.37	4.73	24.84	0	19.77	17.48	82.98	0.27	1708.01	0	0	12.23											0	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16
H2261_010_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	1782.21	116.38	2412.95	2670.41	497.75	1435.09	612.21	749.46	408.44	4149.48	1884.68	91.67	7.51	3961.6	4448.82	9637.11	243.4	901.69	3404.74	6789.34	772.34	68.83	0	274.54	981.48	147.65	53.3	11.15	0	48.31	491.01																																																																																													0	45.71	23.05	11.53	0.17	17.37	0.2	0.02	5.16	43.18	0.75	0.92	0.33	0	5.41	7.73	10	17.27	5.39	0.03	3.38	3.86	13.21	0	19.73	15.73	77.77	0.82	1931.18	0	1.14	10.65											0	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92
H2261_011_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	1619.75	68.23	2171.87	2007.99	393.69	1321	361.29	683.35	319.32	2557.69	1365.26	62.43	25.18	3343.97	4426.32	8780.19	310.85	586.42	4172.18	9756.64	414.11	113.27	0	322.13	1099.44	188.99	52.06	18.21	0	42.45	406.18																																																																																													0	48.31	35.26	11.92	0.08	19.58	0	0.03	5.55	46.18	1.54	1.46	2.52	0	5.18	7.41	9.24	18.29	10.99	0.03	2.53	6.24	22.2	0	19.76	16.76	82.29	1.48	1445.07	0	0.78	13.04												6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03	6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03
H2261_012_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	2089.56	145.85	2624.42	2883.83	447.92	1301.18	335.5	856.68	407.35	2703.77	2001.64	193.51	14.79	4281.94	5285.15	9115.07	356.16	973.53	3841.71	10360.78	881.64	114.14	0	278.13	1030.11	134.36	54.2	12.15	0	0	401.32																																																																																													0	45.63	32.76	11.39	0.07	15.25	0.03	1.98	5.64	39.72	1.11	1.05	0.18	0	5.52	7.42	9.55	18.06	6.2	0.01	2.11	3.79	10.27	0	19.81	16.59	79.17	0.49	2108.99	0	0	11.26											0	7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67	7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67
H2261_013_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	2108.58	114.85	2119.52	2299.2	369.59	1101.06	248.12	703.88	403.59	2238.67	1869.09	81.81	11.71	3305.39	5056.69	7813.73	306.94	766.23	4021.97	10363.61	853.17	55.98	0	342.21	970.7	154.42	59.89	11.6	0	37.6	390.04																																																																																													0	41.8	23.06	11.66	0.07	15.78	0.01	0.11	6.5	46.91	1.79	1.5	0.08	0	4.21	7.31	10.11	18.83	9.49	0.01	2.37	4.73	24.84	0	19.77	17.48	82.98	0.27	1708.01	0	0	12.23											0	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16
H2261_014_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	1782.21	116.38	2412.95	2670.41	497.75	1435.09	612.21	749.46	408.44	4149.48	1884.68	91.67	7.51	3961.6	4448.82	9637.11	243.4	901.69	3404.74	6789.34	772.34	68.83	0	274.54	981.48	147.65	53.3	11.15	0	48.31	491.01																																																																																													0	45.71	23.05	11.53	0.17	17.37	0.2	0.02	5.16	43.18	0.75	0.92	0.33	0	5.41	7.73	10	17.27	5.39	0.03	3.38	3.86	13.21	0	19.73	15.73	77.77	0.82	1931.18	0	1.14	10.65											0	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92
H2261_015_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	1619.75	68.23	2171.87	2007.99	393.69	1321	361.29	683.35	319.32	2557.69	1365.26	62.43	25.18	3343.97	4426.32	8780.19	310.85	586.42	4172.18	9756.64	414.11	113.27	0	322.13	1099.44	188.99	52.06	18.21	0	42.45	406.18																																																																																													0	48.31	35.26	11.92	0.08	19.58	0	0.03	5.55	46.18	1.54	1.46	2.52	0	5.18	7.41	9.24	18.29	10.99	0.03	2.53	6.24	22.2	0	19.76	16.76	82.29	1.48	1445.07	0	0.78	13.04												6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03	6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03
H2261_016_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	2089.56	145.85	2624.42	2883.83	447.92	1301.18	335.5	856.68	407.35	2703.77	2001.64	193.51	14.79	4281.94	5285.15	9115.07	356.16	973.53	3841.71	10360.78	881.64	114.14	0	278.13	1030.11	134.36	54.2	12.15	0	0	401.32																																																																																													0	45.63	32.76	11.39	0.07	15.25	0.03	1.98	5.64	39.72	1.11	1.05	0.18	0	5.52	7.42	9.55	18.06	6.2	0.01	2.11	3.79	10.27	0	19.81	16.59	79.17	0.49	2108.99	0	0	11.26											0	7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67	7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67
H2261_017_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	2108.58	114.85	2119.52	2299.2	369.59	1101.06	248.12	703.88	403.59	2238.67	1869.09	81.81	11.71	3305.39	5056.69	7813.73	306.94	766.23	4021.97	10363.61	853.17	55.98	0	342.21	970.7	154.42	59.89	11.6	0	37.6	390.04																																																																																													0	41.8	23.06	11.66	0.07	15.78	0.01	0.11	6.5	46.91	1.79	1.5	0.08	0	4.21	7.31	10.11	18.83	9.49	0.01	2.37	4.73	24.84	0	19.77	17.48	82.98	0.27	1708.01	0	0	12.23											0	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16
H2261_018_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	1782.21	116.38	2412.95	2670.41	497.75	1435.09	612.21	749.46	408.44	4149.48	1884.68	91.67	7.51	3961.6	4448.82	9637.11	243.4	901.69	3404.74	6789.34	772.34	68.83	0	274.54	981.48	147.65	53.3	11.15	0	48.31	491.01																																																																																													0	45.71	23.05	11.53	0.17	17.37	0.2	0.02	5.16	43.18	0.75	0.92	0.33	0	5.41	7.73	10	17.27	5.39	0.03	3.38	3.86	13.21	0	19.73	15.73	77.77	0.82	1931.18	0	1.14	10.65											0	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92
H2261_801_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	1619.75	68.23	2171.87	2007.99	393.69	1321	361.29	683.35	319.32	2557.69	1365.26	62.43	25.18	3343.97	4426.32	8780.19	310.85	586.42	4172.18	9756.64	414.11	113.27	0	322.13	1099.44	188.99	52.06	18.21	0	42.45	406.18																																																																																													0	48.31	35.26	11.92	0.08	19.58	0	0.03	5.55	46.18	1.54	1.46	2.52	0	5.18	7.41	9.24	18.29	10.99	0.03	2.53	6.24	22.2	0	19.76	16.76	82.29	1.48	1445.07	0	0.78	13.04												6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03	6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03
H2261_802_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	2089.56	145.85	2624.42	2883.83	447.92	1301.18	335.5	856.68	407.35	2703.77	2001.64	193.51	14.79	4281.94	5285.15	9115.07	356.16	973.53	3841.71	10360.78	881.64	114.14	0	278.13	1030.11	134.36	54.2	12.15	0	0	401.32																																																																																													0	45.63	32.76	11.39	0.07	15.25	0.03	1.98	5.64	39.72	1.11	1.05	0.18	0	5.52	7.42	9.55	18.06	6.2	0.01	2.11	3.79	10.27	0	19.81	16.59	79.17	0.49	2108.99	0	0	11.26												7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67	7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67
H2261_803_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	2108.58	114.85	2119.52	2299.2	369.59	1101.06	248.12	703.88	403.59	2238.67	1869.09	81.81	11.71	3305.39	5056.69	7813.73	306.94	766.23	4021.97	10363.61	853.17	55.98	0	342.21	970.7	154.42	59.89	11.6	0	37.6	390.04																																																																																													0	41.8	23.06	11.66	0.07	15.78	0.01	0.11	6.5	46.91	1.79	1.5	0.08	0	4.21	7.31	10.11	18.83	9.49	0.01	2.37	4.73	24.84	0	19.77	17.48	82.98	0.27	1708.01	0	0	12.23											0	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16
H2261_804_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	1782.21	116.38	2412.95	2670.41	497.75	1435.09	612.21	749.46	408.44	4149.48	1884.68	91.67	7.51	3961.6	4448.82	9637.11	243.4	901.69	3404.74	6789.34	772.34	68.83	0	274.54	981.48	147.65	53.3	11.15	0	48.31	491.01																																																																																													0	45.71	23.05	11.53	0.17	17.37	0.2	0.02	5.16	43.18	0.75	0.92	0.33	0	5.41	7.73	10	17.27	5.39	0.03	3.38	3.86	13.21	0	19.73	15.73	77.77	0.82	1931.18	0	1.14	10.65											0	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92
H2261_809_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	1619.75	68.23	2171.87	2007.99	393.69	1321	361.29	683.35	319.32	2557.69	1365.26	62.43	25.18	3343.97	4426.32	8780.19	310.85	586.42	4172.18	9756.64	414.11	113.27	0	322.13	1099.44	188.99	52.06	18.21	0	42.45	406.18																																																																																													0	48.31	35.26	11.92	0.08	19.58	0	0.03	5.55	46.18	1.54	1.46	2.52	0	5.18	7.41	9.24	18.29	10.99	0.03	2.53	6.24	22.2	0	19.76	16.76	82.29	1.48	1445.07	0	0.78	13.04												6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03	6.52	0.2	2.16	0.01	0.64	0	0	0.32	1.23	0.33	0.17	0.01	-	1.44	2.73	6.76	0.47	0.54	0.01	2.06	0.22	0.21	-	0.53	1.54	1.3	0.01	2.19	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.03
H2261_810_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	V	V	V	V	V																																																					-	2089.56	145.85	2624.42	2883.83	447.92	1301.18	335.5	856.68	407.35	2703.77	2001.64	193.51	14.79	4281.94	5285.15	9115.07	356.16	973.53	3841.71	10360.78	881.64	114.14	0	278.13	1030.11	134.36	54.2	12.15	0	0	401.32																																																																																													0	45.63	32.76	11.39	0.07	15.25	0.03	1.98	5.64	39.72	1.11	1.05	0.18	0	5.52	7.42	9.55	18.06	6.2	0.01	2.11	3.79	10.27	0	19.81	16.59	79.17	0.49	2108.99	0	0	11.26												7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67	7.94	0.4	2.49	0.02	0.57	0	0.06	0.4	1.35	0.25	0.17	0	-	1.97	3.27	7.25	0.54	0.5	0	1.83	0.28	0.1	-	0.46	1.42	0.89	0	2.14	-	-	0.38	-	-	-	-	-	-	-	-	-	-	34.67
H2261_811_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	2108.58	114.85	2119.52	2299.2	369.59	1101.06	248.12	703.88	403.59	2238.67	1869.09	81.81	11.71	3305.39	5056.69	7813.73	306.94	766.23	4021.97	10363.61	853.17	55.98	0	342.21	970.7	154.42	59.89	11.6	0	37.6	390.04																																																																																													0	41.8	23.06	11.66	0.07	15.78	0.01	0.11	6.5	46.91	1.79	1.5	0.08	0	4.21	7.31	10.11	18.83	9.49	0.01	2.37	4.73	24.84	0	19.77	17.48	82.98	0.27	1708.01	0	0	12.23											0	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16	7.34	0.22	2.06	0.01	0.49	0	0	0.38	1.58	0.33	0.23	0	-	1.16	3.08	6.58	0.48	0.61	0	2.05	0.34	0.12	-	0.56	1.41	1.07	0	1.65	-	-	0.4	-	-	-	-	-	-	-	-	-	-	32.16
H2261_812_0	2006											0											D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O		V	V	V	V	V		V	V																																																					-	1782.21	116.38	2412.95	2670.41	497.75	1435.09	612.21	749.46	408.44	4149.48	1884.68	91.67	7.51	3961.6	4448.82	9637.11	243.4	901.69	3404.74	6789.34	772.34	68.83	0	274.54	981.48	147.65	53.3	11.15	0	48.31	491.01																																																																																													0	45.71	23.05	11.53	0.17	17.37	0.2	0.02	5.16	43.18	0.75	0.92	0.33	0	5.41	7.73	10	17.27	5.39	0.03	3.38	3.86	13.21	0	19.73	15.73	77.77	0.82	1931.18	0	1.14	10.65											0	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92	6.79	0.22	2.32	0.04	0.72	0.02	0	0.32	1.47	0.26	0.14	0	-	1.79	2.87	8.03	0.35	0.4	0.01	1.91	0.25	0.08	-	0.45	1.29	0.96	0	1.8	-	0	0.44	-	-	-	-	-	-	-	-	-	-	32.92
H2312_004_0	2006											0													D					V							V	V	V			V		V																																																														-			1003					370							6654	6085	274			1969		2																						114 copay for days 21-100					50 copay for ER Visits 10 copay for Urgent Care							10 copay	10 copay	10 copay			10 copay		10 copay																						77.15					49.89							10	10	10			10		10																							77.15					49.89							10	10	10			10		10																				0	-	-	6.45	-	-	-	-	1.54	-	-	-	-	-	-	5.55	5.07	0.23	-	-	1.64	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.47	-	-	6.45	-	-	-	-	1.54	-	-	-	-	-	-	5.55	5.07	0.23	-	-	1.64	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.47
H2312_006_0	2006											0													D					V							V	V	V			V		V																																																														-			1003					370							6654	6085	274			1969		2																						114 copay for days 21-100					50 copay for ER Visits 10 copay for Urgent Care							10 copay	10 copay	10 copay			10 copay		10 copay																						77.15					49.89							10	10	10			10		10																							77.15					49.89							10	10	10			10		10																				0	-	-	6.45	-	-	-	-	1.54	-	-	-	-	-	-	5.55	5.07	0.23	-	-	1.64	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.47	-	-	6.45	-	-	-	-	1.54	-	-	-	-	-	-	5.55	5.07	0.23	-	-	1.64	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.47
H2312_007_0	2006											0													D					V							V	V	V			V		V																																																														-			1108					412							7397	6788	302			2287		2																																																															76.73					49.81							10	10	10			10		10																							76.73					49.81							10	10	10			10		10																				0	-	-	7.08	-	-	-	-	1.71	-	-	-	-	-	-	6.16	5.66	0.25	-	-	1.91	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.77	-	-	7.08	-	-	-	-	1.71	-	-	-	-	-	-	6.16	5.66	0.25	-	-	1.91	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.77
H2312_008_0	2006											0													D					V							V	V	V			V		V																																																														-			1108					412							7397	6788	302			2287		2																																																															76.73					49.81							10	10	10			10		10																							76.73					49.81							10	10	10			10		10																				0	-	-	7.08	-	-	-	-	1.71	-	-	-	-	-	-	6.16	5.66	0.25	-	-	1.91	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.77	-	-	7.08	-	-	-	-	1.71	-	-	-	-	-	-	6.16	5.66	0.25	-	-	1.91	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.77
H2312_009_0	2006											0													D					V							V	V	V			V		V																																																														-			1003					370							6654	6085	274			1969		2																						114 copay for days 21-100					50 copay for ER Visits 10 copay for Urgent Care							10 copay	10 copay	10 copay			10 copay		10 copay																						77.15					49.89							10	10	10			10		10																							77.15					49.89							10	10	10			10		10																				0	-	-	6.45	-	-	-	-	1.54	-	-	-	-	-	-	5.55	5.07	0.23	-	-	1.64	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.47	-	-	6.45	-	-	-	-	1.54	-	-	-	-	-	-	5.55	5.07	0.23	-	-	1.64	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.47
H2312_010_0	2006											0													D					V							V	V	V			V		V																																																														-			1108					412							7397	6788	302			2287		2																																																															76.73					49.81							10	10	10			10		10																							76.73					49.81							10	10	10			10		10																				0	-	-	7.08	-	-	-	-	1.71	-	-	-	-	-	-	6.16	5.66	0.25	-	-	1.91	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.77	-	-	7.08	-	-	-	-	1.71	-	-	-	-	-	-	6.16	5.66	0.25	-	-	1.91	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.77
H2312_801_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	278.64	2.84	40.06	34.09	7.47	13.03	8.41	295.77	27.27	11.24	30.25		0.4	29.43	55.28	111.68	2.06	2.77	30.28	45.6	8.27	6.12																				6.59 Medicare equiv. coins	6.59 Medicare equiv. coins	18.13 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.74	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.74	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	18.36	0.19	7.26	-	1.74	3.03	1.96	1.23	6.35	2.62	7.05	-	0.09	6.86	12.88	26.02	0.48	0.65	7.06	10.63	1.93	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.8	18.36	0.19	7.26	-	1.74	3.03	1.96	1.23	6.35	2.62	7.05	-	0.09	6.86	12.88	26.02	0.48	0.65	7.06	10.63	1.93	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.8
H2312_802_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	278.64	2.84	40.06	34.09	7.47	13.03	8.41	295.77	27.27	11.24	30.25		0.4	29.43	55.28	111.68	2.06	2.77	30.28	45.6	8.27	6.12																				6.59 Medicare equiv. coins	6.59 Medicare equiv. coins	18.13 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.74	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.74	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	18.36	0.19	7.26	-	1.74	3.03	1.96	1.23	6.35	2.62	7.05	-	0.09	6.86	12.88	26.02	0.48	0.65	7.06	10.63	1.93	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.8	18.36	0.19	7.26	-	1.74	3.03	1.96	1.23	6.35	2.62	7.05	-	0.09	6.86	12.88	26.02	0.48	0.65	7.06	10.63	1.93	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.8
H2312_803_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	278.64	2.84	40.06	34.09	7.47	13.03	8.41	295.77	27.27	11.24	30.25		0.4	29.43	55.28	111.68	2.06	2.77	30.28	45.6	8.27	6.12																				6.59 Medicare equiv. coins	6.59 Medicare equiv. coins	18.13 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.74	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.74	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	18.36	0.19	7.26	-	1.74	3.03	1.96	1.23	6.35	2.62	7.05	-	0.09	6.86	12.88	26.02	0.48	0.65	7.06	10.63	1.93	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.8	18.36	0.19	7.26	-	1.74	3.03	1.96	1.23	6.35	2.62	7.05	-	0.09	6.86	12.88	26.02	0.48	0.65	7.06	10.63	1.93	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.8
H2312_804_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	278.64	2.84	40.06	34.09	7.47	13.03	8.41	295.77	27.27	11.24	30.25		0.4	29.43	55.28	111.68	2.06	2.77	30.28	45.6	8.27	6.12																				6.59 Medicare equiv. coins	6.59 Medicare equiv. coins	18.13 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.74	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.74	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	18.36	0.19	7.26	-	1.74	3.03	1.96	1.23	6.35	2.62	7.05	-	0.09	6.86	12.88	26.02	0.48	0.65	7.06	10.63	1.93	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.8	18.36	0.19	7.26	-	1.74	3.03	1.96	1.23	6.35	2.62	7.05	-	0.09	6.86	12.88	26.02	0.48	0.65	7.06	10.63	1.93	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.8
H2312_805_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	305.42	3.14	45.21	36.89	8.55	14.97	9.63	324.47	30.23	12.84	34.63		0.44	33.33	61.52	124.57	2.27	3.12	34.67	51.95	9.33	6.88																				6.60 Medicare equiv. coins	6.60 Medicare equiv. coins	18.00 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER /23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.98	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.98	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	20.15	0.21	8.14	-	1.99	3.49	2.24	1.35	7.04	2.99	8.07	-	0.1	7.77	14.33	29.02	0.53	0.73	8.08	12.1	2.17	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.12	20.15	0.21	8.14	-	1.99	3.49	2.24	1.35	7.04	2.99	8.07	-	0.1	7.77	14.33	29.02	0.53	0.73	8.08	12.1	2.17	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.12
H2312_806_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	305.42	3.14	45.21	36.89	8.55	14.97	9.63	324.47	30.23	12.84	34.63		0.44	33.33	61.52	124.57	2.27	3.12	34.67	51.95	9.33	6.88																				6.60 Medicare equiv. coins	6.60 Medicare equiv. coins	18.00 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER /23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.98	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.98	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	20.15	0.21	8.14	-	1.99	3.49	2.24	1.35	7.04	2.99	8.07	-	0.1	7.77	14.33	29.02	0.53	0.73	8.08	12.1	2.17	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.12	20.15	0.21	8.14	-	1.99	3.49	2.24	1.35	7.04	2.99	8.07	-	0.1	7.77	14.33	29.02	0.53	0.73	8.08	12.1	2.17	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.12
H2312_807_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	305.42	3.14	45.21	36.89	8.55	14.97	9.63	324.47	30.23	12.84	34.63		0.44	33.33	61.52	124.57	2.27	3.12	34.67	51.95	9.33	6.88																				6.60 Medicare equiv. coins	6.60 Medicare equiv. coins	18.00 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER /23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.98	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.98	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	20.15	0.21	8.14	-	1.99	3.49	2.24	1.35	7.04	2.99	8.07	-	0.1	7.77	14.33	29.02	0.53	0.73	8.08	12.1	2.17	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.12	20.15	0.21	8.14	-	1.99	3.49	2.24	1.35	7.04	2.99	8.07	-	0.1	7.77	14.33	29.02	0.53	0.73	8.08	12.1	2.17	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.12
H2312_808_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	305.42	3.14	45.21	36.89	8.55	14.97	9.63	324.47	30.23	12.84	34.63		0.44	33.33	61.52	124.57	2.27	3.12	34.67	51.95	9.33	6.88																				6.60 Medicare equiv. coins	6.60 Medicare equiv. coins	18.00 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER /23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.98	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.98	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	20.15	0.21	8.14	-	1.99	3.49	2.24	1.35	7.04	2.99	8.07	-	0.1	7.77	14.33	29.02	0.53	0.73	8.08	12.1	2.17	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.12	20.15	0.21	8.14	-	1.99	3.49	2.24	1.35	7.04	2.99	8.07	-	0.1	7.77	14.33	29.02	0.53	0.73	8.08	12.1	2.17	1.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.12
H2319_007_1	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	271.84	3.94	405.29	0	0	15.1	1.32	469.32	444.27	0	463.11	0	0	272.79	3884.69	4255.98	181.94	247.27	223.83	1615.47	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	47.95	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	47.95	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	5.66	0.08	0.68	-	-	0.23	0.02	1.88	0.74	-	0.77	-	-	0.45	6.47	7.09	0.3	0.41	0.37	2.69	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	27.88	5.66	0.08	0.68	-	-	0.23	0.02	1.88	0.74	-	0.77	-	-	0.45	6.47	7.09	0.3	0.41	0.37	2.69	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	27.88
H2319_007_2	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	304.37	4.41	439.4	0	0	16.04	1.4	550.74	521.38	0	543.48	0	0	320.14	4553.53	4819.32	183.68	249.64	254.75	1630.94	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	47.95	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	47.95	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	6.34	0.09	0.73	-	-	0.24	0.02	2.2	0.87	-	0.91	-	-	0.53	7.59	8.03	0.31	0.42	0.42	2.72	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	31.44	6.34	0.09	0.73	-	-	0.24	0.02	2.2	0.87	-	0.91	-	-	0.53	7.59	8.03	0.31	0.42	0.42	2.72	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	31.44
H2319_007_3	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	278.99	4.04	380.04	0	0	14.93	1.3	602.22	581.76	0	606.43	0	0	357.22	3592.59	3907.91	163.36	222.03	230.26	1450.55	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	48.52	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	48.52	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	5.81	0.08	0.63	-	-	0.22	0.02	2.44	0.97	-	1.01	-	-	0.6	5.99	6.51	0.27	0.37	0.38	2.42	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	27.75	5.81	0.08	0.63	-	-	0.22	0.02	2.44	0.97	-	1.01	-	-	0.6	5.99	6.51	0.27	0.37	0.38	2.42	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	27.75
H2319_007_4	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	328.27	4.76	567.33	0	0	15.96	1.39	487.08	456.77	0	476.13	0	0	280.47	4545.38	4968.81	210.93	286.68	260.44	1872.93	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	47.69	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	47.69	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	6.84	0.1	0.95	-	-	0.24	0.02	1.94	0.76	-	0.79	-	-	0.47	7.58	8.28	0.35	0.48	0.43	3.12	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	32.36	6.84	0.1	0.95	-	-	0.24	0.02	1.94	0.76	-	0.79	-	-	0.47	7.58	8.28	0.35	0.48	0.43	3.12	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	32.36
H2319_007_5	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	337.71	4.89	405.89	0	0	17.58	1.53	551.05	520.95	0	543.04	0	0	319.88	4643.12	5113.61	222.11	301.88	293.33	1972.24	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	47.91	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	47.91	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	7.04	0.1	0.68	-	-	0.26	0.02	2.2	0.87	-	0.91	-	-	0.53	7.74	8.52	0.37	0.5	0.49	3.29	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	33.54	7.04	0.1	0.68	-	-	0.26	0.02	2.2	0.87	-	0.91	-	-	0.53	7.74	8.52	0.37	0.5	0.49	3.29	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	33.54
H2319_007_6	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	395.74	5.73	582.06	0	0	19.44	1.69	471.24	430.04	0	448.27	0	0	264.06	5812.32	6652.36	321.84	437.42	356.59	2857.74	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	46.94	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	46.94	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	8.24	0.12	0.97	-	-	0.29	0.03	1.84	0.72	-	0.75	-	-	0.44	9.69	11.09	0.54	0.73	0.59	4.76	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	40.82	8.24	0.12	0.97	-	-	0.29	0.03	1.84	0.72	-	0.75	-	-	0.44	9.69	11.09	0.54	0.73	0.59	4.76	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	40.82
H2319_008_1	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	271.84	3.94	405.29	0	0	15.1	1.32	469.32	444.27	0	463.11	0	0	272.79	3884.69	4255.98	181.94	247.27	223.83	1615.47	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	47.95	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	47.95	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	5.66	0.08	0.68	-	-	0.23	0.02	1.88	0.74	-	0.77	-	-	0.45	6.47	7.09	0.3	0.41	0.37	2.69	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	27.88	5.66	0.08	0.68	-	-	0.23	0.02	1.88	0.74	-	0.77	-	-	0.45	6.47	7.09	0.3	0.41	0.37	2.69	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	27.88
H2319_008_2	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	304.37	4.41	439.4	0	0	16.04	1.4	550.74	521.38	0	543.48	0	0	320.14	4553.53	4819.32	183.68	249.64	254.75	1630.94	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	47.95	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	47.95	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	6.34	0.09	0.73	-	-	0.24	0.02	2.2	0.87	-	0.91	-	-	0.53	7.59	8.03	0.31	0.42	0.42	2.72	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	31.44	6.34	0.09	0.73	-	-	0.24	0.02	2.2	0.87	-	0.91	-	-	0.53	7.59	8.03	0.31	0.42	0.42	2.72	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	31.44
H2319_008_3	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	278.99	4.04	380.04	0	0	14.93	1.3	602.22	581.76	0	606.43	0	0	357.22	3592.59	3907.91	163.36	222.03	230.26	1450.55	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	48.52	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	48.52	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	5.81	0.08	0.63	-	-	0.22	0.02	2.44	0.97	-	1.01	-	-	0.6	5.99	6.51	0.27	0.37	0.38	2.42	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	27.75	5.81	0.08	0.63	-	-	0.22	0.02	2.44	0.97	-	1.01	-	-	0.6	5.99	6.51	0.27	0.37	0.38	2.42	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	27.75
H2319_008_4	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	328.27	4.76	567.33	0	0	15.96	1.39	487.08	456.77	0	476.13	0	0	280.47	4545.38	4968.81	210.93	286.68	260.44	1872.93	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	47.69	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	47.69	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	6.84	0.1	0.95	-	-	0.24	0.02	1.94	0.76	-	0.79	-	-	0.47	7.58	8.28	0.35	0.48	0.43	3.12	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	32.36	6.84	0.1	0.95	-	-	0.24	0.02	1.94	0.76	-	0.79	-	-	0.47	7.58	8.28	0.35	0.48	0.43	3.12	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	32.36
H2319_008_5	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	337.71	4.89	405.89	0	0	17.58	1.53	551.05	520.95	0	543.04	0	0	319.88	4643.12	5113.61	222.11	301.88	293.33	1972.24	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	47.91	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	47.91	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	7.04	0.1	0.68	-	-	0.26	0.02	2.2	0.87	-	0.91	-	-	0.53	7.74	8.52	0.37	0.5	0.49	3.29	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	33.54	7.04	0.1	0.68	-	-	0.26	0.02	2.2	0.87	-	0.91	-	-	0.53	7.74	8.52	0.37	0.5	0.49	3.29	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	33.54
H2319_008_7	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	395.74	5.73	582.06	0	0	19.44	1.69	471.24	430.04	0	448.27	0	0	264.06	5812.32	6652.36	321.84	437.42	356.59	2857.74	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			250	250	20	0	0	0.02	0.02	46.94	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50												250	250	20	0	0	0.02	0.02	46.94	20	0	20	0	0	20	20	20	20	20	20	20	0	0	0	0	0	0	0	0	0	0	50											0	8.24	0.12	0.97	-	-	0.29	0.03	1.84	0.72	-	0.75	-	-	0.44	9.69	11.09	0.54	0.73	0.59	4.76	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	40.82	8.24	0.12	0.97	-	-	0.29	0.03	1.84	0.72	-	0.75	-	-	0.44	9.69	11.09	0.54	0.73	0.59	4.76	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	40.82
H2319_009_1	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	405.29	0	0	15.1	1.32	471.46	445.16	0	475.42	0	0	274.17	4143.67	4544.13	194.06	263.76	229.78	1667.03	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			0	0	20	0	0	0.02	0.02	47.1	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50												0	0	20	0	0	0.02	0.02	47.1	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50											0	-	-	0.68	-	-	0.23	0.02	1.85	0.37	-	0.4	-	-	0.23	3.45	3.79	0.16	0.22	0.19	1.39	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	12.99	-	-	0.68	-	-	0.23	0.02	1.85	0.37	-	0.4	-	-	0.23	3.45	3.79	0.16	0.22	0.19	1.39	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	12.99
H2319_009_2	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	427.35	0	0	15.77	1.37	560.22	528.89	0	564.84	0	0	325.74	4932.51	5231.68	200.24	272.15	266.39	1720.05	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			0	0	20	0	0	0.02	0.02	47.1	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50												0	0	20	0	0	0.02	0.02	47.09	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50											0	-	-	0.71	-	-	0.24	0.02	2.2	0.44	-	0.47	-	-	0.27	4.11	4.36	0.17	0.23	0.22	1.43	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.89	-	-	0.71	-	-	0.24	0.02	2.2	0.44	-	0.47	-	-	0.27	4.11	4.36	0.17	0.23	0.22	1.43	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.89
H2319_009_3	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	380.04	0	0	14.93	1.3	604.2	582.93	0	622.55	0	0	359.02	3832.09	4172.33	174.25	236.83	236.38	1496.84	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			0	0	20	0	0	0.02	0.02	47.9	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50												0	0	20	0	0	0.02	0.02	47.9	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50											0	-	-	0.63	-	-	0.22	0.02	2.41	0.49	-	0.52	-	-	0.3	3.19	3.48	0.15	0.2	0.2	1.25	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	13.07	-	-	0.63	-	-	0.22	0.02	2.41	0.49	-	0.52	-	-	0.3	3.19	3.48	0.15	0.2	0.2	1.25	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	13.07
H2319_009_4	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	539.46	0	0	16.07	1.4	485.14	454.28	0	485.16	0	0	279.79	4714.85	5135.63	214.77	291.9	261.9	1844.89	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			0	0	20	0	0	0.02	0.02	46.79	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50												0	0	20	0	0	0.02	0.02	46.79	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50											0	-	-	0.9	-	-	0.24	0.02	1.89	0.38	-	0.4	-	-	0.23	3.93	4.28	0.18	0.24	0.22	1.54	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.47	-	-	0.9	-	-	0.24	0.02	1.89	0.38	-	0.4	-	-	0.23	3.93	4.28	0.18	0.24	0.22	1.54	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.47
H2319_009_5	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	405.89	0	0	17.58	1.53	553.61	522	0	557.48	0	0	321.49	4952.66	5459.97	236.92	322.01	301.13	2035.18	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			0	0	20	0	0	0.02	0.02	47.04	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50												0	0	20	0	0	0.02	0.02	47.04	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50											0	-	-	0.68	-	-	0.26	0.02	2.17	0.43	-	0.46	-	-	0.27	4.13	4.55	0.2	0.27	0.25	1.7	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	15.41	-	-	0.68	-	-	0.26	0.02	2.17	0.43	-	0.46	-	-	0.27	4.13	4.55	0.2	0.27	0.25	1.7	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	15.41
H2319_009_6	2006																						A	A	D			Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V											V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	582.06	0	0	19.44	1.69	474.45	430.9	0	460.19	0	0	265.39	6199.81	7104.37	343.3	466.58	366.07	2948.95	0	0	0	0	0	0	0	0	0	0	4.7													for days 21-100			50 coinsurance on 3 utilization	50 coinsurance on 3 utilization																																			0	0	20	0	0	0.02	0.02	45.68	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50												0	0	20	0	0	0.02	0.02	45.68	10	0	10	0	0	10	10	10	10	10	10	10	0	0	0	0	0	0	0	0	0	0	50											0	-	-	0.97	-	-	0.29	0.03	1.81	0.36	-	0.38	-	-	0.22	5.17	5.92	0.29	0.39	0.31	2.46	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	18.6	-	-	0.97	-	-	0.29	0.03	1.81	0.36	-	0.38	-	-	0.22	5.17	5.92	0.29	0.39	0.31	2.46	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	18.6
H2319_801_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	287.32	3.08	43.4	0	8.43	18.16	1.58	6.06	27.96	10.93	29.7	0	8.28	29.42	27.44	43.05	2.21	2.32	30.67	138.96	19.08	2.4	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	20.15	0.22	7.8	-	1.96	4.23	0.37	1.41	6.51	2.55	6.92	-	1.93	6.85	6.39	10.03	0.51	0.54	7.15	32.38	4.45	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.92	20.15	0.22	7.8	-	1.96	4.23	0.37	1.41	6.51	2.55	6.92	-	1.93	6.85	6.39	10.03	0.51	0.54	7.15	32.38	4.45	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.92
H2319_802_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	287.32	3.08	43.4	0	8.43	18.16	1.58	6.06	27.96	10.93	29.7	0	8.28	29.42	27.44	43.05	2.21	2.32	30.67	138.96	19.08	2.4	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	20.15	0.22	7.8	-	1.96	4.23	0.37	1.41	6.51	2.55	6.92	-	1.93	6.85	6.39	10.03	0.51	0.54	7.15	32.38	4.45	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.92	20.15	0.22	7.8	-	1.96	4.23	0.37	1.41	6.51	2.55	6.92	-	1.93	6.85	6.39	10.03	0.51	0.54	7.15	32.38	4.45	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.92
H2319_803_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	287.32	3.08	43.4	0	8.43	18.16	1.58	6.06	27.96	10.93	29.7	0	8.28	29.42	27.44	43.05	2.21	2.32	30.67	138.96	19.08	2.4	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	20.15	0.22	7.8	-	1.96	4.23	0.37	1.41	6.51	2.55	6.92	-	1.93	6.85	6.39	10.03	0.51	0.54	7.15	32.38	4.45	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.92	20.15	0.22	7.8	-	1.96	4.23	0.37	1.41	6.51	2.55	6.92	-	1.93	6.85	6.39	10.03	0.51	0.54	7.15	32.38	4.45	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.92
H2319_804_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	287.32	3.08	43.4	0	8.43	18.16	1.58	6.06	27.96	10.93	29.7	0	8.28	29.42	27.44	43.05	2.21	2.32	30.67	138.96	19.08	2.4	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	20.15	0.22	7.8	-	1.96	4.23	0.37	1.41	6.51	2.55	6.92	-	1.93	6.85	6.39	10.03	0.51	0.54	7.15	32.38	4.45	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.92	20.15	0.22	7.8	-	1.96	4.23	0.37	1.41	6.51	2.55	6.92	-	1.93	6.85	6.39	10.03	0.51	0.54	7.15	32.38	4.45	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.92
H2320_001_0	2006											2710											D	D	D	V	T	Coin	Coin	V	P	O	V				V	V	Coin	V	V		S						V															3500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	979.46	20.57	582.58	1632.99	228.48	18.92	1.32	423.55	396.91	0	825.85	0	0	0	3909.08	4525.64	1.33	235.64	648.88	0	790.57	0	0	0	0	0	124.37	0	0	0	0											50/day first 8 days	50/day first 8 days	25/day first 20 days	10/visit	100/trip	20 coinsurance	20 coinsurance	50/visit	50/procedure		25/visit				15/visit	25/visit	50 coinsurance	25/visit	25/visit		10/script						25/visit															50	50	25	10	100	0.2	0.2	48.2	50	0	25	0	0	0	15	25	0.5	25	25	0	10	0	0	0	0	0	25	0	0	0	0											6210	48.07	48.07	24.03	9.61	96.14	0.19	0.19	46.33	48.07	0	24.03	0	0	0	14.42	24.03	0.48	24.03	24.03	0	9.61	0	0	0	0	0	24.03	0	0	0	0											0	3.92	0.08	1.17	1.31	1.83	3.64	0.25	1.64	1.59	-	1.65	-	-	-	4.7	9.06	0.64	0.47	1.3	-	0.63	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.14	3.92	0.08	1.17	1.31	1.83	3.64	0.25	1.64	1.59	-	1.65	-	-	-	4.7	9.06	0.64	0.47	1.3	-	0.63	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.14
H2320_003_0	2006											2710											D	D	D	V	T	Coin	Coin	V	P	O	V				V	V	Coin	V	V		S						V															3500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	979.46	20.57	582.58	1632.99	228.48	18.92	1.32	423.55	396.91	0	825.85	0	0	0	3909.08	4525.64	1.33	235.64	648.88	0	790.57	0	0	0	0	0	124.37	0	0	0	0											50/day first 8 days	50/day first 8 days	25/day first 20 days	10/visit	100/trip	20 coinsurance	20 coinsurance	50/visit	50/procedure		25/visit				15/visit	25/visit	50 coinsurance	25/visit	25/visit		10/script						25/visit															50	50	25	10	100	0.2	0.2	48.2	50	0	25	0	0	0	15	25	0.5	25	25	0	10	0	0	0	0	0	25	0	0	0	0											6210	48.07	48.07	24.03	9.61	96.14	0.19	0.19	46.33	48.07	0	24.03	0	0	0	14.42	24.03	0.48	24.03	24.03	0	9.61	0	0	0	0	0	24.03	0	0	0	0											0	3.92	0.08	1.17	1.31	1.83	3.64	0.25	1.64	1.59	-	1.65	-	-	-	4.7	9.06	0.64	0.47	1.3	-	0.63	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.14	3.92	0.08	1.17	1.31	1.83	3.64	0.25	1.64	1.59	-	1.65	-	-	-	4.7	9.06	0.64	0.47	1.3	-	0.63	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.14
H2320_802_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A																																										-	193.68	2.08	28.57	0	6.75	18.19	1.27	4.86	22.55	8.82	23.96	0	6.68	23.73	18.73	29.21	1.45	1.53	16.89	97.32	12.57	1.59																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				N/A	0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	13.91	0.15	4.99	-	1.57	4.24	0.3	1.13	5.26	2.05	5.58	-	1.56	5.53	4.36	6.81	0.34	0.36	3.93	22.67	2.93	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.04	13.91	0.15	4.99	-	1.57	4.24	0.3	1.13	5.26	2.05	5.58	-	1.56	5.53	4.36	6.81	0.34	0.36	3.93	22.67	2.93	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.04
H2320_803_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A																																										-	193.68	2.08	28.57	0	6.75	18.19	1.27	4.86	22.55	8.82	23.96	0	6.68	23.73	18.73	29.21	1.45	1.53	16.89	97.32	12.57	1.59																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				N/A	0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	13.91	0.15	4.99	-	1.57	4.24	0.3	1.13	5.26	2.05	5.58	-	1.56	5.53	4.36	6.81	0.34	0.36	3.93	22.67	2.93	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.04	13.91	0.15	4.99	-	1.57	4.24	0.3	1.13	5.26	2.05	5.58	-	1.56	5.53	4.36	6.81	0.34	0.36	3.93	22.67	2.93	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.04
H2320_804_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A																																										-	203.87	2.19	30.08	0	7.11	19.15	1.34	5.12	23.74	9.28	25.23	0	7.03	24.98	19.71	30.75	1.53	1.61	17.77	102.44	13.23	1.67																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				N/A	0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	14.64	0.16	5.25	-	1.66	4.46	0.31	1.19	5.53	2.16	5.88	-	1.64	5.82	4.59	7.16	0.36	0.37	4.14	23.87	3.08	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.67	14.64	0.16	5.25	-	1.66	4.46	0.31	1.19	5.53	2.16	5.88	-	1.64	5.82	4.59	7.16	0.36	0.37	4.14	23.87	3.08	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.67
H2320_805_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A																																										-	203.87	2.19	30.08	0	7.11	19.15	1.34	5.12	23.74	9.28	25.23	0	7.03	24.98	19.71	30.75	1.53	1.61	17.77	102.44	13.23	1.67																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				N/A	0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	14.64	0.16	5.25	-	1.66	4.46	0.31	1.19	5.53	2.16	5.88	-	1.64	5.82	4.59	7.16	0.36	0.37	4.14	23.87	3.08	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.67	14.64	0.16	5.25	-	1.66	4.46	0.31	1.19	5.53	2.16	5.88	-	1.64	5.82	4.59	7.16	0.36	0.37	4.14	23.87	3.08	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.67
H2320_806_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A																																										-	193.68	2.08	28.57	0	6.75	18.19	1.27	4.86	22.55	8.82	23.96	0	6.68	23.73	18.73	29.21	1.45	1.53	16.89	97.32	12.57	1.59																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				N/A	0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	13.91	0.15	4.99	-	1.57	4.24	0.3	1.13	5.26	2.05	5.58	-	1.56	5.53	4.36	6.81	0.34	0.36	3.93	22.67	2.93	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.04	13.91	0.15	4.99	-	1.57	4.24	0.3	1.13	5.26	2.05	5.58	-	1.56	5.53	4.36	6.81	0.34	0.36	3.93	22.67	2.93	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.04
H2320_807_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A																																										-	193.68	2.08	28.57	0	6.75	18.19	1.27	4.86	22.55	8.82	23.96	0	6.68	23.73	18.73	29.21	1.45	1.53	16.89	97.32	12.57	1.59																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				N/A	0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	13.91	0.15	4.99	-	1.57	4.24	0.3	1.13	5.26	2.05	5.58	-	1.56	5.53	4.36	6.81	0.34	0.36	3.93	22.67	2.93	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.04	13.91	0.15	4.99	-	1.57	4.24	0.3	1.13	5.26	2.05	5.58	-	1.56	5.53	4.36	6.81	0.34	0.36	3.93	22.67	2.93	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.04
H2320_808_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A																																										-	203.87	2.19	30.08	0	7.11	19.15	1.34	5.12	23.74	9.28	25.23	0	7.03	24.98	19.71	30.75	1.53	1.61	17.77	102.44	13.23	1.67																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				N/A	0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	14.64	0.16	5.25	-	1.66	4.46	0.31	1.19	5.53	2.16	5.88	-	1.64	5.82	4.59	7.16	0.36	0.37	4.14	23.87	3.08	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.67	14.64	0.16	5.25	-	1.66	4.46	0.31	1.19	5.53	2.16	5.88	-	1.64	5.82	4.59	7.16	0.36	0.37	4.14	23.87	3.08	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.67
H2320_809_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A																																										-	203.87	2.19	30.08	0	7.11	19.15	1.34	5.12	23.74	9.28	25.23	0	7.03	24.98	19.71	30.75	1.53	1.61	17.77	102.44	13.23	1.67																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				N/A	0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	14.64	0.16	5.25	-	1.66	4.46	0.31	1.19	5.53	2.16	5.88	-	1.64	5.82	4.59	7.16	0.36	0.37	4.14	23.87	3.08	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.67	14.64	0.16	5.25	-	1.66	4.46	0.31	1.19	5.53	2.16	5.88	-	1.64	5.82	4.59	7.16	0.36	0.37	4.14	23.87	3.08	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.67
H2322_001_0	2006											0													D					V							V	V	V			V		P																				0																																										-			1081.8					443.8							6691.5	6147	295.2			2095.2		1.8																						114 copay for days 21-100					50 copay for ER Visits 10 copay for Urgent Care							10 copay	10 copay	10 copay			10 copay		10 copay																						76.42					49.84							10	10	10			10		10																				0			76.42					49.84							10	10	10			10		10																				0	-	-	6.89	-	-	-	-	1.84	-	-	-	-	-	-	5.58	5.12	0.25	-	-	1.75	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.42	-	-	6.89	-	-	-	-	1.84	-	-	-	-	-	-	5.58	5.12	0.25	-	-	1.75	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.42
H2322_003_0	2006											0													D					V							V	V	V			V		P																				0																																										-			1081.8					443.8							6691.5	6147	295.2			2095.2		1.8																						114 copay for days 21-100					50 copay for ER Visits 10 copay for Urgent Care							10 copay	10 copay	10 copay			10 copay		10 copay																						76.42					49.84							10	10	10			10		10																				0			76.42					49.84							10	10	10			10		10																				0	-	-	6.89	-	-	-	-	1.84	-	-	-	-	-	-	5.58	5.12	0.25	-	-	1.75	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.42	-	-	6.89	-	-	-	-	1.84	-	-	-	-	-	-	5.58	5.12	0.25	-	-	1.75	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.42
H2322_004_0	2006											0													D					V							V	V	V			V		P																				0																																										-			1081.8					443.8							6691.5	6147	295.2			2095.2		1.8																						114 copay for days 21-100					50 copay for ER Visits 10 copay for Urgent Care							10 copay	10 copay	10 copay			10 copay		10 copay																						76.42					49.84							10	10	10			10		10																				0			76.42					49.84							10	10	10			10		10																				0	-	-	6.89	-	-	-	-	1.84	-	-	-	-	-	-	5.58	5.12	0.25	-	-	1.75	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.42	-	-	6.89	-	-	-	-	1.84	-	-	-	-	-	-	5.58	5.12	0.25	-	-	1.75	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.42
H2322_801_0	2006																						coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin		coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	292.5	3.11	43.25	34.44	7.77	13.62	8.74	341.73	28.61	11.66	31.47		0.4	30.19	56.93	116.74	2.22	2.84	31.84	43.88	8.46	6.23																				6.6 Medicare equiv. coins	6.6 Medicare equiv. coins	18 Medicare equiv. coins	0	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	50 ER/23.3 UC	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins		23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.84	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.84	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	19.3	0.2	7.79	-	1.81	3.17	2.04	1.42	6.67	2.72	7.33	-	0.09	7.03	13.26	27.2	0.52	0.66	7.42	10.22	1.97	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.27	19.3	0.2	7.79	-	1.81	3.17	2.04	1.42	6.67	2.72	7.33	-	0.09	7.03	13.26	27.2	0.52	0.66	7.42	10.22	1.97	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.27
H2322_802_0	2006																						coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin		coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	292.5	3.11	43.25	34.44	7.77	13.62	8.74	341.73	28.61	11.66	31.47		0.4	30.19	56.93	116.74	2.22	2.84	31.84	43.88	8.46	6.23																				6.6 Medicare equiv. coins	6.6 Medicare equiv. coins	18 Medicare equiv. coins	0	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	50 ER/23.3 UC	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins		23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.84	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.84	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	19.3	0.2	7.79	-	1.81	3.17	2.04	1.42	6.67	2.72	7.33	-	0.09	7.03	13.26	27.2	0.52	0.66	7.42	10.22	1.97	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.27	19.3	0.2	7.79	-	1.81	3.17	2.04	1.42	6.67	2.72	7.33	-	0.09	7.03	13.26	27.2	0.52	0.66	7.42	10.22	1.97	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.27
H2322_803_0	2006																						coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin		coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	292.5	3.11	43.25	34.44	7.77	13.62	8.74	341.73	28.61	11.66	31.47		0.4	30.19	56.93	116.74	2.22	2.84	31.84	43.88	8.46	6.23																				6.6 Medicare equiv. coins	6.6 Medicare equiv. coins	18 Medicare equiv. coins	0	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	50 ER/23.3 UC	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins		23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.84	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.84	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	19.3	0.2	7.79	-	1.81	3.17	2.04	1.42	6.67	2.72	7.33	-	0.09	7.03	13.26	27.2	0.52	0.66	7.42	10.22	1.97	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.27	19.3	0.2	7.79	-	1.81	3.17	2.04	1.42	6.67	2.72	7.33	-	0.09	7.03	13.26	27.2	0.52	0.66	7.42	10.22	1.97	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.27
H2322_804_0	2006																						coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin		coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	292.5	3.11	43.25	34.44	7.77	13.62	8.74	341.73	28.61	11.66	31.47		0.4	30.19	56.93	116.74	2.22	2.84	31.84	43.88	8.46	6.23																				6.6 Medicare equiv. coins	6.6 Medicare equiv. coins	18 Medicare equiv. coins	0	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	50 ER/23.3 UC	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins		23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins	23.3 Medicare equiv. coins																				0.07	0.07	0.18	0	0.23	0.23	0.23	49.84	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	49.84	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	19.3	0.2	7.79	-	1.81	3.17	2.04	1.42	6.67	2.72	7.33	-	0.09	7.03	13.26	27.2	0.52	0.66	7.42	10.22	1.97	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.27	19.3	0.2	7.79	-	1.81	3.17	2.04	1.42	6.67	2.72	7.33	-	0.09	7.03	13.26	27.2	0.52	0.66	7.42	10.22	1.97	1.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.27
H2323_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	331.44	29.32			29.91	7.11	12.98	17.85	12.99	35.98	8.23	1.41	1.08	95.21		22.84	23.58	1.79	21.06	94.98	36.39	0.16																				FFS Med Ded/Coin	FFS Med Ded/Coin			FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin		FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin																				0.07	0.07			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23																				110	21.84	1.93	-	-	6.97	1.66	3.02	4.16	3.03	8.38	1.92	0.33	0.25	22.18	-	5.32	5.49	0.42	4.91	22.13	8.48	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.46	21.84	1.93	-	-	6.97	1.66	3.02	4.16	3.03	8.38	1.92	0.33	0.25	22.18	-	5.32	5.49	0.42	4.91	22.13	8.48	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.46
H2354_001_0	2006											0																		V						V	V	V	V			V					V		V																							0						0	0	0	0			0					0		0															-								184.09						0.19	6131.84	2812.26	196.8			696.46					747.33		4.31																						50 Copay for ER Visit 20 Copay Urgent Care (worldwide coverage)						10 OP Substance Abuse	10 Office Visit Copay	10 Office Visit Copay	10 Office Visit Copay			10 Copay Podiatry Chiro and Other Specialty					10 Eye Exam Copay		10 Hearing Exam Copay																						50						10	10	10	10			10					10		10																							50						10	10	10	10			10					10		10															0	-	-	-	-	-	-	-	0.77	-	-	-	-	-	0	5.11	2.34	0.16	-	-	0.58	-	-	-	-	0.62	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9.59	-	-	-	-	-	-	-	0.77	-	-	-	-	-	0	5.11	2.34	0.16	-	-	0.58	-	-	-	-	0.62	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9.59
H2354_801_0	2006																						Coin		Coin	Coin	Coin	Coin		V	Coin	Coin					Coin							Coin																																																														-	267.69		18.4	3.84	6.51	15.03		223.94	53.3	32.64					266.7							25.01																																																													0.04		0.18	0	0.2	0.2		50	0.2	0.2					0.2							0.2																					0.04		0.18	0	0.2	0.2		50	0.2	0.2					0.2							0.2																				0	11.45	-	3.23	-	1.3	3.01	-	0.93	10.66	6.53	-	-	-	-	53.34	-	-	-	-	-	-	5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.45	11.45	-	3.23	-	1.3	3.01	-	0.93	10.66	6.53	-	-	-	-	53.34	-	-	-	-	-	-	5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.45
H2354_802_0	2006																						Coin		Coin	Coin	Coin	Coin		V	Coin	Coin					Coin							Coin																																																														-	267.69		18.4	3.84	6.51	15.03		223.94	53.3	32.64					266.7							25.01																																																													0.04		0.18	0	0.2	0.2		50	0.2	0.2					0.2							0.2																					0.04		0.18	0	0.2	0.2		50	0.2	0.2					0.2							0.2																				0	11.45	-	3.23	-	1.3	3.01	-	0.93	10.66	6.53	-	-	-	-	53.34	-	-	-	-	-	-	5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.45	11.45	-	3.23	-	1.3	3.01	-	0.93	10.66	6.53	-	-	-	-	53.34	-	-	-	-	-	-	5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.45
H2406_001_0	2006											2700											D	D	D	P	P	Coin	P	V	V	V	V	V	Coin	V	P	P	P	P		P	S	P	P		P	P	P																																																									-	1836.78	132.98			2763.97	20.06		452.36	185.8	819.36	271.93	85.22	0.13	291.89	81.58	33565.69	1261.33	0.94		1069.9		893.08			32.11																	75	7500			50/trip	0		50	100/25	0/10	0/10	100/25	0.2	100/25	0/25	0/25	0/35/25	0/10		0/25		0/25			0/25		0/25															75	75			16.67	0.2		50	100	0.2	0.2	25	0.2	25	0.5	0.5	0.6	0.2		0.5		0.5			0.5		0.5																72.91	72.91			16.2	0.19		48.6	97.21	0.19	0.19	24.3	0.19	24.3	0.49	0.49	0.58	0.19		0.49		0.5			0.5		0.5																11.16	0.81	-	-	3.73	3.9	-	1.83	1.51	0.01	0	0.17	0.03	0.59	0	1.36	0.06	0	-	0.04	-	0.04	-	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.25	11.16	0.81	-	-	3.73	3.9	-	1.83	1.51	0.01	0	0.17	0.03	0.59	0	1.36	0.06	0	-	0.04	-	0.04	-	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.25
H2407_001_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																															-	1		1		1	1		1	1	1					1						1																																																																																																								32.14		19.58		6.67	18.02		4.26	10.3	4.76					106.52						0.59																						32.14	-	19.58	-	6.67	18.02	-	4.26	10.3	4.76	-	-	-	-	106.52	-	-	-	-	-	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	202.83	32.14	-	19.58	-	6.67	18.02	-	4.26	10.3	4.76	-	-	-	-	106.52	-	-	-	-	-	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	202.83
H2408_001_0	2006											2900											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1322.79	72.32	835.45	0	114.24	8.68	11.45	294.86	31.21	1521.19	20.98	3.88	0.21	22.34	3467.75	4393.7	273.48	1.55	15.61	234.13	16.15	0	0	0	124	0	222	0	0	0	0											265	265	125	0	150	20	20	50	20	5	20-May	20	20	20/40/30	10.00/0.00	25	40.00/30.00	20	0/20	0/25	20	0			25		25			0												265	265	125	0	150	0.2	0.2	50	0.2	5	0.15	0.2	0.2	0.2	9.84	25	37.5	0.2	0.14	0.5	0.2	0	0	0	25	0	25	0	0	0	0												166.32	166.32	78.45	0	94.14	0.13	0.13	31.38	0.13	3.14	0.1	0.13	0.13	0.13	9.84	25	37.5	0.13	0.14	0.5	0.13	0	0	0	25	0	25	0	0	0	0												18.33	1	5.46	-	0.9	1.09	1.44	0.77	3.92	0.4	2	0.49	0.03	2.82	2.84	9.15	0.85	0.2	2.17	0.01	2.03	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.62	18.33	1	5.46	-	0.9	1.09	1.44	0.77	3.92	0.4	2	0.49	0.03	2.82	2.84	9.15	0.85	0.2	2.17	0.01	2.03	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.62
H2408_011_0	2006											3800											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1346.7	91.21	869.57	0	135.97	8.52	10.38	292.71	32.06	1503.54	20.23	2.74	0.21	17.9	3372.95	4569.95	268.04	2.78	17.96	1678.94	16.99	0	0	0	124	0	222	0	0	0	0											250	250	150	0	150	20	20	50	20	10	10.00/20	20	20	20/40/30	15.00/0.00	30	40.00/30.00	20	0/20	0/30.00	20	0			30		30			0												250	250	150	0	150	0.2	0.2	50	0.2	10	0.16	0.2	0.2	0.2	14.79	30	37.5	0.2	0.17	25.01	0.2	0	0	0	30	0	35	0	0	0	0												171.96	171.96	103.18	0	103.18	0.14	0.14	34.39	0.14	6.88	0.11	0.14	0.14	0.14	14.79	30	37.5	0.14	0.17	25.01	0.14	0	0	0	30	0	35	0	0	0	0												19.3	1.31	7.48	-	1.17	1.17	1.43	0.84	4.41	0.86	2.19	0.38	0.03	2.46	4.16	11.42	0.84	0.38	3.08	3.5	2.34	-	-	-	0.31	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.69	19.3	1.31	7.48	-	1.17	1.17	1.43	0.84	4.41	0.86	2.19	0.38	0.03	2.46	4.16	11.42	0.84	0.38	3.08	3.5	2.34	-	-	-	0.31	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.69
H2408_013_0	2006											3900											D	D	Coin	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1505.15	82.43	22.48	0	110.92	12.5	14.15	321.41	35.78	1337.51	20.83	2.83	0.27	18.44	3939.65	4750.73	241.56	1.87	19.02	1781.5	19.68	0	0	0	124	0	222	0	0	0	0											375	375	30	0	150	30	30	50	30	10	10.00/30	30	30	30/40/30	20.00/0.00	35	40.00/30.00	30	0.00/30	0.00/35.00	30	0			35		35			0												375	375	0.3	0	150	0.3	0.3	50	0.3	10	0.24	0.3	0.3	0.3	20	34.94	37.5	0.3	0.22	28.44	0.3	0	0	0	35	0	35	0	0	0	0												225.9	225.9	0.18	0	90.36	0.18	0.18	30.12	0.18	6.02	0.14	0.18	0.18	0.18	20	34.94	37.5	0.18	0.22	28.44	0.18	0	0	0	35	0	35	0	0	0	0												28.33	1.55	4.06	-	0.84	2.26	2.56	0.81	6.47	0.67	2.97	0.51	0.05	3.3	6.57	13.83	0.75	0.34	4.27	4.22	3.56	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.93	28.33	1.55	4.06	-	0.84	2.26	2.56	0.81	6.47	0.67	2.97	0.51	0.05	3.3	6.57	13.83	0.75	0.34	4.27	4.22	3.56	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.93
H2408_015_0	2006											4400											D	D	Coin	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1683.01	119.91	23.1	0	139.35	9.07	12.14	295.01	28.22	1883.22	19.96	1.55	0.23	16.72	3903.59	5007.37	331.15	3	18.43	2081.46	18.93	0	0	0	124	0	222	0	0	0	0											330	330	25	0	150	20	20	50	20	10	20-Oct	20	25	20/40/30	20	35	40.00/30.00	20	20/0	0/35	25	0			35		35			0												330	330	0.25	0	150	0.2	0.2	50	0.2	10	0.23	0.2	0.25	0.2	20	34.94	37.5	0.2	0.22	28.31	0.25	0	0	0	35	0	35	0	0	0	0												220.77	220.77	0.17	0	100.35	0.13	0.13	33.45	0.13	6.69	0.15	0.13	0.17	0.13	20	34.94	37.5	0.13	0.22	28.31	0.17	0	0	0	35	0	35	0	0	0	0												30.96	2.21	3.86	-	1.17	1.21	1.62	0.82	3.78	1.05	3.01	0.21	0.04	2.25	6.51	14.58	1.03	0.4	4.14	4.91	3.17	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.93	30.96	2.21	3.86	-	1.17	1.21	1.62	0.82	3.78	1.05	3.01	0.21	0.04	2.25	6.51	14.58	1.03	0.4	4.14	4.91	3.17	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.93
H2408_801_0	2006											3900											D	D	D	V	P	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1659.26	94.72	798.57	0	132.96	11.57	13.31	307.07	35.8	9.05	21.27	2.47	0.24	19	3975.14	5226.2	326.69	5.96	25.01	412.76	20.28	0	0	0	124	0	222	0	0	0	0											250	250	150	0	150	30	30	50	30	10	30-Oct	30	30	30/40/30	25.00/0.00	35	40.00/30.00	30	0/30	0/35	30	0			35		35			0												250	250	150	0	150	0.3	0.3	50	0.3	0.14	0.23	0.3	0.3	0.29	24.65	34.94	37.5	0.38	0.22	0.5	0.3	0	0	0	35	0	35	0	0	0	0												163.32	158.33	95	0	95	0.19	0.19	31.67	0.19	0.09	0.15	0.19	0.19	0.19	24.65	34.94	37.5	0.31	0.22	0.5	0.19	0	0	0	35	0	35	0	0	0	0												22.58	1.25	6.32	-	1.05	2.2	2.53	0.81	6.8	0.79	3.1	0.47	0.05	3.54	8.16	15.22	1.02	1.86	5.62	0.02	3.85	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.25	22.58	1.25	6.32	-	1.05	2.2	2.53	0.81	6.8	0.79	3.1	0.47	0.05	3.54	8.16	15.22	1.02	1.86	5.62	0.02	3.85	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.25
H2408_802_0	2006											4000											D	D	D	V	P	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1660.33	95.27	803.18	0	133.73	11.7	13.46	308.83	36.22	9.16	21.52	2.5	0.24	19.22	3997.68	5255.95	328.58	6.03	25.3	415.15	20.52	0	0	0	124	0	222	0	0	0	0											295	295	150	0	150	20	20	50	20	10	20-Oct	20	20	20/40/30	25.00/0.00	35	40.00/30.00	20	0/20	0/35	20	0			35		35			0												295	295	150	0	150	0.2	0.2	50	0.2	0.14	0.16	0.2	0.2	0.2	24.65	34.94	37.5	0.32	0.17	0.5	0.2	0	0	0	35	0	35	0	0	0	0												198.88	193.35	98.31	0	98.31	0.13	0.13	32.77	0.13	0.09	0.1	0.13	0.13	0.13	24.65	34.94	37.5	0.27	0.17	0.5	0.13	0	0	0	35	0	35	0	0	0	0												27.52	1.54	6.58	-	1.1	1.53	1.76	0.84	4.75	0.82	2.21	0.33	0.03	2.49	8.21	15.3	1.03	1.65	4.33	0.02	2.69	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.74	27.52	1.54	6.58	-	1.1	1.53	1.76	0.84	4.75	0.82	2.21	0.33	0.03	2.49	8.21	15.3	1.03	1.65	4.33	0.02	2.69	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.74
H2409_003_0	2006											5000											D	D	D		T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P			Coin	Coin					P																																																									-	1445.28	62.75	977.4		124.2	7.35	9.45	274.04	333.95	1522.3	722.4	56.85	1.78	1446.09	3341.99	3701.53	206.87	918.2			19.91	0.4					222															150 days 1-7	150 days 1-7	75 days 8+		100	30	30	Oct-50	75	75	75	75	75	75	10	10	20	10			20	30					10															122.2	122.2	38.03		100	0.3	0.3	49.96	75	75	75	75	75	75	10	10	20	10			0.2	0.3					10																102.44	102.44	31.88		83.83	0.25	0.25	41.89	62.87	62.87	62.87	62.87	62.87	62.87	8.38	8.38	16.77	8.38			0.17	0.25					10																12.34	0.54	2.6	-	0.87	1.85	2.38	0.96	1.75	7.98	3.78	0.3	0.01	7.58	2.33	2.59	0.29	0.64	-	-	3.34	0.1	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.39	12.34	0.54	2.6	-	0.87	1.85	2.38	0.96	1.75	7.98	3.78	0.3	0.01	7.58	2.33	2.59	0.29	0.64	-	-	3.34	0.1	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.39
H2409_801_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	263.61	4.58	33.4		4.07	7.54	9.69	280.5	34.95	20.41	24.77	3.25	0.18	23.86	18.52	23.35	1.52	5.86	20.53	79.08	20.42	0.41																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	20.66	0.36	5.46	-	0.95	1.76	2.26	1.17	8.14	4.76	5.77	0.76	0.04	5.56	4.31	5.44	0.35	1.36	4.78	18.42	4.76	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.17	20.66	0.36	5.46	-	0.95	1.76	2.26	1.17	8.14	4.76	5.77	0.76	0.04	5.56	4.31	5.44	0.35	1.36	4.78	18.42	4.76	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.17
H2409_802_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	263.61	4.58	33.4		4.07	7.54	9.69	280.5	34.95	20.41	24.77	3.25	0.18	23.86	18.52	23.35	1.52	5.86	20.53	79.08	20.42	0.41																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	20.65	0.36	5.46	-	0.95	1.76	2.26	1.17	8.14	4.76	5.77	0.76	0.04	5.56	4.31	5.44	0.35	1.36	4.78	18.42	4.76	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.17	20.65	0.36	5.46	-	0.95	1.76	2.26	1.17	8.14	4.76	5.77	0.76	0.04	5.56	4.31	5.44	0.35	1.36	4.78	18.42	4.76	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.17
H2409_803_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	263.61	4.58	33.4		4.07	7.54	9.69	280.5	34.95	20.41	24.77	3.25	0.18	23.86	18.52	23.35	1.52	5.86	20.53	79.08	20.42	0.41																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	20.65	0.36	5.46	-	0.95	1.76	2.26	1.17	8.14	4.76	5.77	0.76	0.04	5.56	4.31	5.44	0.35	1.36	4.78	18.42	4.76	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.17	20.65	0.36	5.46	-	0.95	1.76	2.26	1.17	8.14	4.76	5.77	0.76	0.04	5.56	4.31	5.44	0.35	1.36	4.78	18.42	4.76	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.17
H2409_804_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	263.61	4.58	33.4		4.07	7.54	9.69	280.5	34.95	20.41	24.77	3.25	0.18	23.86	18.52	23.35	1.52	5.86	20.53	79.08	20.42	0.41																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	20.65	0.36	5.46	-	0.95	1.76	2.26	1.17	8.14	4.76	5.77	0.76	0.04	5.56	4.31	5.44	0.35	1.36	4.78	18.42	4.76	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.17	20.65	0.36	5.46	-	0.95	1.76	2.26	1.17	8.14	4.76	5.77	0.76	0.04	5.56	4.31	5.44	0.35	1.36	4.78	18.42	4.76	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.17
H2410_001_0	2006											5000											D	D	D		T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P			Coin	Coin					P																																																									-	1611.03	69.94	1089.42		138.44	9.13	11.74	305.34	372.25	1696.88	805.24	63.37	1.98	1611.93	3725.26	4126.03	230.59	1023.5			24.74	0.5					222															150 days 1-7	150 days 1-7	75 days 8+		100	30	30	Oct-50	75	75	75	75	75	75	10	10	20	10			20	30					10															122.2	122.2	38.03		100	0.3	0.3	49.97	75	75	75	75	75	75	10	10	20	10			0.2	0.3					10																99.62	99.62	31		81.52	0.24	0.24	40.74	61.14	61.14	61.14	61.14	61.14	61.14	8.15	8.15	16.3	8.15			0.16	0.24					10																13.37	0.58	2.81	-	0.94	2.23	2.87	1.04	1.9	8.65	4.1	0.32	0.01	8.21	2.53	2.8	0.31	0.7	-	-	4.03	0.12	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.73	13.37	0.58	2.81	-	0.94	2.23	2.87	1.04	1.9	8.65	4.1	0.32	0.01	8.21	2.53	2.8	0.31	0.7	-	-	4.03	0.12	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.73
H2410_002_0	2006											5000											D	D	D		T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P			Coin	Coin					P																																																									-	1436.54	62.37	971.49		123.44	7.26	9.33	272.38	331.93	1513.09	718.03	56.5	1.77	1437.34	3321.78	3679.14	205.61	912.65			19.67	0.4					222															150 days 1-7	150 days 1-7	75 days 8+		100	30	30	Oct-50	75	75	75	75	75	75	10	10	20	10			20	30					10															122.2	122.2	38.03		100	0.3	0.3	49.96	75	75	75	75	75	75	10	10	20	10			0.2	0.3					10																102.58	102.58	31.92		83.94	0.25	0.25	41.95	62.96	62.96	62.96	62.96	62.96	62.96	8.39	8.39	16.79	8.39			0.17	0.25					10																12.28	0.53	2.58	-	0.86	1.83	2.35	0.95	1.74	7.94	3.77	0.3	0.01	7.54	2.32	2.57	0.29	0.64	-	-	3.3	0.1	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.1	12.28	0.53	2.58	-	0.86	1.83	2.35	0.95	1.74	7.94	3.77	0.3	0.01	7.54	2.32	2.57	0.29	0.64	-	-	3.3	0.1	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.1
H2410_009_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	335.31	51.1	87.84		10.14	18.11	16.69	23.46	29.13	24.85	23.66	4.33	1.72	42.77	20.65	22.76	14.63	4.35	16.48	86.34	19.82	0.22																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.08	0.08	0.16		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.16		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	25.48	3.88	14.15	-	2.36	4.22	3.89	5.47	6.79	5.79	5.51	1.01	0.4	9.97	4.81	5.3	3.41	1.01	3.84	20.12	4.62	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.07	25.48	3.88	14.15	-	2.36	4.22	3.89	5.47	6.79	5.79	5.51	1.01	0.4	9.97	4.81	5.3	3.41	1.01	3.84	20.12	4.62	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.07
H2410_801_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	278.53	4.84	35.29		4.3	7.96	10.24	288.33	36.93	21.57	26.18	3.44	0.19	25.21	19.56	24.67	1.61	6.19	21.69	83.55	21.58	0.44																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	21.23	0.37	5.7	-	1	1.86	2.39	1.2	8.61	5.03	6.1	0.8	0.04	5.87	4.56	5.75	0.37	1.44	5.05	19.47	5.03	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.97	21.23	0.37	5.7	-	1	1.86	2.39	1.2	8.61	5.03	6.1	0.8	0.04	5.87	4.56	5.75	0.37	1.44	5.05	19.47	5.03	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.97
H2410_802_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	278.53	4.84	35.29		4.3	7.96	10.24	288.33	36.93	21.57	26.18	3.44	0.19	25.21	19.56	24.67	1.61	6.19	21.69	83.55	21.58	0.44																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	21.23	0.37	5.7	-	1	1.86	2.39	1.2	8.61	5.03	6.1	0.8	0.04	5.87	4.56	5.75	0.37	1.44	5.05	19.47	5.03	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.97	21.23	0.37	5.7	-	1	1.86	2.39	1.2	8.61	5.03	6.1	0.8	0.04	5.87	4.56	5.75	0.37	1.44	5.05	19.47	5.03	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.97
H2410_803_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	278.53	4.84	35.29		4.3	7.96	10.24	288.33	36.93	21.57	26.18	3.44	0.19	25.21	19.56	24.67	1.61	6.19	21.69	83.55	21.58	0.44																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	21.23	0.37	5.7	-	1	1.86	2.39	1.2	8.61	5.03	6.1	0.8	0.04	5.87	4.56	5.75	0.37	1.44	5.05	19.47	5.03	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.97	21.23	0.37	5.7	-	1	1.86	2.39	1.2	8.61	5.03	6.1	0.8	0.04	5.87	4.56	5.75	0.37	1.44	5.05	19.47	5.03	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.97
H2410_804_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	278.53	4.84	35.29		4.3	7.96	10.24	288.33	36.93	21.57	26.18	3.44	0.19	25.21	19.56	24.67	1.61	6.19	21.69	83.55	21.58	0.44																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	21.23	0.37	5.7	-	1	1.86	2.39	1.2	8.61	5.03	6.1	0.8	0.04	5.87	4.56	5.75	0.37	1.44	5.05	19.47	5.03	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.97	21.23	0.37	5.7	-	1	1.86	2.39	1.2	8.61	5.03	6.1	0.8	0.04	5.87	4.56	5.75	0.37	1.44	5.05	19.47	5.03	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.97
H2411_001_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											7500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	292.44	3.98	88.09	2925.22	407.85	48.59	923.19	975.63	471.1	8989.95	1613.32	0	0	626.06	6714.71	2130.48	248.62	309.22	0	5.15	1299.71	0	0	150.81	213.69	12.08	0	0	0	10.83	6.95											250	25000	250	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	15	15	15	15	0	15	4.65044	0	0	0	15	0	0	0	0	15	0											250	250	250	0	50	0	0	46.5	0	0	50	0	0	0	15	15	15	15	0	15	4.65	0	0	0	15	0	0	0	0	15	0											0	248.75	248.75	248.75	0	49.75	0	0	46.27	0	0	49.75	0	0	0	14.93	14.93	14.93	14.93	0	14.93	4.63	0	0	0	14.93	0	0	0	0	14.93	0											0	6.06	0.08	1.83	-	1.69	-	-	3.76	-	-	6.69	-	-	-	8.35	2.65	0.31	0.38	-	0.01	0.5	-	-	-	0.27	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	32.59	6.06	0.08	1.83	-	1.69	-	-	3.76	-	-	6.69	-	-	-	8.35	2.65	0.31	0.38	-	0.01	0.5	-	-	-	0.27	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	32.59
H2411_002_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											7500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	292.44	3.98	88.09	2925.22	407.85	48.59	923.19	975.63	471.1	8989.95	1613.32	0	0	626.06	6714.71	2130.48	248.62	309.22	0	5.15	1299.71	0	0	150.81	213.69	12.08	0	0	0	10.83	6.95											250	25000	250	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	15	15	15	15	0	15	4.65044	0	0	0	15	0	0	0	0	15	0											250	250	250	0	50	0	0	46.5	0	0	50	0	0	0	15	15	15	15	0	15	4.65	0	0	0	15	0	0	0	0	15	0											0	248.75	248.75	248.75	0	49.75	0	0	46.27	0	0	49.75	0	0	0	14.93	14.93	14.93	14.93	0	14.93	4.63	0	0	0	14.93	0	0	0	0	14.93	0											0	6.06	0.08	1.83	-	1.69	-	-	3.76	-	-	6.69	-	-	-	8.35	2.65	0.31	0.38	-	0.01	0.5	-	-	-	0.27	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	32.59	6.06	0.08	1.83	-	1.69	-	-	3.76	-	-	6.69	-	-	-	8.35	2.65	0.31	0.38	-	0.01	0.5	-	-	-	0.27	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	32.59
H2411_003_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											7500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	292.44	3.98	88.09	2925.22	407.85	48.59	923.19	975.63	471.1	8989.95	1613.32	0	0	626.06	6714.71	2130.48	248.62	309.22	0	5.15	1299.71	0	0	150.81	213.69	12.08	0	0	0	10.83	6.95											250	25000	250	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	15	15	15	15	0	15	4.65044	0	0	0	15	0	0	0	0	15	0											250	250	250	0	50	0	0	46.5	0	0	50	0	0	0	15	15	15	15	0	15	4.65	0	0	0	15	0	0	0	0	15	0											0	248.75	248.75	248.75	0	49.75	0	0	46.27	0	0	49.75	0	0	0	14.93	14.93	14.93	14.93	0	14.93	4.63	0	0	0	14.93	0	0	0	0	14.93	0											0	6.06	0.08	1.83	-	1.69	-	-	3.76	-	-	6.69	-	-	-	8.35	2.65	0.31	0.38	-	0.01	0.5	-	-	-	0.27	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	32.59	6.06	0.08	1.83	-	1.69	-	-	3.76	-	-	6.69	-	-	-	8.35	2.65	0.31	0.38	-	0.01	0.5	-	-	-	0.27	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	32.59
H2411_801_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											7500	0	0	0		0			0	0		0	0			0	0	0	0		0	0				0					0												-	240.27	5.02	64.75		315.55			811.68	488.67		1513.19	0			6368.54	2008.79	235.87	372.76		7.39	1188.97				229.44					10.4												450	450	450		50			50 ER 20 UC	225		50	225			20	25	20	20		22.5	3.8215				20					20												450	450	450		50			47	225		50	225			20	25	20	20		22.5	3.82				20					20												0	447.75	447.75	447.75		49.75			46.77	223.88		49.75	223.88			19.9	24.88	19.9	19.9		22.39	3.8				19.9					19.9												0	8.97	0.19	2.42	-	1.31	-	-	3.16	9.12	-	6.27	-	-	-	10.56	4.16	0.39	0.62	-	0.01	0.38	-	-	-	0.38	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	47.95	8.97	0.19	2.42	-	1.31	-	-	3.16	9.12	-	6.27	-	-	-	10.56	4.16	0.39	0.62	-	0.01	0.38	-	-	-	0.38	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	47.95
H2411_802_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											7500	0	0	0		0			0	0		0	0			0	0	0	0		0	0				0					0												-	240.27	5.02	64.75		315.55			811.68	488.67		1513.19	0			6368.54	2008.79	235.87	372.76		7.39	1188.97				229.44					10.4												450	450	450		50			50 ER 20 UC	225		50	225			20	25	20	20		22.5	3.8215				20					20												450	450	450		50			47	225		50	225			20	25	20	20		22.5	3.82				20					20												0	447.75	447.75	447.75		49.75			46.77	223.88		49.75	223.88			19.9	24.88	19.9	19.9		22.39	3.8				19.9					19.9												0	8.97	0.19	2.42	-	1.31	-	-	3.16	9.12	-	6.27	-	-	-	10.56	4.16	0.39	0.62	-	0.01	0.38	-	-	-	0.38	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	47.95	8.97	0.19	2.42	-	1.31	-	-	3.16	9.12	-	6.27	-	-	-	10.56	4.16	0.39	0.62	-	0.01	0.38	-	-	-	0.38	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	47.95
H2411_803_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											7500	0	0	0		0			0	0		0	0			0	0	0	0		0	0				0					0												-	240.27	5.02	64.75		315.55			811.68	488.67		1513.19	0			6368.54	2008.79	235.87	372.76		7.39	1188.97				229.44					10.4												450	450	450		50			50 ER 20 UC	225		50	225			20	25	20	20		22.5	3.8215				20					20												450	450	450		50			47	225		50	225			20	25	20	20		22.5	3.82				20					20												0	447.75	447.75	447.75		49.75			46.77	223.88		49.75	223.88			19.9	24.88	19.9	19.9		22.39	3.8				19.9					19.9												0	8.97	0.19	2.42	-	1.31	-	-	3.16	9.12	-	6.27	-	-	-	10.56	4.16	0.39	0.62	-	0.01	0.38	-	-	-	0.38	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	47.95	8.97	0.19	2.42	-	1.31	-	-	3.16	9.12	-	6.27	-	-	-	10.56	4.16	0.39	0.62	-	0.01	0.38	-	-	-	0.38	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	47.95
H2416_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	483.73	20.4	89.35	56.52	7.05	52.58	1.61	20.03	74.56	17.67	39.8	3.57	3.16	41.56	0	174.11	2.56	2.53	17.79	0.08	7.74	0.84																				Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare																				0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					37.73	1.59	15.21	-	1.64	12.25	0.38	4.67	17.37	4.12	9.27	0.83	0.74	9.68	-	40.77	0.6	0.59	4.17	0.02	1.8	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	163.62	37.73	1.59	15.21	-	1.64	12.25	0.38	4.67	17.37	4.12	9.27	0.83	0.74	9.68	-	40.77	0.6	0.59	4.17	0.02	1.8	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	163.62
H2417_001_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	497.45	20.98	88.78		7.01	52.24	1.66	20.6	76.67	18.18	40.94	3.67	3.25	35.6	0	179.03	2.63	2.6	18.3	0.08	7.27	0.86																				Same as Medicare	Same as Medicare	Same as Medicare		Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare																				0.08	0.08	0.17		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.17		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					38.6	1.63	15.11	-	1.63	12.17	0.39	4.8	17.86	4.24	9.54	0.86	0.76	8.29	-	41.71	0.61	0.61	4.26	0.02	1.69	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	164.99	38.6	1.63	15.11	-	1.63	12.17	0.39	4.8	17.86	4.24	9.54	0.86	0.76	8.29	-	41.71	0.61	0.61	4.26	0.02	1.69	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	164.99
H2419_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	537.33	27.1	400.95	0	36.43	12.49	16.11	18.42	14.63	31.62	9.57	1.47	2.55	87.41	9.42	23.73	17.21	2.06	20.23	168.02	31.76	0																				Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co																				0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					41.7	2.1	68.24	-	8.49	2.91	3.75	4.29	3.41	7.37	2.23	0.34	0.59	20.37	2.19	5.53	4.01	0.48	4.71	39.15	7.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	229.27	41.7	2.1	68.24	-	8.49	2.91	3.75	4.29	3.41	7.37	2.23	0.34	0.59	20.37	2.19	5.53	4.01	0.48	4.71	39.15	7.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	229.27
H2422_002_0	2006																						Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																															-	474.13		98.48	11.23	40.32	27.7		26.69	36.58	200.94					328.25						1.93																																																														0.07		0.15	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23																						0.07		0.15	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23																						34.99	-	14.61	-	9.39	6.45	-	6.22	8.52	46.82	-	-	-	-	76.48	-	-	-	-	-	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	203.95	34.99	-	14.61	-	9.39	6.45	-	6.22	8.52	46.82	-	-	-	-	76.48	-	-	-	-	-	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	203.95
H2424_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin							Coin	Coin																																																						-	447.48	4.49	78.21	49.96	9.16	7.33	45.3	18.06	54.99	8.12	23.92	0	9.85	43.52	58.9	179.55	1.97	6.86	41.51	46.83	0	0							0	0												Days 1 - 60 : an initial deductible of 912. Days 61 - 90: 228 each day. Days 91 - 150: 456 each lifetime reserve day	Days 1 - 60 : an initial deductible of 912. Days 61 - 90: 228 each day. Days 91 - 150: 456 each lifetime reserve day. Beneficiaries may only receive 190 days in a Psychiatric Hospital in a lifetime.	Days 1 - 20: 0 for each day Days 21 - 100: 114 for each day There is a limit of 100 days for each benefit period.	No copayment for all covered home health visits	20 of Medicare-approved amounts or applicable fee schedule charge. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of the facility charge or applicable Copayment for each emergency room visit; member does NOT pay this amount if they are admitted to the hospital for the same condition within 3 days of the emergency room visit. 20 of doctor charges.NOT covered outside the U.S. except under limited circumstances. Total of one 110 deductible per year	20 of Medicare-approved amounts for the doctor. 20 of outpatient facility charges. Total of one 110 deductible per year	20 of Medicare-approved amounts except for approved lab services. There is no copayment for Medicare-approved lab services.	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year																				0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23							1	1													0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23							1	1													34.72	0.35	13.31	-	2.13	1.71	10.55	4.21	12.81	1.89	5.57	-	2.3	10.14	13.72	41.83	0.46	1.6	9.67	10.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	177.9	34.72	0.35	13.31	-	2.13	1.71	10.55	4.21	12.81	1.89	5.57	-	2.3	10.14	13.72	41.83	0.46	1.6	9.67	10.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	177.9
H2425_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin							Coin	Coin																																																						-	404.1	4.05	70.62	45.12	8.27	6.62	40.91	16.31	49.66	7.33	21.6	0	8.9	39.3	53.19	162.14	1.78	6.19	37.49	42.29	0	0							0	0												Days 1 - 60 : an initial deductible of 912. Days 61 - 90: 228 each day. Days 91 - 150: 456 each lifetime reserve day	Days 1 - 60 : an initial deductible of 912. Days 61 - 90: 228 each day. Days 91 - 150: 456 each lifetime reserve day. Beneficiaries may only receive 190 days in a Psychiatric Hospital in a lifetime.	Days 1 - 20: 0 for each day Days 21 - 100: 114 for each day There is a limit of 100 days for each benefit period.	No copayment for all covered home health visits	20 of Medicare-approved amounts or applicable fee schedule charge. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of the facility charge or applicable Copayment for each emergency room visit; member does NOT pay this amount if they are admitted to the hospital for the same condition within 3 days of the emergency room visit. 20 of doctor charges.NOT covered outside the U.S. except under limited circumstances. Total of one 110 deductible per year	20 of Medicare-approved amounts for the doctor. 20 of outpatient facility charges. Total of one 110 deductible per year	20 of Medicare-approved amounts except for approved lab services. There is no copayment for Medicare-approved lab services.	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year	20 of Medicare-approved amounts. Total of one 110 deductible per year																				0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23							1	1													0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23							1	1													31.08	0.31	11.77	-	1.93	1.54	9.53	3.8	11.57	1.71	5.03	-	2.07	9.16	12.39	37.78	0.41	1.44	8.73	9.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	160.12	31.08	0.31	11.77	-	1.93	1.54	9.53	3.8	11.57	1.71	5.03	-	2.07	9.16	12.39	37.78	0.41	1.44	8.73	9.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	160.12
H2456_002_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																															-	1		1		1	1		1	1	1					1						1																																																																																																								24.93		15.86		4.98	13.54		3.23	6.26	3.47					85.09						0.5																						24.93	-	15.86	-	4.98	13.54	-	3.23	6.26	3.47	-	-	-	-	85.09	-	-	-	-	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	157.86	24.93	-	15.86	-	4.98	13.54	-	3.23	6.26	3.47	-	-	-	-	85.09	-	-	-	-	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	157.86
H2457_002_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	577.17	24.34	102.06		7.54	56.23	1.72	21.52	85.79	20.34	45.79	4.1	3.38	47.83	0	197.55	2.9	2.7	20.19	0.09	7.82	0.9																				Same as Medicare	Same as Medicare	Same as Medicare		Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare																				0.07	0.07	0.15		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.15		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					42.83	1.81	15.41	-	1.76	13.1	0.4	5.01	19.99	4.74	10.67	0.96	0.79	11.14	-	46.03	0.68	0.63	4.7	0.02	1.82	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	182.7	42.83	1.81	15.41	-	1.76	13.1	0.4	5.01	19.99	4.74	10.67	0.96	0.79	11.14	-	46.03	0.68	0.63	4.7	0.02	1.82	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	182.7
H2458_002_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	285.88	32.18	142.19		11.31	22.45	0	0	0	0	0	0	3.33	360.79	25.34	299.74	11.27	3.26	0	0.01	17.49	4.72																				FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin		FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin																				0.07	0.07	0.15		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.15		0.23	0.23	0	0	0	0	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23																				110	21.19	2.38	21.38	-	2.64	5.23	-	-	-	-	-	-	0.78	84.06	5.9	69.84	2.63	0.76	-	0	4.07	1.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	221.97	21.19	2.38	21.38	-	2.64	5.23	0	0	0	0	0	0	0.78	84.06	5.9	69.84	2.63	0.76	0	0	4.07	1.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	221.97
H2459_001_0	2006											3500											A	A	D		T	Coin		V	P	V	V			V		V	V	V		V									Coin																																																							-	319.43	5.73	513.17		198.6	10.73		163.6	336.61	1170.65	475.75			1682.71		1618.32	108.12	298.75		1031.6									1.27													250 per Admission	250 per Admission	50 for Days 21 to 100		100 per Trip	20 coinsurance DME/Prosthetics		50 per ER	50 per OP Surgery and ASC	25 per Visit	25 per Visit			25 for UC and Other OP Visits		25 per Visit	25 per Visit	25 per Visit		25 per Podiatry Visit and 15 for Routine Vision & Hearing Exams																						250	250	50		100	0.2		50	50	25	25			25		25	25	25		16.59									0.2														227.5	227.5	45.5		91	0.18		45.5	45.5	22.75	22.75			22.75		22.75	22.75	22.75		15.1									0.2														6.06	0.11	1.95	-	1.51	1.95	-	0.62	1.28	2.22	0.9	-	-	3.19	-	3.07	0.2	0.57	-	1.3	-	-	-	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	25.17	6.06	0.11	1.95	-	1.51	1.95	-	0.62	1.28	2.22	0.9	-	-	3.19	-	3.07	0.2	0.57	-	1.3	-	-	-	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	25.17
H2459_002_0	2006											3500											A	A			T	Coin		V						V		V	V	V		V									Coin																																																							-	354.57	6.36			220.45	11.96		181.6						119.2		1796.36	120.01	331.62		1145.08									2.02													100 per admit	100 per admit			100 per Trip	20 / 10 DME and Prosthetics/Supplies		50 per ER						20 per UC Visit		10 per Visit	10 per Visit	10 per Visit		10 per Podiatry Visit and Routine Vision & Hearing Exams																						100	100			100	0.18		50						20		10	10	10		10									0.2														98.5	98.5			98.5	0.18		49.25						19.7		9.85	9.85	9.85		9.85									0.2														2.91	0.05	-	-	1.81	2.17	-	0.75	-	-	-	-	-	0.2	-	1.47	0.1	0.27	-	0.94	-	-	-	-	-	-	-	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	11.08	2.91	0.05	-	-	1.81	2.17	-	0.75	-	-	-	-	-	0.2	-	1.47	0.1	0.27	-	0.94	-	-	-	-	-	-	-	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	11.08
H2459_005_0	2006											3500											A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	V	V	V	P	P	S	P	T	P	V	P	V	P	Coin	P	P	P	P	P	P	P	P	P	P	P	P																																											-	303.6	10.61	1160.51	0	93.83	6.61	1.45	265.68	289.82	1610.2	618.84	34.14	2.07	1402.31	0	2854.94	224.04	216.48	0	0	0	0	0	0	124	0	222	0	1.27	0	0	0	0	0	0	0	0	0	0	0	0	250/admit	250/admit	50/day  (days 21-100)		100/trip	20 coins	20 coins	50/ER;25 UC	50/visit	25/visit	25/visit	25/visit	25/visit	25/visit		25/visit	25/visit	25/visit							15/visit		15/visit		20 coins;5000 ben max													250	250	15	0	100	0.2	0.2	39.99	50	25	25	25	25	25	0	25	25	25	0	0	0	0	0	0	15	0	15	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		228.45	228.45	15	0	91.38	0.18	0.18	36.55	45.69	22.84	22.84	22.84	22.84	22.84	0	22.84	22.84	22.84	0	0	0	0	0	0	13.71	0	13.71	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		5.78	0.2	1.45	-	0.71	1.21	0.26	0.81	1.1	3.07	1.18	0.07	0	2.67	-	5.43	0.43	0.41	-	-	-	-	-	-	0.14	-	0.25	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	25.44	5.78	0.2	1.45	-	0.71	1.21	0.26	0.81	1.1	3.07	1.18	0.07	0	2.67	-	5.43	0.43	0.41	-	-	-	-	-	-	0.14	-	0.25	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	25.44
H2459_006_0	2006											3500											A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	P	S	P	T	P	V	P	P	P	Coin	P	P	P	P	P	P	P	P	P	P	P	P																																											-	322.47	11.27	0	0	99.66	7.46	1.63	282.13	0	0	0	0	0	0	0	3107.76	237.96	229.93	0	0	0	0	0	0	124	0	222	0	2	0	0	0	0	0	0	0	0	0	0	0	0	100/admit	100/admit			100/trip	20 coins	10 coins	50/ER;20 UC								10	10	10							10				20 coins;10000 ben max													100	100	0	0	100	0.2	0.1	37.99	0	0	0	0	0	0	0	10	10	10	0	0	0	0	0	0	10	0	10	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		98.3	98.3	0	0	98.3	0.2	0.1	37.35	0	0	0	0	0	0	0	9.83	9.83	9.83	0	0	0	0	0	0	9.83	0	9.83	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		2.64	0.09	-	-	0.82	1.47	0.16	0.88	-	-	-	-	-	-	-	2.55	0.19	0.19	-	-	-	-	-	-	0.1	-	0.18	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	9.67	2.64	0.09	-	-	0.82	1.47	0.16	0.88	-	-	-	-	-	-	-	2.55	0.19	0.19	-	-	-	-	-	-	0.1	-	0.18	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	9.67
H2459_007_0	2006											3500											A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	P	P	P	T	P	V	P	V	P	Coin	P	P	P	P	P	P	P	P	P	P	P	P																																											-	297.88	10.41	1138.66	0	92.06	6.36	1.39	260.7	284.36	1579.88	607.19	33.5	2.03	1375.9	0	2801.18	219.82	212.4	0	0	0	0	0	0	124	0	222	0	1.27	0	0	0	0	0	0	0	0	0	0	0	0	250/admit	250/admit	50/day  (days 21-100)		100/trip	20 coins	20 coins	50/ER;25 UC	50/visit	25/visit	25/visit	25/visit	25/visit	25/visit		25/visit	25/visit	25/visit							15/visit		15/visit		20 coins;5000 ben max													250	250	15	0	100	0.2	0.2	39.99	50	25	25	25	25	25	0	25	25	25	0	0	0	0	0	0	15	0	15	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		227.51	227.51	13.65	0	91.01	0.18	0.18	36.4	45.5	22.75	22.75	22.75	22.75	22.75	0	22.75	22.75	22.75	0	0	0	0	0	0	13.65	0	13.65	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		5.65	0.2	1.3	-	0.7	1.16	0.25	0.79	1.08	3	1.15	0.06	0	2.61	-	5.31	0.42	0.4	-	-	-	-	-	-	0.14	-	0.25	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	24.72	5.65	0.2	1.3	-	0.7	1.16	0.25	0.79	1.08	3	1.15	0.06	0	2.61	-	5.31	0.42	0.4	-	-	-	-	-	-	0.14	-	0.25	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	24.72
H2459_008_0	2006											3500											A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	P	S	P	T	P	V	P	P	P	Coin	P	P	P	P	P	P	P	P	P	P	P	P																																											-	316.39	11.06	0	0	97.79	7.18	1.57	276.83	0	0	0	0	0	0	0	3049.24	233.48	225.6	0	0	0	0	0	0	124	0	222	0	2	0	0	0	0	0	0	0	0	0	0	0	0	100/admit	100/admit			100/trip	20 coins	10 coins	50/ER;20 UC								10/visit	10/visit	10/visit							10/visit				20 coins;10000 ben max													100	100	0	0	100	0.2	0.1	37.99	0	0	0	0	0	0	0	10	10	10	0	0	0	0	0	0	10	0	10	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		98.37	98.37	0	0	98.37	0.2	0.1	37.37	0	0	0	0	0	0	0	9.84	9.84	9.84	0	0	0	0	0	0	9.84	0	9.84	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		2.59	0.09	-	-	0.8	1.41	0.15	0.86	-	-	-	-	-	-	-	2.5	0.19	0.18	-	-	-	-	-	-	0.1	-	0.18	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	9.47	2.59	0.09	-	-	0.8	1.41	0.15	0.86	-	-	-	-	-	-	-	2.5	0.19	0.18	-	-	-	-	-	-	0.1	-	0.18	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	9.47
H2459_013_0	2006											3500											A	A	D		T	Coin		V	P	V	V			V		V	V	V		V									Coin																																																							-	337	6.05	541.4		209.52	11.35		172.6	355.13	1235.04	501.92			1775.26		1707.34	114.07	315.19		1088.34									1.37													250 per Admission	250 per Admission	50 for Days 21 to 100		100 per Trip	20 for DME and Prosthetics/Supplies		50 per ER Visit	50 per OP Surgery and ASC	25 per procedure	25 per procedure			25 per UC Visits and Other OP Facility Visits		25 per Visit	25 per Visit	25 per Visit		25 per Podiatry Visit and 15 per Routine Vision & Hearing Exams																						250	250	50		100	0.2		50	50	25	25			25		25	25	25		16.59									0.2														227.5	227.5	45.5		91	0.18		45.5	45.5	22.75	22.75			22.75		22.75	22.75	22.75		15.1									0.2														6.39	0.11	2.05	-	1.59	2.06	-	0.65	1.35	2.34	0.95	-	-	3.37	-	3.24	0.22	0.6	-	1.37	-	-	-	-	-	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	26.56	6.39	0.11	2.05	-	1.59	2.06	-	0.65	1.35	2.34	0.95	-	-	3.37	-	3.24	0.22	0.6	-	1.37	-	-	-	-	-	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	26.56
H2459_014_0	2006											3500											A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	P	S	P	T	P	V	P	V	P	Coin	P	P	P	P	P	P	P	P	P	P	P	P																																											-	313.18	10.95	1197.11	0	96.79	7.03	1.54	274.03	298.96	1660.99	638.36	35.22	2.14	1446.54	0	2944.98	231.1	223.31	0	0	0	0	0	0	124	0	222	0	1.27	0	0	0	0	0	0	0	0	0	0	0	0	250/admit	250/admit	50/day  (days 21-100)	0	100/trip	20 coins	20 coins	50/ER;25 UC	50	25	25	25	25	25	0	25	25	25							15		15		20 coins;5000 ben max													250	250	15	0	100	0.2	0.2	40	50	25	25	25	25	25	0	25	25	25	0	0	0	0	0	0	15	0	15	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		225.79	225.79	13.55	0	90.32	0.18	0.18	36.12	45.16	22.58	22.58	22.58	22.58	22.58	0	22.58	22.58	22.58	0	0	0	0	0	0	13.55	0	13.55	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		5.89	0.21	1.35	-	0.73	1.27	0.28	0.82	1.13	3.13	1.2	0.07	0	2.72	-	5.54	0.43	0.42	-	-	-	-	-	-	0.14	-	0.25	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	25.84	5.89	0.21	1.35	-	0.73	1.27	0.28	0.82	1.13	3.13	1.2	0.07	0	2.72	-	5.54	0.43	0.42	-	-	-	-	-	-	0.14	-	0.25	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	25.84
H2459_015_0	2006											3500											A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	p	V	V	V	P	P	S	P	P	P	V	P	V	P	Coin	P	P	P	P	P	P	P	P	P	P	P	P																																											-	307.28	10.74	1174.57	0	94.97	6.77	1.48	268.89	293.33	1629.71	626.34	34.56	2.1	1419.3	0	2889.53	226.75	219.1	0	0	0	0	0	0	124	0	222	0	1.27	0	0	0	0	0	0	0	0	0	0	0	0	250/admit	250/admit	50/day  (days 21-100)		100/trip	20 coins	20 coins	50/ER;25 UC	50/visit	25/visit	25/visit	25/visit	25/visit	25/visit		25/visit	25/visit	25/visit							15/visit		15/visit		20 coins;5000 ben max													250	250	15	0	100	0.2	0.2	39.99	50	25	25	25	25	25	0	25	25	25	0	0	0	0	0	0	15	0	15	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		226.44	226.44	13.59	0	90.57	0.18	0.18	36.23	45.29	22.64	22.64	22.64	22.64	22.64	0	22.64	22.64	22.64	0	0	0	0	0	0	13.59	0	13.59	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0		5.8	0.2	1.33	-	0.72	1.23	0.27	0.81	1.11	3.08	1.18	0.07	0	2.68	-	5.45	0.43	0.41	-	-	-	-	-	-	0.14	-	0.25	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	25.41	5.8	0.2	1.33	-	0.72	1.23	0.27	0.81	1.11	3.08	1.18	0.07	0	2.68	-	5.45	0.43	0.41	-	-	-	-	-	-	0.14	-	0.25	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	25.41
H2459_801_0	2006											3500											A	A	D		T	Coin		V	P	V	V			V	V	V	V	V		V									Coin																																																							-	199.94	1.12	391.45		146.79	9.02		172.82	440.3	1381.12	569.41			2295.3	2579.69	2123.16	183.13	502.1		1128.49									2.99													250 per Admission	250 per Admission	50 for Days 21 to 100		100 per Trip	20 Coinsurance DME & Prosthetics/Supplies		50 per ER Visit	50 per OP Surgery and ASC	25 per Visit	25 per Visit			25 per UC Visit and Other OP Facility Visits	15 per Visit	25 per Visit	25 per Visit	25 per Visit		25 per Podiaty and Vision/Hearing Medicare Covered																						250	250	50		100	0.2		50	50	25	25			25	15	25	25	25		15.78									0.2														227.5	227.5	45.5		91	0.18		45.5	45.5	22.75	22.75			22.75	13.65	22.75	22.75	22.75		14.36									0.2														3.79	0.02	1.48	-	1.11	1.64	-	0.66	1.67	2.62	1.08	-	-	4.35	2.93	4.03	0.35	0.95	-	1.35	-	-	-	-	-	-	-	-	0.6	-	-	-	-	-	-	-	-	-	-	-	-	28.63	3.79	0.02	1.48	-	1.11	1.64	-	0.66	1.67	2.62	1.08	-	-	4.35	2.93	4.03	0.35	0.95	-	1.35	-	-	-	-	-	-	-	-	0.6	-	-	-	-	-	-	-	-	-	-	-	-	28.63
H2459_802_0	2006											3500											A	A	D		T	Coin		V	P	V	V			V	V	V	V	V		V									Coin																																																							-	199.94	1.12	391.45		146.79	9.02		172.82	440.3	1381.12	569.41			2295.3	2579.69	2123.16	183.13	502.1		1128.49									2.99													250 per Admission	250 per Admission	50 for Days 21 to 100		100 per Trip	20 Coinsurance DME & Prosthetics/Supplies		50 per ER Visit	50 per OP Surgery and ASC	25 per Visit	25 per Visit			25 per UC Visit and Other OP Facility Visits	15 per Visit	25 per Visit	25 per Visit	25 per Visit		25 per Podiaty and Vision/Hearing Medicare Covered									20 Coinsurance													250	250	50		100	0.2		50	50	25	25			25	15	25	25	25		15.78									0.2														227.5	227.5	45.5		91	0.18		45.5	45.5	22.75	22.75			22.75	13.65	22.75	22.75	22.75		14.36									0.2														3.79	0.02	1.48	-	1.11	1.64	-	0.66	1.67	2.62	1.08	-	-	4.35	2.93	4.03	0.35	0.95	-	1.35	-	-	-	-	-	-	-	-	0.6	-	-	-	-	-	-	-	-	-	-	-	-	28.63	3.79	0.02	1.48	-	1.11	1.64	-	0.66	1.67	2.62	1.08	-	-	4.35	2.93	4.03	0.35	0.95	-	1.35	-	-	-	-	-	-	-	-	0.6	-	-	-	-	-	-	-	-	-	-	-	-	28.63
H2459_803_0	2006											3500											A	A	D		T	Coin		V	P	V	V			V	V	V	V	V		V									Coin																																																							-	199.94	1.12	391.45		146.79	9.02		172.82	440.3	1381.12	569.41			2295.3	2579.69	2123.16	183.13	502.1		1128.49									2.99													250 per Admission	250 per Admission	50 for Days 21 to 100		100 per Trip	20 Coinsurance DME & Prosthetics/Supplies		50 per ER Visit	50 per OP Surgery and ASC	25 per Visit	25 per Visit			25 per UC Visit and Other OP Facility Visits	15 per Visit	25 per Visit	25 per Visit	25 per Visit		25 per Podiaty and Vision/Hearing Medicare Covered																						250	250	50		100	0.2		50	50	25	25			25	15	25	25	25		15.78									0.2														227.5	227.5	45.5		91	0.18		45.5	45.5	22.75	22.75			22.75	13.65	22.75	22.75	22.75		14.36									0.2														3.79	0.02	1.48	-	1.11	1.64	-	0.66	1.67	2.62	1.08	-	-	4.35	2.93	4.03	0.35	0.95	-	1.35	-	-	-	-	-	-	-	-	0.6	-	-	-	-	-	-	-	-	-	-	-	-	28.63	3.79	0.02	1.48	-	1.11	1.64	-	0.66	1.67	2.62	1.08	-	-	4.35	2.93	4.03	0.35	0.95	-	1.35	-	-	-	-	-	-	-	-	0.6	-	-	-	-	-	-	-	-	-	-	-	-	28.63
H2610_004_0	2006											900											D	D	D	V	P	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	V	T	V	V	P	V	V	V	V	V																																																					-	1292.82	69.31	656.94	0	83.7	11.06	13.12	307.4	335.61	1400.45	16.38	2.26	0	20.39	3841.53	4536.16	155.07	217.33	0	342.85	23.31	75.35	0	0	124	264	222	0	0	0	0											150 - (days 1-4 only)	27500	100 - (days 4-9 only)		150	0	0	50 Em / 25 UC	200	10	20 / 15	0.2	0.2	20 / 20 / 30	5	30 / 25 / 20	30	20		20	20	20			20	20	25															75	275	29.27	0	150	0.2	0.2	47.48	200	10	0.19	0.2	0	0.16	5	21.31	30	20	0	0.3	0.2	20	0	0	20	20	25	0	0	0	0												75	146.71	15.61	0	150	0.11	0.11	47.44	106.7	5.33	0.1	0.11	0	0.09	5	21.31	30	20	0	0.3	0.2	20	0	0	20	20	25	0	0	0	0												8.08	0.85	0.85	-	1.05	1.18	1.4	1.22	2.98	0.62	1.7	0.24	-	1.83	1.6	8.05	0.39	0.36	-	0.01	4.66	0.13	-	-	0.21	0.44	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.32	8.08	0.85	0.85	-	1.05	1.18	1.4	1.22	2.98	0.62	1.7	0.24	-	1.83	1.6	8.05	0.39	0.36	-	0.01	4.66	0.13	-	-	0.21	0.44	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.32
H2610_802_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	191.79	3.74	16.93	0	4.49	10.83	12.94	302.03	29.91	18.78	16.23	2.25	0	20.21	18.77	30.24	0.88	2.08	16.42	88.16	23.36	0.34	0	0	0	0	0	0	0	0	0											Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	50 Copay	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing																				0.07	0.07	0.17	0	0.22	0.22	0.22	50	0.22	0.22	0.22	0.22	0	0.22	0.22	0.22	0.22	0.22	0.22	0.22	0.37	0.22	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.22	0.22	0.22	50	0.22	0.22	0.22	0.22	0	0.22	0.22	0.22	0.22	0.22	0.22	0.22	0.37	0.22	0	0	0	0	0	0	0	0	0												14.2	0.28	2.93	-	1.01	2.43	2.9	1.26	6.71	4.21	3.64	0.5	-	4.53	4.21	6.79	0.2	0.47	3.68	19.78	8.53	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.35	14.2	0.28	2.93	-	1.01	2.43	2.9	1.26	6.71	4.21	3.64	0.5	-	4.53	4.21	6.79	0.2	0.47	3.68	19.78	8.53	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.35
H2611_001_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	30.29	1.68	0.86	1.24	0.69	1.14	0.36	1.37	1.12	0.71	0.17	0.25	0	0.71	2.41	1.73	0.19	0	5.2	18.25	4.04	0	0	0	0.09	0	0.01	0	0	0	0	0.03	0.49									73.01	260.64	14.48	7.38	10.7	5.9	9.78	3.12	2698.6	9.65	6.12	1.42	2.11	0	6.14	3741.15	2843.12	235.43	0	44.79	157.04	34.74	0	0	0	0.79	0	0.06	0	0	0	0	79.91	1050.97									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	N\A	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.57	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.57	15									1200	-	-	-	-	-	-	-	1.35	-	-	-	-	-	-	4.68	3.55	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.16	1.31	-	-	-	-	-	-	-	-	11.35	30.29	1.68	0.86	1.24	0.69	1.14	0.36	2.71	1.12	0.71	0.17	0.25	-	0.71	7.08	5.28	0.48	-	5.2	18.25	4.04	-	-	-	0.09	-	0.01	-	-	-	-	0.19	1.81	-	-	-	-	-	-	-	-	84.36
H2611_002_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	28.28	2.55	0.4	0.97	0.66	1.25	2.29	2.61	0.11	0.13	0.16	0.19	0	2.29	2.12	1.3	0.13	0	7.53	20.69	5.14	0	0.26	0	0.01	0	0	0	0	0	0	0.09	0.25									79.39	221.81	19.98	3.12	7.58	5.21	9.79	17.95	3152.22	0.82	1.03	1.23	1.48	0	17.97	3473.41	2299.27	139.58	0	59.05	162.29	40.32	0	2.07	0	0.07	0	0	0	0	0	0	291.2	420.15									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									1350	-	-	-	-	-	-	-	1.58	-	-	-	-	-	-	4.34	2.87	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.61	0.53	-	-	-	-	-	-	-	-	10.1	28.28	2.55	0.4	0.97	0.66	1.25	2.29	4.19	0.11	0.13	0.16	0.19	-	2.29	6.46	4.18	0.3	-	7.53	20.69	5.14	-	0.26	-	0.01	-	-	-	-	-	-	0.7	0.78	-	-	-	-	-	-	-	-	89.49
H2611_003_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	28.85	2.6	0.41	0.97	0.67	1.26	2.3	2.63	0.11	0.13	0.16	0.19	0	2.31	2.13	1.29	0.13	0	7.44	20.5	5.15	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.25									79.84	233.21	21.01	3.28	7.87	5.41	10.16	18.62	3024.52	0.86	1.07	1.28	1.53	0	18.65	3332.7	2161.54	133.92	0	60.11	165.73	41.59	0	2.15	0	0.07	0	0	0	0	0	0	279.4	403.13									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									1350	-	-	-	-	-	-	-	1.51	-	-	-	-	-	-	4.17	2.7	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.58	0.5	-	-	-	-	-	-	-	-	9.63	28.85	2.6	0.41	0.97	0.67	1.26	2.3	4.14	0.11	0.13	0.16	0.19	-	2.31	6.3	3.99	0.3	-	7.44	20.5	5.15	-	0.27	-	0.01	-	-	-	-	-	-	0.68	0.76	-	-	-	-	-	-	-	-	89.47
H2611_004_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	30.29	1.68	0.86	1.24	0.69	1.14	0.36	1.37	1.12	0.71	0.17	0.25	0	0.71	2.41	1.73	0.19	0	5.2	18.25	4.04	0	0	0	0.09	0	0.01	0	0	0	0	0.03	0.49									73.01	260.64	14.48	7.38	10.7	5.9	9.78	3.12	2698.6	9.65	6.12	1.42	2.11	0	6.14	3741.15	2843.12	235.43	0	44.79	157.04	34.74	0	0	0	0.79	0	0.06	0	0	0	0	79.91	1050.97									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	N\A	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.57	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.57	15									1200	-	-	-	-	-	-	-	1.35	-	-	-	-	-	-	4.68	3.55	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.16	1.31	-	-	-	-	-	-	-	-	11.35	30.29	1.68	0.86	1.24	0.69	1.14	0.36	2.71	1.12	0.71	0.17	0.25	-	0.71	7.08	5.28	0.48	-	5.2	18.25	4.04	-	-	-	0.09	-	0.01	-	-	-	-	0.19	1.81	-	-	-	-	-	-	-	-	84.36
H2611_005_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	28.28	2.55	0.4	0.97	0.66	1.25	2.29	2.61	0.11	0.13	0.16	0.19	0	2.29	2.12	1.3	0.13	0	7.53	20.69	5.14	0	0.26	0	0.01	0	0	0	0	0	0	0.09	0.25									79.39	221.81	19.98	3.12	7.58	5.21	9.79	17.95	3152.22	0.82	1.03	1.23	1.48	0	17.97	3473.41	2299.27	139.58	0	59.05	162.29	40.32	0	2.07	0	0.07	0	0	0	0	0	0	291.2	420.15									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									1350	-	-	-	-	-	-	-	1.58	-	-	-	-	-	-	4.34	2.87	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.61	0.53	-	-	-	-	-	-	-	-	10.1	28.28	2.55	0.4	0.97	0.66	1.25	2.29	4.19	0.11	0.13	0.16	0.19	-	2.29	6.46	4.18	0.3	-	7.53	20.69	5.14	-	0.26	-	0.01	-	-	-	-	-	-	0.7	0.78	-	-	-	-	-	-	-	-	89.49
H2611_006_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	28.85	2.6	0.41	0.97	0.67	1.26	2.3	2.63	0.11	0.13	0.16	0.19	0	2.31	2.13	1.29	0.13	0	7.44	20.5	5.15	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.25									79.84	233.21	21.01	3.28	7.87	5.41	10.16	18.62	3024.52	0.86	1.07	1.28	1.53	0	18.65	3332.7	2161.54	133.92	0	60.11	165.73	41.59	0	2.15	0	0.07	0	0	0	0	0	0	279.4	403.13									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									1350	-	-	-	-	-	-	-	1.51	-	-	-	-	-	-	4.17	2.7	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.58	0.5	-	-	-	-	-	-	-	-	9.63	28.85	2.6	0.41	0.97	0.67	1.26	2.3	4.14	0.11	0.13	0.16	0.19	-	2.31	6.3	3.99	0.3	-	7.44	20.5	5.15	-	0.27	-	0.01	-	-	-	-	-	-	0.68	0.76	-	-	-	-	-	-	-	-	89.47
H2611_007_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	28.28	2.55	0.4	0.97	0.66	1.25	2.29	2.61	0.11	0.13	0.16	0.19	0	2.29	2.12	1.3	0.13	0	7.53	20.69	5.14	0	0.26	0	0.01	0	0	0	0	0	0	0.09	0.25									79.39	221.81	19.98	3.12	7.58	5.21	9.79	17.95	3152.22	0.82	1.03	1.23	1.48	0	17.97	3473.41	2299.27	139.58	0	59.05	162.29	40.32	0	2.07	0	0.07	0	0	0	0	0	0	291.2	420.15									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									1350	-	-	-	-	-	-	-	1.58	-	-	-	-	-	-	4.34	2.87	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.61	0.53	-	-	-	-	-	-	-	-	10.1	28.28	2.55	0.4	0.97	0.66	1.25	2.29	4.19	0.11	0.13	0.16	0.19	-	2.29	6.46	4.18	0.3	-	7.53	20.69	5.14	-	0.26	-	0.01	-	-	-	-	-	-	0.7	0.78	-	-	-	-	-	-	-	-	89.49
H2611_801_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	25.12	2.06	0.61	1.09	0.61	1.03	0.5	1.16	1.69	0.88	0.15	0.32	0	0.78	2.39	2.14	0.21	0	5.88	20.39	4.75	0	0	0	0.14	0	0.14	0	0	0	0	0.02	0.54									72.57	209.38	17.15	5.05	9.09	5.09	8.6	4.18	2201.69	14.05	7.3	1.23	2.65	0	6.46	3464.29	3354.95	245.62	0	48.98	169.89	39.57	0	0.04	1.5	1.15	0	1.17	0	0	0	0	57.91	1065.72									0	0	0	0	0	0	0	50	0	0	0	0	0	0	20	20	20	0	0	0	0	0	N\A	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	20	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.94	20									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	20	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.94	20									1200	-	-	-	-	-	-	-	1.1	-	-	-	-	-	-	5.77	5.59	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.12	1.78	-	-	-	-	-	-	-	-	14.77	25.12	2.06	0.61	1.09	0.61	1.03	0.5	2.26	1.69	0.88	0.15	0.32	-	0.78	8.16	7.73	0.62	-	5.88	20.39	4.75	-	0	0	0.14	-	0.14	-	-	-	-	0.14	2.31	-	-	-	-	-	-	-	-	87.34
H2611_802_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									A	A	A	Coin	Coin	Coin	Coin	V	P	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P									0	28.54	2.57	0.4	0.98	0.67	1.26	2.31	2.63	0.11	0.13	0.16	0.19	0	2.31	2.12	1.26	0.13	0	7.23	20.38	5.19	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.25									79.19	221.81	19.98	3.12	7.58	5.21	9.79	17.95	3152.22	0.82	1.03	1.23	1.48	0	17.97	3438.68	2207.3	139.58	0	56.21	158.41	40.32	0	2.07	0	0.07	0	0	0	0	0	0	291.2	420.15									200	200	200	0	0	0	0	50	200	0	0	0	0	0	20	25	25	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	25	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	25	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									1350	-	-	-	-	-	-	-	1.58	-	-	-	-	-	-	5.73	4.6	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.61	0.53	-	-	-	-	-	-	-	-	13.21	28.54	2.57	0.4	0.98	0.67	1.26	2.31	4.21	0.11	0.13	0.16	0.19	-	2.31	7.85	5.86	0.3	-	7.23	20.38	5.19	-	0.27	-	0.01	-	-	-	-	-	-	0.7	0.78	-	-	-	-	-	-	-	-	92.4
H2611_803_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P									0	29.27	2.64	0.41	0.99	0.68	1.27	2.34	2.67	0.11	0.13	0.16	0.19	0	2.34	2.1	1.23	0.13	0	7	20.02	5.22	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.26									79.52	233.21	21.01	3.28	7.87	5.41	10.16	18.62	3024.52	0.86	1.07	1.28	1.53	0	18.65	3232.72	2031.85	133.92	0	55.73	159.51	41.59	0	2.15	0	0.07	0	0	0	0	0	0	279.4	403.13									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	30	30	30	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	30									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	30	30	30	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	30									1350	-	-	-	-	-	-	-	1.51	-	-	-	-	-	-	8.08	5.08	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.58	1.01	-	-	-	-	-	-	-	-	16.6	29.27	2.64	0.41	0.99	0.68	1.27	2.34	4.18	0.11	0.13	0.16	0.19	-	2.34	10.18	6.31	0.47	-	7	20.02	5.22	-	0.27	-	0.01	-	-	-	-	-	-	0.68	1.27	-	-	-	-	-	-	-	-	96.12
H2611_804_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	25.12	2.06	0.61	1.09	0.61	1.03	0.5	1.16	1.69	0.88	0.15	0.32	0	0.78	2.39	2.14	0.21	0	5.88	20.39	4.75	0	0	0	0.14	0	0.14	0	0	0	0	0.02	0.54									72.57	209.38	17.15	5.05	9.09	5.09	8.6	4.18	2201.69	14.05	7.3	1.23	2.65	0	6.46	3464.29	3354.95	245.62	0	48.98	169.89	39.57	0	0.04	1.5	1.15	0	1.17	0	0	0	0	57.91	1065.72									0	0	0	0	0	0	0	50	0	0	0	0	0	0	20	20	20	0	0	0	0	0	N\A	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	20	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.94	20									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	20	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.94	20									1200	-	-	-	-	-	-	-	1.1	-	-	-	-	-	-	5.77	5.59	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.12	1.78	-	-	-	-	-	-	-	-	14.77	25.12	2.06	0.61	1.09	0.61	1.03	0.5	2.26	1.69	0.88	0.15	0.32	-	0.78	8.16	7.73	0.62	-	5.88	20.39	4.75	-	0	0	0.14	-	0.14	-	-	-	-	0.14	2.31	-	-	-	-	-	-	-	-	87.34
H2611_805_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									A	A	A	Coin	Coin	Coin	Coin	V	P	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P									0	28.54	2.57	0.4	0.98	0.67	1.26	2.31	2.63	0.11	0.13	0.16	0.19	0	2.31	2.12	1.26	0.13	0	7.23	20.38	5.19	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.25									79.19	221.81	19.98	3.12	7.58	5.21	9.79	17.95	3152.22	0.82	1.03	1.23	1.48	0	17.97	3438.68	2207.3	139.58	0	56.21	158.41	40.32	0	2.07	0	0.07	0	0	0	0	0	0	291.2	420.15									200	200	200	0	0	0	0	50	200	0	0	0	0	0	20	25	25	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	25	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	25	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									1350	-	-	-	-	-	-	-	1.58	-	-	-	-	-	-	5.73	4.6	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.61	0.53	-	-	-	-	-	-	-	-	13.21	28.54	2.57	0.4	0.98	0.67	1.26	2.31	4.21	0.11	0.13	0.16	0.19	-	2.31	7.85	5.86	0.3	-	7.23	20.38	5.19	-	0.27	-	0.01	-	-	-	-	-	-	0.7	0.78	-	-	-	-	-	-	-	-	92.4
H2611_806_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P									0	29.27	2.64	0.41	0.99	0.68	1.27	2.34	2.67	0.11	0.13	0.16	0.19	0	2.34	2.1	1.23	0.13	0	7	20.02	5.22	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.26									79.52	233.21	21.01	3.28	7.87	5.41	10.16	18.62	3024.52	0.86	1.07	1.28	1.53	0	18.65	3232.72	2031.85	133.92	0	55.73	159.51	41.59	0	2.15	0	0.07	0	0	0	0	0	0	279.4	403.13									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	30	30	30	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	30									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	30	30	30	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	30									1350	-	-	-	-	-	-	-	1.51	-	-	-	-	-	-	8.08	5.08	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.58	1.01	-	-	-	-	-	-	-	-	16.6	29.27	2.64	0.41	0.99	0.68	1.27	2.34	4.18	0.11	0.13	0.16	0.19	-	2.34	10.18	6.31	0.47	-	7	20.02	5.22	-	0.27	-	0.01	-	-	-	-	-	-	0.68	1.27	-	-	-	-	-	-	-	-	96.12
H2611_807_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	25.12	2.06	0.61	1.09	0.61	1.03	0.5	1.16	1.69	0.88	0.15	0.32	0	0.78	2.39	2.14	0.21	0	5.88	20.39	4.75	0	0	0	0.14	0	0.14	0	0	0	0	0.02	0.54									72.57	209.38	17.15	5.05	9.09	5.09	8.6	4.18	2201.69	14.05	7.3	1.23	2.65	0	6.46	3464.29	3354.95	245.62	0	48.98	169.89	39.57	0	0.04	1.5	1.15	0	1.17	0	0	0	0	57.91	1065.72									0	0	0	0	0	0	0	50	0	0	0	0	0	0	20	20	20	0	0	0	0	0	N\A	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	20	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.94	20									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	20	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.94	20									1200	-	-	-	-	-	-	-	1.1	-	-	-	-	-	-	5.77	5.59	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.12	1.78	-	-	-	-	-	-	-	-	14.77	25.12	2.06	0.61	1.09	0.61	1.03	0.5	2.26	1.69	0.88	0.15	0.32	-	0.78	8.16	7.73	0.62	-	5.88	20.39	4.75	-	0	0	0.14	-	0.14	-	-	-	-	0.14	2.31	-	-	-	-	-	-	-	-	87.34
H2611_808_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V									0	25.12	2.06	0.61	1.09	0.61	1.03	0.5	1.16	1.69	0.88	0.15	0.32	0	0.78	2.39	2.14	0.21	0	5.88	20.39	4.75	0	0	0	0.14	0	0.14	0	0	0	0	0.02	0.54									72.57	209.38	17.15	5.05	9.09	5.09	8.6	4.18	2201.69	14.05	7.3	1.23	2.65	0	6.46	3464.29	3354.95	245.62	0	48.98	169.89	39.57	0	0.04	1.5	1.15	0	1.17	0	0	0	0	57.91	1065.72									0	0	0	0	0	0	0	50	0	0	0	0	0	0	20	20	20	0	0	0	0	0	N\A	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	20	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.94	20									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	20	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.94	20									1200	-	-	-	-	-	-	-	1.1	-	-	-	-	-	-	5.77	5.59	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.12	1.78	-	-	-	-	-	-	-	-	14.77	25.12	2.06	0.61	1.09	0.61	1.03	0.5	2.26	1.69	0.88	0.15	0.32	-	0.78	8.16	7.73	0.62	-	5.88	20.39	4.75	-	0	0	0.14	-	0.14	-	-	-	-	0.14	2.31	-	-	-	-	-	-	-	-	87.34
H2611_809_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									A	A	A	Coin	Coin	Coin	Coin	V	P	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P									0	28.54	2.57	0.4	0.98	0.67	1.26	2.31	2.63	0.11	0.13	0.16	0.19	0	2.31	2.12	1.26	0.13	0	7.23	20.38	5.19	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.25									79.19	221.81	19.98	3.12	7.58	5.21	9.79	17.95	3152.22	0.82	1.03	1.23	1.48	0	17.97	3438.68	2207.3	139.58	0	56.21	158.41	40.32	0	2.07	0	0.07	0	0	0	0	0	0	291.2	420.15									200	200	200	0	0	0	0	50	200	0	0	0	0	0	20	25	25	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	25	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	25	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									1350	-	-	-	-	-	-	-	1.58	-	-	-	-	-	-	5.73	4.6	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.61	0.53	-	-	-	-	-	-	-	-	13.21	28.54	2.57	0.4	0.98	0.67	1.26	2.31	4.21	0.11	0.13	0.16	0.19	-	2.31	7.85	5.86	0.3	-	7.23	20.38	5.19	-	0.27	-	0.01	-	-	-	-	-	-	0.7	0.78	-	-	-	-	-	-	-	-	92.4
H2611_810_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									A	A	A	Coin	Coin	Coin	Coin	V	P	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P									0	28.54	2.57	0.4	0.98	0.67	1.26	2.31	2.63	0.11	0.13	0.16	0.19	0	2.31	2.12	1.26	0.13	0	7.23	20.38	5.19	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.25									79.19	221.81	19.98	3.12	7.58	5.21	9.79	17.95	3152.22	0.82	1.03	1.23	1.48	0	17.97	3438.68	2207.3	139.58	0	56.21	158.41	40.32	0	2.07	0	0.07	0	0	0	0	0	0	291.2	420.15									200	200	200	0	0	0	0	50	200	0	0	0	0	0	20	25	25	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	25	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	20	25	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	15									1350	-	-	-	-	-	-	-	1.58	-	-	-	-	-	-	5.73	4.6	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.61	0.53	-	-	-	-	-	-	-	-	13.21	28.54	2.57	0.4	0.98	0.67	1.26	2.31	4.21	0.11	0.13	0.16	0.19	-	2.31	7.85	5.86	0.3	-	7.23	20.38	5.19	-	0.27	-	0.01	-	-	-	-	-	-	0.7	0.78	-	-	-	-	-	-	-	-	92.4
H2611_811_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P									0	29.27	2.64	0.41	0.99	0.68	1.27	2.34	2.67	0.11	0.13	0.16	0.19	0	2.34	2.1	1.23	0.13	0	7	20.02	5.22	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.26									79.52	233.21	21.01	3.28	7.87	5.41	10.16	18.62	3024.52	0.86	1.07	1.28	1.53	0	18.65	3232.72	2031.85	133.92	0	55.73	159.51	41.59	0	2.15	0	0.07	0	0	0	0	0	0	279.4	403.13									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	30	30	30	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	30									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	30	30	30	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	30									1350	-	-	-	-	-	-	-	1.51	-	-	-	-	-	-	8.08	5.08	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.58	1.01	-	-	-	-	-	-	-	-	16.6	29.27	2.64	0.41	0.99	0.68	1.27	2.34	4.18	0.11	0.13	0.16	0.19	-	2.34	10.18	6.31	0.47	-	7	20.02	5.22	-	0.27	-	0.01	-	-	-	-	-	-	0.68	1.27	-	-	-	-	-	-	-	-	96.12
H2611_812_0	2006	OP Facility - Other	Professional									0	Other Copay	Other Copay									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P									0	29.27	2.64	0.41	0.99	0.68	1.27	2.34	2.67	0.11	0.13	0.16	0.19	0	2.34	2.1	1.23	0.13	0	7	20.02	5.22	0	0.27	0	0.01	0	0	0	0	0	0	0.1	0.26									79.52	233.21	21.01	3.28	7.87	5.41	10.16	18.62	3024.52	0.86	1.07	1.28	1.53	0	18.65	3232.72	2031.85	133.92	0	55.73	159.51	41.59	0	2.15	0	0.07	0	0	0	0	0	0	279.4	403.13									0	0	0	0	0	0	0	50	0	0	0	0	0	0	15	15	15	0	0	0	0	0	0	0	0	0	15	15	N\A	N\A	N\A	0-25	0-15									0	0	0	0	0	0	0	6	0	0	0	0	0	0	30	30	30	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	30									0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	30	30	30	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.98	30									1350	-	-	-	-	-	-	-	1.51	-	-	-	-	-	-	8.08	5.08	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.58	1.01	-	-	-	-	-	-	-	-	16.6	29.27	2.64	0.41	0.99	0.68	1.27	2.34	4.18	0.11	0.13	0.16	0.19	-	2.34	10.18	6.31	0.47	-	7	20.02	5.22	-	0.27	-	0.01	-	-	-	-	-	-	0.68	1.27	-	-	-	-	-	-	-	-	96.12
H2613_001_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	Coin	P	V	P	O	O	O																																																					-	1026.72	20.25	1592	24.11	233.79	16.85	1.18	557.81	526.08	0	1743.13	0	0.28	2154.33	0	0	175.19	238.94	0	8834.55	9.49	574.58	0	0	1.87	0	147.71	0	0	0	0											150 / day up to 5 days.	300 / admit	75 / day days 21 - 100	15 coinsurance	100 copay	30 coinsurance	30 coinsurance	50 ER copay / 10 Urgent Care copay	100 copay		25 Radiation Therapy copay		0 coinsurance	10 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	10 copay		10 PCP copay / 10 SCP copay		10 Vision Exams copay			50 coinsurance		10 copay															150	73.14	17.88	0.15	98.98	0.3	0.3	36.07	98.98	0	1.32	0	0	3.51	0	0	32.86	9.9	0	9.91	0	9.9	0	0	0.49	0	9.9	0	0	0	0												150	73.14	17.88	0.15	98.98	0.3	0.3	36.07	98.98	0	1.32	0	0	3.51	0	0	32.86	9.9	0	9.91	0	9.9	0	0	0.49	0	9.9	0	0	0	0												12.83	0.12	2.37	3.62	1.93	5	0.35	1.68	4.34	-	0.19	-	-	0.63	-	-	0.48	0.2	-	7.29	-	0.47	-	-	0.92	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.55	12.83	0.12	2.37	3.62	1.93	5	0.35	1.68	4.34	-	0.19	-	-	0.63	-	-	0.48	0.2	-	7.29	-	0.47	-	-	0.92	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.55
H2613_002_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	Coin	P	V	P	O	O	O																																																					-	1258.47	24.58	1627	20.58	281.29	19.5	1.36	628.55	592.89	0	1964.47	0	0.33	2428.04	0	0	204.4	278.86	0	9950.1	11.34	643.2	0	0	2.21	0	165.5	0	0	0	0											150 / day up to 5 days.	300 / admit	75 / day days 21 - 100	15 coinsurance	100 copay	30 coinsurance	30 coinsurance	50 ER copay / 10 Urgent Care copay	100 copay		25 Radiation Therapy copay		0 coinsurance	10 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	10 copay		10 PCP copay / 10 SCP copay		10 Vision Exams copay			50 coinsurance		10 copay															150	73.62	17.88	0.15	98.97	0.3	0.3	36.07	98.97	0	1.34	0	0	3.51	0	0	33.53	9.9	0	9.91	0	9.9	0	0	0.49	0	9.9	0	0	0	0												150	73.62	17.88	0.15	98.97	0.3	0.3	36.07	98.97	0	1.34	0	0	3.51	0	0	33.53	9.9	0	9.91	0	9.9	0	0	0.49	0	9.9	0	0	0	0												15.73	0.15	2.42	3.09	2.32	5.79	0.4	1.89	4.89	-	0.22	-	-	0.71	-	-	0.57	0.23	-	8.22	-	0.53	-	-	1.1	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.39	15.73	0.15	2.42	3.09	2.32	5.79	0.4	1.89	4.89	-	0.22	-	-	0.71	-	-	0.57	0.23	-	8.22	-	0.53	-	-	1.1	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.39
H2613_003_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	Coin	P	V	P	O	O	O																																																					-	1330.22	25.94	1632.1	31.41	274.19	20.33	1.42	599.34	565.27	0	1872.85	0	0.32	2314.72	0	0	250.03	341.09	0	11189.39	11	712.28	0	0	2.57	0	183.1	0	0	0	0											150 / day up to 5 days.	300 / admit	75 / day days 21 - 100	15 coinsurance	100 copay	30 coinsurance	30 coinsurance	50 ER copay / 10 Urgent Care copay	100 copay		25 Radiation Therapy copay		0 coinsurance	10 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	10 copay		10 PCP copay / 10 SCP copay		10 Vision Exams copay			50 coinsurance		10 copay															150	73.49	17.88	0.15	98.91	0.3	0.3	36.05	98.91	0	1.35	0	0	3.5	0	0	35.38	9.89	0	9.9	0	9.89	0	0	0.49	0	9.89	0	0	0	0												150	73.49	17.88	0.15	98.91	0.3	0.3	36.05	98.91	0	1.35	0	0	3.5	0	0	35.38	9.89	0	9.9	0	9.89	0	0	0.49	0	9.89	0	0	0	0												16.63	0.16	2.43	4.71	2.26	6.03	0.42	1.8	4.66	-	0.21	-	-	0.68	-	-	0.74	0.28	-	9.23	-	0.59	-	-	1.27	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.25	16.63	0.16	2.43	4.71	2.26	6.03	0.42	1.8	4.66	-	0.21	-	-	0.68	-	-	0.74	0.28	-	9.23	-	0.59	-	-	1.27	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.25
H2613_004_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	Coin	P	V	P	O	O	O																																																					-	1026.74	19.89	1575.9	24.11	231.39	16.68	1.16	534.67	520.67	0	1725.19	0	0.27	2132.15	0	0	173.39	221.72	0	8334.39	9.39	521.27	0	0	1.69	0	133.99	0	0	0	0											200 / day up to 5 days.	900 / admit	100 / day days 21 - 100	15 coinsurance	150 copay	30 coinsurance	30 coinsurance	50 ER copay / 25 Urgent Care copay	100 copay		25 Radiation Therapy copay		0 coinsurance	25 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	25 copay		10 PCP copay / 25 SCP copay	20 coinsurance	25 Vision Exams copay			50 coinsurance		25 copay															200	140.46	23.83	0.15	150.01	0.3	0.3	41.52	100.01	0	1.33	0	0	7	0	0	33.2	19.98	0	18.29	0.2	25	0	0	0.5	0	25	0	0	0	0												200	140.46	23.83	0.15	150.01	0.3	0.3	41.52	100.01	0	1.33	0	0	7	0	0	33.2	19.98	0	18.29	0.2	25	0	0	0.5	0	25	0	0	0	0												17.11	0.23	3.13	3.62	2.89	5	0.35	1.85	4.34	-	0.19	-	-	1.24	-	-	0.48	0.37	-	12.7	1.88	1.09	-	-	0.85	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.6	17.11	0.23	3.13	3.62	2.89	5	0.35	1.85	4.34	-	0.19	-	-	1.24	-	-	0.48	0.37	-	12.7	1.88	1.09	-	-	0.85	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.6
H2613_005_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	Coin	P	V	P	O	O	O																																																					-	1258.53	24.42	1610.6	20.58	278.39	19.3	1.35	602.48	586.78	0	1944.25	0	0.33	2403.05	0	0	202.29	258.73	0	9384.62	11.22	583.58	0	0	2.01	0	150.2	0	0	0	0											200 / day up to 5 days.	900 / admit	100 / day days 21 - 100	15 coinsurance	150 copay	30 coinsurance	30 coinsurance	50 ER copay / 25 Urgent Care copay	100 copay		25 Radiation Therapy copay		0 coinsurance	25 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	25 copay		10 PCP copay / 25 SCP copay	20 coinsurance	25 Vision Exams copay			50 coinsurance		25 copay															200	140.36	23.83	0.15	150	0.3	0.3	41.52	100	0	1.36	0	0	7	0	0	33.88	20.4	0	18.33	0.2	25	0	0	0.5	0	25	0	0	0	0												200	140.36	23.83	0.15	150	0.3	0.3	41.52	100	0	1.36	0	0	7	0	0	33.88	20.4	0	18.33	0.2	25	0	0	0.5	0	25	0	0	0	0												20.98	0.29	3.2	3.09	3.48	5.79	0.4	2.08	4.89	-	0.22	-	-	1.4	-	-	0.57	0.44	-	14.33	2.24	1.22	-	-	1	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.94	20.98	0.29	3.2	3.09	3.48	5.79	0.4	2.08	4.89	-	0.22	-	-	1.4	-	-	0.57	0.44	-	14.33	2.24	1.22	-	-	1	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.94
H2613_006_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	Coin	P	V	P	O	O	O																																																					-	1330.25	25.59	1615.6	31.41	271.3	20.11	1.4	574.32	559.32	0	1853.12	0	0.32	2290.33	0	0	247.4	312.89	0	10544.01	10.88	646.05	0	0	2.33	0	166.06	0	0	0	0											200 / day up to 5 days.	900 / admit	100 / day days 21 - 100	15 coinsurance	150 copay	30 coinsurance	30 coinsurance	50 ER copay / 25 Urgent Care copay	100 copay		25 Radiation Therapy copay		0 coinsurance	25 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	25 copay		10 PCP copay / 25 SCP copay	20 coinsurance	25 Vision Exams copay			50 coinsurance		25 copay															200	140.68	23.83	0.15	149.94	0.3	0.3	41.5	99.96	0	1.36	0	0	7	0	0	35.76	21.56	0	18.41	0.2	24.99	0	0	0.5	0	24.99	0	0	0	0												200	140.68	23.83	0.15	149.94	0.3	0.3	41.5	99.96	0	1.36	0	0	7	0	0	35.76	21.56	0	18.41	0.2	24.99	0	0	0.5	0	24.99	0	0	0	0												22.17	0.3	3.21	4.71	3.39	6.03	0.42	1.99	4.66	-	0.21	-	-	1.34	-	-	0.74	0.56	-	16.18	2.18	1.35	-	-	1.16	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.93	22.17	0.3	3.21	4.71	3.39	6.03	0.42	1.99	4.66	-	0.21	-	-	1.34	-	-	0.74	0.56	-	16.18	2.18	1.35	-	-	1.16	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.93
H2613_801_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	Coin	P	V	P	O	O	O																																																					-	1110.41	21.34	1484.8	25.41	242.29	17.63	1.23	531.97	518.1	0	1716.56	0	0.28	2121.63	0	0	200.97	257.02	0	8708.68	9.77	557.42	0	0	0	0	0	0	0	0	0											200 / day up to 5 days.	900 / admit	100 / day days 21 - 100	15 coinsurance	150 copay	30 coinsurance	30 coinsurance	50 ER copay / 25 Urgent Care copay	100 copay		25 Radiation Therapy copay		0 coinsurance	25 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	25 copay		25 PCP copay / 25 SCP copay		25 Vision Exams copay																				200	140.68	23.83	0.15	150.32	0.3	0.3	41.61	100.21	0	1.35	0	0	7.02	0	0	33.27	20.86	0	24.95	0	25.05	0	0	0	0	0	0	0	0	0												200	140.68	23.83	0.15	150.32	0.3	0.3	41.61	100.21	0	1.35	0	0	7.02	0	0	33.27	20.86	0	24.95	0	25.05	0	0	0	0	0	0	0	0	0												18.51	0.25	2.95	3.81	3.04	5.3	0.37	1.84	4.33	-	0.19	-	-	1.24	-	-	0.56	0.45	-	18.11	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.1	18.51	0.25	2.95	3.81	3.04	5.3	0.37	1.84	4.33	-	0.19	-	-	1.24	-	-	0.56	0.45	-	18.11	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.1
H2613_802_0	2006											0											D	A	D	Coin	T	Coin	Coin	P	P	V	O	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	Coin	P	V	P	O	O	O																																																					-	1110.41	21.34	1484.8	25.41	242.29	17.63	1.23	531.97	518.1	0	1716.56	0	0.28	2121.63	0	0	200.97	257.02	0	8708.68	9.77	557.42	0	0	0	0	0	0	0	0	0											200 / day up to 5 days.	900 / admit	100 / day days 21 - 100	15 coinsurance	150 copay	30 coinsurance	30 coinsurance	50 ER copay / 25 Urgent Care copay	100 copay		25 Radiation Therapy copay		0 coinsurance	25 PT/OT/ST copay 25 Chemo copay			50 MH coinsurance 10 SA copay	25 copay		25 PCP copay / 25 SCP copay		25 Vision Exams copay																				200	140.68	23.83	0.15	150.32	0.3	0.3	41.61	100.21	0	1.35	0	0	7.02	0	0	33.27	20.86	0	24.95	0	25.05	0	0	0	0	0	0	0	0	0												200	140.68	23.83	0.15	150.32	0.3	0.3	41.61	100.21	0	1.35	0	0	7.02	0	0	33.27	20.86	0	24.95	0	25.05	0	0	0	0	0	0	0	0	0												18.51	0.25	2.95	3.81	3.04	5.3	0.37	1.84	4.33	-	0.19	-	-	1.24	-	-	0.56	0.45	-	18.11	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.1	18.51	0.25	2.95	3.81	3.04	5.3	0.37	1.84	4.33	-	0.19	-	-	1.24	-	-	0.56	0.45	-	18.11	-	1.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.1
H2613_803_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H2613_804_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H2649_004_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				3500	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1880.87	11.8	1050.98	1934.35	257.57	0.53	0.04	387.82	677.87				24.2	1126.53	7308.88	5286.91					4.45			6.31	356		230					98.99	0.62	10.73	0	0	0	0				195 per day (1-5)	195 per day (1-5)	0 per day (1-13) 100 per day (14-100)	5	100	20	20	35-50	175				0	0-100	10-100	35-100					20			0	0-20		0					195 per day (1-5)	195 per day (1-5)	20	0	0	0	0				132.64	132.64	31.45	5	100	0.2	0.2	47	175				0	28.12	11.77	36.28					20			0	13.88		0					132.64	132.64	0.2	0	0	0	0					93.35	132.64	22.13	3.52	70.38	0.14	0.14	33.08	123.17				0	19.79	8.28	25.53					20			0	13.88		0					93.35	132.64	0.14	0	0	0	0				0	14.63	0.13	1.94	0.57	1.51	0.07	0.01	1.07	6.96	-	-	-	-	1.86	5.04	11.25	-	-	-	-	0.89	-	-	-	0.41	-	-	-	-	-	-	0.77	0.01	1.51	-	-	-	-	-	-	-	48.62	14.63	0.13	1.94	0.57	1.51	0.07	0.01	1.07	6.96	-	-	-	-	1.86	5.04	11.25	-	-	-	-	0.89	-	-	-	0.41	-	-	-	-	-	-	0.77	0.01	1.51	-	-	-	-	-	-	-	48.62
H2649_011_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				5000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2052.31	12.88	1146.78	2110.67	281.05	0.6	0.04	423.17	739.66				26.4	1229.21	7975.09	5768.82					4.45			0	356		230					108.02	0.68	12.14	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-13) 100 per day (14-100)	5	150	20	20	35-50	175				0	0-100	10-100	35-100					20				0-20		0					300 per day (1-5)	300 per day (1-5)	20	0	0	0	0				204.06	204.06	31.45	5	150	0.2	0.2	47	175				0	28.91	11.77	36.28					20			0	13.88		0					204.06	204.06	0.2	0	0	0	0					147.59	204.06	22.75	3.62	108.49	0.14	0.14	33.99	126.57				0	20.91	8.51	26.24					20			0	13.88		0					147.59	204.06	0.14	0	0	0	0				0	25.24	0.22	2.17	0.64	2.54	0.09	0.01	1.2	7.8	-	-	-	-	2.14	5.66	12.61	-	-	-	-	0.89	-	-	-	0.41	-	-	-	-	-	-	1.33	0.01	1.76	-	-	-	-	-	-	-	64.71	25.24	0.22	2.17	0.64	2.54	0.09	0.01	1.2	7.8	-	-	-	-	2.14	5.66	12.61	-	-	-	-	0.89	-	-	-	0.41	-	-	-	-	-	-	1.33	0.01	1.76	-	-	-	-	-	-	-	64.71
H2649_012_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				4000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1820.43	11.42	2034.43	1827.33	234.79	0.51	0.04	353.52	617.91				22.86	1026.88	6904.53	4994.42					4.45			6.31	0		0					95.81	0	10.41	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-13) 100 per day (14-100)	5	150	20	20	35-50	200				0	0-150	0-150	0-150					0.2			0 - 0	0		0					300 per day (1-5)	0 per day (0-0)	20	0	0	0	0				204.06	204.06	15.73	5	150	0.2	0.2	47	200				0	37.2	2.94	2.94					0.2			0	0		0					204.06	0	0.2	0	0	0	0					154.51	204.06	11.91	3.79	113.58	0.15	0.15	35.59	151.43				0	28.17	2.23	2.23					0.2			0	0		0					154.51	0	0.15	0	0	0	0				0	23.44	0.19	2.02	0.58	2.22	0.08	0.01	1.05	7.8	-	-	-	-	2.41	1.28	0.93	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.23	-	1.58	-	-	-	-	-	-	-	45.7	23.44	0.19	2.02	0.58	2.22	0.08	0.01	1.05	7.8	-	-	-	-	2.41	1.28	0.93	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.23	-	1.58	-	-	-	-	-	-	-	45.7
H2649_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1908.66	11.97	2133.02	1948.54	256.72	0.55	0.04	386.55	675.64				24.37	1122.83	7362.52	5325.71					4.45			0	0		0					100.46	0.63	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	50.59	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	50.59	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	32.46	0.2	1.96	-	2.14	0.11	0.01	1.49	11.26	-	-	-	-	4.73	13.84	16.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.71	0.01	-	-	-	-	-	-	-	-	87.34	32.46	0.2	1.96	-	2.14	0.11	0.01	1.49	11.26	-	-	-	-	4.73	13.84	16.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.71	0.01	-	-	-	-	-	-	-	-	87.34
H2649_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1908.55	11.97	2132.9	1948.43	256.71	0.55	0.04	386.53	675.61				24.37	1122.76	7362.1	5325.41					4.45			0	0		0					100.45	0.63	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	50.59	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	50.59	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	32.45	0.2	1.96	-	2.14	0.11	0.01	1.49	11.26	-	-	-	-	4.73	13.83	16.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.71	0.01	-	-	-	-	-	-	-	-	87.33	32.45	0.2	1.96	-	2.14	0.11	0.01	1.49	11.26	-	-	-	-	4.73	13.83	16.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.71	0.01	-	-	-	-	-	-	-	-	87.33
H2649_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1908.66	11.97	2133.02	1948.54	256.72	0.55	0.04	386.55	675.64				24.37	1122.83	7362.52	5325.71					4.45			0	0		0					100.46	0.63	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	50.59	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	50.59	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	32.46	0.2	1.96	-	2.14	0.11	0.01	1.49	11.26	-	-	-	-	4.73	13.84	16.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.71	0.01	-	-	-	-	-	-	-	-	87.34	32.46	0.2	1.96	-	2.14	0.11	0.01	1.49	11.26	-	-	-	-	4.73	13.84	16.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.71	0.01	-	-	-	-	-	-	-	-	87.34
H2649_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1908.55	11.97	2132.9	1948.43	256.71	0.55	0.04	386.53	675.61				24.37	1122.76	7362.1	5325.41					4.45			0	0		0					100.45	0.63	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	50.59	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	50.59	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	32.45	0.2	1.96	-	2.14	0.11	0.01	1.49	11.26	-	-	-	-	4.73	13.83	16.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.71	0.01	-	-	-	-	-	-	-	-	87.33	32.45	0.2	1.96	-	2.14	0.11	0.01	1.49	11.26	-	-	-	-	4.73	13.83	16.53	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.71	0.01	-	-	-	-	-	-	-	-	87.33
H2654_004_0	2006											4600											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1671.12	141.13	533.13	0	68.43	10.08	4.81	281.86	45.01	10549.99	36.27	0	0.41	0.81	9055.1	3228.66	599.58	1.26	0	0	21.33	2203.5	0	0	330.24	502.1	243.49	0	0	0	0											265	175	85	0	150	20	20	50	20	10	20-Oct	20 (included in g.)	25	20 / 40 / 30	15 / 0	30	40 / 30	20	0	0	25	0 / 30	0		30	05-Oct	30			0												265	175	85.02		50	20	20	50	20	4	15		25	18	15	30	37.5	20			25	30			30	8.81	30																189.68	125.26	60.86	0	35.79	14.3	16.7	35.79	14	2.86	11	0	18	0.13	15	30	37.5	14	0	0	18	30	0	0	30	8.81	17.88	0	0	0	0												26.41	1.47	2.7	-	0.2	1.44	0.8	0.84	6.44	2.52	3.89	-	0.07	0.1	11.32	8.07	1.87	0.18	-	-	3.82	5.51	-	-	0.83	0.37	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.24	26.41	1.47	2.7	-	0.2	1.44	0.8	0.84	6.44	2.52	3.89	-	0.07	0.1	11.32	8.07	1.87	0.18	-	-	3.82	5.51	-	-	0.83	0.37	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.24
H2654_010_0	2006											4000											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1555.6	131.97	514.06	0	24.73	12.92	3.84	1150.35	49.45	6748.58	36.93	0	0.17	0.69	3930.32	2787.1	572.2	1.39	0	0	13.37	2542.23	0	0	381.44	493.5	241.08	0	0	0	0											270	175	125	0	150	20	20	50	20	10	20-Oct	20 (included in g.)	30	20 / 40 / 30	15 / 0	30	40 / 30	20	0	0	30	0 / 30	0		30	05-Oct	30			0												270	175	125		50	20	20	50	20	4	15		30	18	15	30	37.5	20			30	30			30	8.7	30																182.81	118.49	84.64	0	33.85	13.5	17.1	33.85	14	2.71	10	0	20	13	15	30	37.5	14	0	0	20	30	0	0	30	8.7	18.33	0	0	0	0												23.7	1.3	3.63	-	0.07	1.75	0.65	3.25	6.7	1.52	3.75	-	0.03	0.09	4.91	6.97	1.79	0.19	-	-	2.72	6.36	-	-	0.95	0.36	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.05	23.7	1.3	3.63	-	0.07	1.75	0.65	3.25	6.7	1.52	3.75	-	0.03	0.09	4.91	6.97	1.79	0.19	-	-	2.72	6.36	-	-	0.95	0.36	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.05
H2654_013_0	2006											3200											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	O																																																							-	1211.84	141.27	477.91	0	53.94	8.54	6.83	276.58	49.37	9345.4	35.79	0	0.31	1.29	9596.1	3162.45	599.2	1.5	0	0	19.51	2178.74	0	0	326.22	502.29	126.54	0	394.39	0	0											200/250/265	175	85	0	150	20	20	50	20	10	20-Oct	20 (included in g.)	25	20 / 40 / 30	15 / 0	30	40 / 30	20	0	0	25	0 / 30	0		30	05-Oct	30		265	0												245.26	175	85.03		50	20	20	50	20	4	15		25	19	15	30	37.5	20			25	30			30	8.77	30		265														157.39	112.3	54.56	0	32.09	12.8	15	32.09	13	2.57	10	0	16	12	15	30	37.5	13	0	0	16	30	0	0	30	8.77	27.23	0	170.05	0	0												15.89	1.32	2.17	-	0.14	1.1	1.02	0.74	6.34	2	3.45	-	0.05	0.16	12	7.91	1.87	0.19	-	-	3.13	5.45	-	-	0.82	0.37	0.29	-	5.59	-	-	-	-	-	-	-	-	-	-	-	-	71.98	15.89	1.32	2.17	-	0.14	1.1	1.02	0.74	6.34	2	3.45	-	0.05	0.16	12	7.91	1.87	0.19	-	-	3.13	5.45	-	-	0.82	0.37	0.29	-	5.59	-	-	-	-	-	-	-	-	-	-	-	-	71.98
H2654_020_0	2006											4500											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1671.12	141.13	533.13	0	68.43	10.08	4.81	281.86	45.01	10549.99	36.27	0	0.41	0.81	9055.1	3228.66	599.58	1.26	0	0	21.33	2203.5	0	0	330.24	502.1	243.49	0	0	0	0											265	175	85	0	150	20	20	50	20	10	20-Oct	20 (included in g.)	20	20 / 40 / 30	Oct-00	25	40 / 30	20	0	0	20	0 / 25	0		25	05-Oct	25			0												265	175	85		50	20	20	50	20	4	15		20	17	10	25	37.5	20			20	25			25	8.81	25																189.28	125	60.71	0	35.71	14.3	16.7	35.71	14	2.86	11	0	14	12	10	25	37.5	14	0	0	14	25	0	0	25	8.81	17.88	0	0	0	0												26.36	1.47	2.7	-	0.2	1.44	0.8	0.84	6.43	2.51	3.89	-	0.06	0.1	7.55	6.73	1.87	0.18	-	-	3.05	4.59	-	-	0.69	0.37	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.18	26.36	1.47	2.7	-	0.2	1.44	0.8	0.84	6.43	2.51	3.89	-	0.06	0.1	7.55	6.73	1.87	0.18	-	-	3.05	4.59	-	-	0.69	0.37	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.18
H2654_021_0	2006											3400											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1555.6	131.97	514.06	0	24.73	12.92	3.84	1150.35	49.45	6748.58	36.93	0	0.17	0.69	3930.32	2787.1	572.2	1.39	0	0	13.37	2542.23	0	0	381.44	493.5	241.08	0	0	0	0											250	175	85	0	150	20	20	50	20	0	0 / 20	20 (included in g.)	20	20 / 40 / 30	Dec-00	25	40 / 30	20	0	0	20	0 / 25	0		25	05-Oct	25			0												250	175	85		50	20	20	50	20	0	13		20	16	12	25	37.5	20			20	25			25	8.7	25																167.12	116.98	56.82	0	33.42	13.4	17	33.42	13	0	9	0	13	11	12	25	37.5	13	0	0	13	25	0	0	25	8.7	18.33	0	0	0	0												21.66	1.29	2.43	-	0.07	1.73	0.65	3.2	6.61	-	3.31	-	0.02	0.08	3.93	5.81	1.79	0.19	-	-	1.79	5.3	-	-	0.79	0.36	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.37	21.66	1.29	2.43	-	0.07	1.73	0.65	3.2	6.61	-	3.31	-	0.02	0.08	3.93	5.81	1.79	0.19	-	-	1.79	5.3	-	-	0.79	0.36	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.37
H2654_022_0	2006											2800											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	O																																																							-	1211.84	141.27	477.91	0	53.94	8.54	6.83	276.58	49.37	9345.4	35.79	0	0.31	1.29	9596.1	3162.45	599.2	1.5	0	0	19.51	2178.74	0	0	326.22	502.29	126.54	0	394.39	0	0											200/250/265	175	85	0	150	20	20	50	20	10	20-Oct	20 (included in g.)	20	20 / 40 / 30	Oct-00	25	40 / 30	20	0	0	20	0 / 25	0		25	05-Oct	25		265	0												245.26	175	85		50	20	20	50	20	4	15		20	18	10	25	37.5	20			20	25			25	8.77	25		265														150.19	107.17	52.05	0	30.62	12.2	14.5	30.62	12	2.45	9	0	12	11	10	25	37.5	12	0	0	12	25	0	0	25	8.77	22.72	0	162.28	0	0												15.17	1.26	2.07	-	0.14	1.05	0.99	0.71	6.05	1.91	3.29	-	0.04	0.15	8	6.59	1.87	0.18	-	-	2.39	4.54	-	-	0.68	0.37	0.24	-	5.33	-	-	-	-	-	-	-	-	-	-	-	-	63	15.17	1.26	2.07	-	0.14	1.05	0.99	0.71	6.05	1.91	3.29	-	0.04	0.15	8	6.59	1.87	0.18	-	-	2.39	4.54	-	-	0.68	0.37	0.24	-	5.33	-	-	-	-	-	-	-	-	-	-	-	-	63
H2654_023_0	2006											600											D	D	D	V	P	Coin	Coin	V	V	O	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P																																																								-	1470.97	173.94	553.54	0	79.28	14.1	6.61	456.68	1020.89	0	4941.62	0	0.54	17.88	10729.82	3975.8	745.39	445.62	0	0	25.32	1558.72	0	0	240.52	0	321.86	0	0	0	0											25	25	15	0	100	20	20	40	15	0	0 / 10	15 (included in g.)	20	10 / 15 / 8 / 4	Feb-00	4	04-Aug	10	0	0	20	0 / 4	0		4	0	4	0		0												25	25	15		33.33	20	20	40	15	0	6.7	0	20	9.57	2	4	7	10			20	4			4	0	4																17.69	17.69	10.62	0	23.59	14.2	16.6	28.31	10.62	0	4.74	0	14	7.09	2	4	7	7.08	0	0	14	4	0	0	4	0	3.88	0	0	0	0												2.17	0.26	0.49	-	0.16	2	1.1	1.08	0.9	-	1.95	-	0.08	0.01	1.79	1.33	0.43	0.26	-	-	3.58	0.52	-	-	0.08	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.28	2.17	0.26	0.49	-	0.16	2	1.1	1.08	0.9	-	1.95	-	0.08	0.01	1.79	1.33	0.43	0.26	-	-	3.58	0.52	-	-	0.08	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.28
H2654_024_0	2006											600											D	D	D	V	P	Coin	Coin	V	V	O	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P																																																								-	1980.56	198.06	631.85	0	102.94	15.29	7.22	424	1099.81	0	5570.88	0	0.62	19.06	12804.06	4559.99	847.82	494.36	0	0	30.32	1520.2	0	0	234.49	0	366.29	0	0	0	0											25	25	15	0	100	20	20	40	15	0	0 / 10	15 (included in g.)	20	10 / 15 / 8 / 4	Feb-00	4	04-Aug	10	0	0	20	0 / 4	0		4	0	4	0		0												25	25	15		33.33	20	20	40	15	0	6.7	0	20	9.54	2	4	7	10			20	4			4	0	4																16.83	16.83	10.1	0	22.45	13.5	16.2	26.93	10.1	0	4.51	0	13	6.8	2	4	7	6.73	0	0	13	4	0	0	4	0	3.87	0	0	0	0												2.78	0.28	0.53	-	0.19	2.06	1.17	0.95	0.93	-	2.09	-	0.08	0.01	2.13	1.52	0.49	0.28	-	-	4.08	0.51	-	-	0.08	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.29	2.78	0.28	0.53	-	0.19	2.06	1.17	0.95	0.93	-	2.09	-	0.08	0.01	2.13	1.52	0.49	0.28	-	-	4.08	0.51	-	-	0.08	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.29
H2654_801_0	2006											3800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1596.79	140.84	487.63	0	93.37	10.12	5.93	268.34	61.68	11944.28	44.11	0	0.1	1.19	9548.49	3751.31	599.23	1.93	0	0	27.83	2191.49	0	0	328.85	0	245.28	0	0	0	0											265	175	125	0	150	25	25	50	25	10	25-Oct	25 (included in g.)	25	25 / 40 / 30	15 / 0	30	40 / 30	25	0	0	25	0 / 30			30		30			0												265	175	125		150	25	25	50	25	4	19		25	19.7	15	30	37.5	25			25	30			30		30																166.82	110.16	78.69	0	94.43	15.7	18.9	31.48	16	2.52	12	0	16	12.6	15	30	37.5	16	0	0	16	30	0	0	30	0	17.77	0	0	0	0												22.2	1.29	3.2	-	0.73	1.59	1.12	0.7	9.71	2.51	5.21	-	0.02	0.15	11.94	9.38	1.87	0.3	-	-	4.38	5.48	-	-	0.82	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.96	22.2	1.29	3.2	-	0.73	1.59	1.12	0.7	9.71	2.51	5.21	-	0.02	0.15	11.94	9.38	1.87	0.3	-	-	4.38	5.48	-	-	0.82	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.96
H2654_802_0	2006											4500											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1596.79	140.84	487.63	0	93.37	10.12	5.93	268.34	61.68	11944.28	44.11	0	0.1	1.19	9548.49	3751.31	599.23	1.93	0	0	27.83	2191.49	0	0	328.85	0	245.28	0	0	0	0											265	17500	85	0	150	0	0	50	0	10	20-Oct	20 (included in g.)	0.2	20 / 40 / 30	Oct-00	25	40 / 30	0	0	0	0.2	0 / 25			25		25			0												265	175	85		150	0.2	0.2	50	0.2	4	0.15		0.2	0.16	10	25	37.5	0.2			0.2	25			25		25																184.67	121.95	59.23	0	104.53	0.14	0.16	34.84	0.14	2.79	0.1	0	0.14	0.11	10	25	37.5	0.14	0	0	0.14	25	0	0	25	0	17.77	0	0	0	0												24.57	1.43	2.41	-	0.81	1.41	0.95	0.78	8.6	2.77	4.61	-	0.01	0.13	7.96	7.82	1.87	0.27	-	-	3.88	4.57	-	-	0.69	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.9	24.57	1.43	2.41	-	0.81	1.41	0.95	0.78	8.6	2.77	4.61	-	0.01	0.13	7.96	7.82	1.87	0.27	-	-	3.88	4.57	-	-	0.69	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.9
H2654_803_0	2006											3400											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1241.78	114.06	341.88	0	61.24	9.31	5.26	333.14	49.77	8930.2	37.84	0	0.07	1.06	6824.86	3004.94	489.65	1.39	0	0	19.96	1527.44	0	0	224.36	0	199.86	0	0	0	0											250	175	85	0	150	30	30	50	30	10	30-Oct	30 (included in g.)	30	30 / 40 / 30	15 / 0	27	40 / 30	30	0	0	30	0 / 27			27		27			0												250	175	85.03		50	30	30	50	30	4	23		30	23.9	15	27	37.5	30			30	27			27		27																162.68	113.88	55.33	0	32.54	19.5	23.7	32.54	20	2.6	15	0	20	15.7	15	27	37.5	20	0	0	20	27	0	0	27	0	18.09	0	0	0	0												16.83	1.08	1.58	-	0.17	1.82	1.25	0.9	9.72	1.94	5.54	-	0.01	0.17	8.53	6.76	1.53	0.27	-	-	3.9	3.44	-	-	0.5	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.23	16.83	1.08	1.58	-	0.17	1.82	1.25	0.9	9.72	1.94	5.54	-	0.01	0.17	8.53	6.76	1.53	0.27	-	-	3.9	3.44	-	-	0.5	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.23
H2654_804_0	2006											3400											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1241.78	114.06	341.88	0	61.24	9.31	5.26	333.14	49.77	0	37.84	0	0.07	1.06	6824.86	3004.94	489.65	1.39	0	0	19.96	1527.44	0	0	224.36	0	199.86	0	0	0	0											250	17500	85	0	150	0	0	50	0	0	0 / 20	20 (included in g.)	0.2	20 / 40 / 30	Dec-00	25	40 / 30	0	0	0	0.2	0 / 25			25		25			0												250	175	85		50	0.2	0.2	50	0.2	0	0.13		0.2	0.16	12	25	37.5	0.2			0.2	25			25		25																177.36	124.15	60.3	0	35.47	0.14	0.16	35.47	0.14	0	0.1	0	0.14	0.12	12	25	37.5	0.14	0	0	0.14	25	0	0	25	0	18.09	0	0	0	0												18.35	1.18	1.72	-	0.18	1.32	0.87	0.98	7.06	-	3.6	-	0.01	0.12	6.82	6.26	1.53	0.2	-	-	2.83	3.18	-	-	0.47	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.99	18.35	1.18	1.72	-	0.18	1.32	0.87	0.98	7.06	-	3.6	-	0.01	0.12	6.82	6.26	1.53	0.2	-	-	2.83	3.18	-	-	0.47	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.99
H2663_002_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional							1500	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P	T	V	V	P	V	P	P	P	P	V	V	V	V																																																	-	2328.72	11.21	805.73	0	292.29	7.31	40.39	286.61	352.26	0	46.04	4.77	1.14	22.92	4556.36	5602.52	147.73	4.32	12.45	1.68	11.98	1.7	0	0	146.64	112.44	1.43	0	0	0	355.02	2249.99	475.38	58.41	65.95							150 days 1-5	300 days 1-5	75 days 6-25		100	0	0	50	250		0.2	0.2	0.2	0	10	25	VARIES	0	20	VARIES	0.2	15			25	15	10 PCP 25 SCP				25	5	15	5	15							86.93	165.18	53.33	0	100	0.2	0.2	50	250	0	0.2	0.2	0.2	0.2	10	23.37	46.24	0.2	0.2	17.5	0.2	15	0	0	25	15	20.45	0	0	0	24.98	5	15	5	15								56.89	165.18	34.9	0	65.44	0.13	0.13	32.72	163.61	0	0.13	0.13	0.13	0.13	10	23.37	40.06	0.13	0.13	17.5	0.2	15	0	0	25	15	20.45	0	0	0	24.98	3.27	9.82	3.27	9.82								11.04	0.15	2.34	-	1.59	0.96	5.29	0.78	4.8	-	6.03	0.62	0.15	3	3.8	10.91	0.49	0.57	1.63	0	2.4	0	-	-	0.31	0.14	0	-	-	-	0.74	0.61	0.39	0.02	0.05	-	-	-	-	-	-	58.81	11.04	0.15	2.34	-	1.59	0.96	5.29	0.78	4.8	-	6.03	0.62	0.15	3	3.8	10.91	0.49	0.57	1.63	0	2.4	0	-	-	0.31	0.14	0	-	-	-	0.74	0.61	0.39	0.02	0.05	-	-	-	-	-	-	58.81
H2663_005_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional							1800	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P	T	V	V	P	V	P	P	P	P	V	V	V	V																																																	-	1617.4	23.98	562.29	0	148.26	4.82	20.77	265.26	246.31	0	34.03	4.47	0	19.55	3951.64	4065.79	169.83	4.39	17.23	0.48	5.67	0	0	0	146.79	112.44	0.66	0	0	0	126.18	2249.52	320.52	9.53	91.51							250 days 1-5	300 days 1-5	125 days 6-23		150	0	0	50	VARIES		0.2	0.2	0.2	0	5	25	VARIES	0	20	5	0.2				25	15	10 PCP 25 SCP				25	5	15	5	15							144.9	165.18	88.88	0	150	0.19	0.19	47.29	199.18	0	0.19	0.19	0.19	0.19	5	22.84	54.34	0.19	0.19	5	0.2	0	0	0	25	15	23.56	0	0	0	24.53	5	15	5	15								138.34	165.18	84.86	0	149.82	0.18	0.18	45.15	190.17	0	0.18	0.18	0.19	0.18	4.99	22.81	53.2	0.18	0.18	5	0.2	0	0	0	25	15	23.56	0	0	0	24.53	4.77	14.35	4.77	14.32								18.65	0.33	3.98	-	1.85	0.86	3.71	1	3.9	-	6.08	0.8	0	3.49	1.64	7.73	0.75	0.78	3.08	0	1.13	-	-	-	0.31	0.14	0	-	-	-	0.26	0.89	0.38	0	0.11	-	-	-	-	-	-	61.87	18.65	0.33	3.98	-	1.85	0.86	3.71	1	3.9	-	6.08	0.8	0	3.49	1.64	7.73	0.75	0.78	3.08	0	1.13	-	-	-	0.31	0.14	0	-	-	-	0.26	0.89	0.38	0	0.11	-	-	-	-	-	-	61.87
H2663_006_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional							5000	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P	T	V	V	P	V	P	P	P	P	V	V	V	V																																																	-	2238.49	11.03	774.12	0	275.8	6.9	38.19	270.53	332.55	0	43.46	4.5	1	21.64	4358.19	4958.58	147.21	4.08	11.75	0	11.59	1.6	0	0	146.58	112.44	1.36	0	0	0	334.95	2231.53	448.78	57.72	62.21							300 days 1-5	300 days 1-5	125 days 6-45		100	0	0	50	250		0.2	0.2	0.2	0	10	25	VARIES	0	20		0.2	15			25	15	10 PCP 25 SCP				25	5	15	5	15							173.84	165.18	88.88	0	100	0.2	0.2	50	250	0	0.2	0.2	0.2	0.2	10	24.91	30.07	0.2	0.2	0	0.2	15	0	0	25	15	20.4	0	0	0	24.98	5	15	5	15								145.59	165.18	74.43	0	97.69	0.17	0.17	41.87	209.37	0	0.17	0.17	0.17	0.17	10	24.91	29.8	0.17	0.17	0	0.2	15	0	0	25	15	20.4	0	0	0	24.98	4.19	12.58	4.19	12.56								27.16	0.15	4.8	-	2.25	1.16	6.4	0.94	5.8	-	7.28	0.75	0.17	3.63	3.63	10.29	0.37	0.68	1.97	-	2.32	0	-	-	0.31	0.14	0	-	-	-	0.7	0.78	0.47	0.02	0.07	-	-	-	-	-	-	82.22	27.16	0.15	4.8	-	2.25	1.16	6.4	0.94	5.8	-	7.28	0.75	0.17	3.63	3.63	10.29	0.37	0.68	1.97	-	2.32	0	-	-	0.31	0.14	0	-	-	-	0.7	0.78	0.47	0.02	0.07	-	-	-	-	-	-	82.22
H2663_007_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional							1500	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P	T	V	V	P	V	P	P	P	P	V	V	V	V																																																	-	1453.04	22.12	490.27	0	152.1	4.81	20.67	251.59	266.16	0	32.13	4.55	0	16.78	3942.59	3722.51	159.76	4.18	16.03	0	6.23	0	0	0	146.73	112.44	0.87	0	0	0	141.75	2207.32	278.57	11.84	115.03							150 days 1-5	150 days 1-5	75 days 6-25		100	0	0	50	VARIES		0.2	0.2	0.2	0	5	VARIES	VARIES	0	20		0.2	15			20	15	10 PCP 25 SCP				VARIES	5	15	5	15							86.94	165.18	53.33	0	100	0.19	0.19	47.62	174.31	0	0.19	0.19	0	0.18	5	15.83	50.18	0.14	0.19	0	0.2	0	0	0	20	15	10.25	0	0	0	14.37	5	15	5	15								45.05	165.18	27.64	0	98.57	0.1	0.1	24.68	90.33	0	0.1	0.1	0	0.1	4.96	15.49	40.16	0.07	0.1	0	0.2	0	0	0	20	15	10.25	0	0	0	14.37	2.59	8.02	2.59	7.77								5.46	0.3	1.13	-	1.25	0.47	2.01	0.52	2	-	3.12	0.44	-	1.6	1.63	4.81	0.53	0.3	1.56	-	1.25	-	-	-	0.24	0.14	0	-	-	-	0.17	0.48	0.19	0	0.07	-	-	-	-	-	-	29.66	5.46	0.3	1.13	-	1.25	0.47	2.01	0.52	2	-	3.12	0.44	-	1.6	1.63	4.81	0.53	0.3	1.56	-	1.25	-	-	-	0.24	0.14	0	-	-	-	0.17	0.48	0.19	0	0.07	-	-	-	-	-	-	29.66
H2663_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	255.25	1.62	20.18	0	6.91	9.53	36.31	223.48	35.91	0.85	49	3.95	0.27	19.84	30.53	97.03	3.83	6.04	50.75	1.13	22.03	0	0	0	0	0	0	0	0	0	0	2.45	2.04	5.28	0.24																																																0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.76	19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.76
H2663_802_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	255.25	1.62	20.18	0	6.91	9.53	36.31	223.48	35.91	0.85	49	3.95	0.27	19.84	30.53	97.03	3.83	6.04	50.75	1.13	22.03	0	0	0	0	0	0	0	0	0	0	2.45	2.04	5.28	0.24																																																0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.77	19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.77
H2663_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	255.25	1.62	20.18	0	6.91	9.53	36.31	223.48	35.91	0.85	49	3.95	0.27	19.84	30.53	97.03	3.83	6.04	50.75	1.13	22.03	0	0	0	0	0	0	0	0	0	0	2.45	2.04	5.28	0.24																																																0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.76	19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.76
H2663_804_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	255.25	1.62	20.18	0	6.91	9.53	36.31	223.48	35.91	0.85	49	3.95	0.27	19.84	30.53	97.03	3.83	6.04	50.75	1.13	22.03	0	0	0	0	0	0	0	0	0	0	2.45	2.04	5.28	0.24																																																0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.77	19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.77
H2663_805_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	255.25	1.62	20.18	0	6.91	9.53	36.31	223.48	35.91	0.85	49	3.95	0.27	19.84	30.53	97.03	3.83	6.04	50.75	1.13	22.03	0	0	0	0	0	0	0	0	0	0	2.45	2.04	5.28	0.24																																																0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.76	19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.76
H2663_806_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	255.25	1.62	20.18	0	6.91	9.53	36.31	223.48	35.91	0.85	49	3.95	0.27	19.84	30.53	97.03	3.83	6.04	50.75	1.13	22.03	0	0	0	0	0	0	0	0	0	0	2.45	2.04	5.28	0.24																																																0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								0.08	0.08	0.18	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0.23	0.23	0.23	0.23								19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.76	19.63	0.12	3.62	-	1.61	2.22	8.46	0.93	8.37	0.2	11.42	0.92	0.06	4.62	7.11	22.61	0.89	1.41	11.83	0.26	5.13	-	-	-	-	-	-	-	-	-	-	0.57	0.47	1.23	0.06	-	-	-	-	-	-	113.76
H2667_001_0	2006	OP Facility - Other										0	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	319.24	25.99	32.16	7.98	260.26	10.3	18.89	3318.13	28.56	709.37	1.3	1.56	0	1954.11	3656.22	2275.07	146.92	0	57.72	28933.62	42.44	0	102.6	0	3.88	0	0	0	0	0	0	1.5										150	150	125 for day 11-16	0	100	0	0	50	150	0	0.2	0.2	0.2	0-30	15	30	30	0	20	0-30	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										467.55	416.29	368.15	0	25	0.2	0.2	6	31.08	0	0.15	0.2	0	3.91	15	30	30	0	0.08	0.46	0.2	0	0	0	0	0	0	0	0	0	0	0.1										0	467.55	416.29	368.15	0	25	0.2	0.2	6	31.08	0	0.15	0.2	0	3.91	15	30	30	0	0.08	0.46	0.2	0	0	0	0	0	0	0	0	0	0	0.1										0	12.44	0.9	0.99	-	0.54	2.06	3.78	1.66	0.07	-	0.2	0.31	-	0.64	4.57	5.69	0.37	-	4.65	1.11	8.49	-	-	-	-	-	-	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	48.6	12.44	0.9	0.99	-	0.54	2.06	3.78	1.66	0.07	-	0.2	0.31	-	0.64	4.57	5.69	0.37	-	4.65	1.11	8.49	-	-	-	-	-	-	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	48.6
H2667_003_0	2006	OP Facility - Other										3600	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	401.78	23.91	35.1	11.72	393.32	10.71	3.41	2899	286.94	5302.48	1.56	2.31	0	1322.63	4057.94	2998.49	252.91	0	47.93	27497.25	38.09	0	2.2	0	96.42	0	5.79	0	0	0	0	2.32										185	185	100 for day 11-25	0	100	0	0	50	200	0	0.2	0.2	0.2	0-25	10	20	20	0	20	0-20	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										776.06	633.99	248.29	0	16	0.2	0.2	6.13	46.78	0	0.2	0.2	0	1.55	10	20	20	0	0.1	0.82	0.2	0	0	0	0	0	25	0	0	0	0	0.2										0	690.23	563.87	220.83	0	14.23	0.18	0.18	5.45	41.6	0	0.18	0.18	0	1.38	10	20	20	0	0.09	0.82	0.2	0	0	0	0	0	25	0	0	0	0	0.18										0	23.11	1.12	0.65	-	0.47	1.9	0.61	1.32	0.99	-	0.28	0.41	-	0.15	3.38	5	0.42	-	4.36	1.88	7.62	-	-	-	-	-	0.01	-	-	-	-	0.41	-	-	-	-	-	-	-	-	-	54.1	23.11	1.12	0.65	-	0.47	1.9	0.61	1.32	0.99	-	0.28	0.41	-	0.15	3.38	5	0.42	-	4.36	1.88	7.62	-	-	-	-	-	0.01	-	-	-	-	0.41	-	-	-	-	-	-	-	-	-	54.1
H2667_005_0	2006	OP Facility - Other										3600	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	435.98	22.22	53.76	11.03	898.84	15.17	10.39	3558.05	370.13	8893.84	0.98	2.41	0	644.32	4695.46	2538.68	328.4	0	53.94	25162.42	22.26	0	9.62	0	88.1	0	11.24	0	0	0	0	2.2										135	135	100 for day 11-25	0	100	0	0	50	200	0	0.2	0.2	0.2	0-25	10	20	20	0	20	0-20	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										582.91	462.64	248.29	0	15	0.2	0.2	5.5	46.11	0	0.2	0.2	0	0.51	10	20	20	0	0.09	0.68	0.2	0	0	0	0	0	25	0	0	0	0	0.2										0	517.24	410.52	220.32	0	13.31	0.18	0.18	4.88	40.91	0	0.18	0.18	0	0.46	10	20	20	0	0.08	0.68	0.2	0	0	0	0	0	25	0	0	0	0	0.18										0	18.79	0.76	0.99	-	1	2.69	1.84	1.45	1.26	-	0.17	0.43	-	0.02	3.91	4.23	0.55	-	4.41	1.42	4.45	-	-	-	-	-	0.02	-	-	-	-	0.39	-	-	-	-	-	-	-	-	-	48.8	18.79	0.76	0.99	-	1	2.69	1.84	1.45	1.26	-	0.17	0.43	-	0.02	3.91	4.23	0.55	-	4.41	1.42	4.45	-	-	-	-	-	0.02	-	-	-	-	0.39	-	-	-	-	-	-	-	-	-	48.8
H2667_012_0	2006	OP Facility - Other										0	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	319.24	25.99	32.16	7.98	260.26	10.3	18.89	3318.13	28.56	709.37	1.3	1.56	0	1954.11	3656.22	2275.07	146.92	0	57.72	28933.62	42.44	0	102.6	0	3.88	0	0	0	0	0	0	1.5										150	15000	125 for day 11-16	0	100	0	0	50	150	0	0.2	0.2	0.2	0-30	15	30	30	0	20	0-30	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										467.55	416.29	368.15	0	25	0.2	0.2	6	31.08	0	0.15	0.2	0	3.91	15	30	30	0	0.08	0.46	0.2	0	0	0	0	0	0	0	0	0	0	0.1										0	467.55	416.29	368.15	0	25	0.2	0.2	6	31.08	0	0.15	0.2	0	3.91	15	30	30	0	0.08	0.46	0.2	0	0	0	0	0	0	0	0	0	0	0.1										0	12.44	0.9	0.99	-	0.54	2.06	3.78	1.66	0.07	-	0.2	0.31	-	0.64	4.57	5.69	0.37	-	4.65	1.11	8.49	-	-	-	-	-	-	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	48.6	12.44	0.9	0.99	-	0.54	2.06	3.78	1.66	0.07	-	0.2	0.31	-	0.64	4.57	5.69	0.37	-	4.65	1.11	8.49	-	-	-	-	-	-	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	48.6
H2667_013_0	2006	OP Facility - Other										3600	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	401.78	23.91	35.1	11.72	393.32	10.71	3.41	2899	286.94	5302.48	1.56	2.31	0	1322.63	4057.94	2998.49	252.91	0	47.93	27497.25	38.09	0	2.2	0	96.42	0	5.79	0	0	0	0	2.32										185	185	100 for day 11-25	0	100	0	0	50	200	0	0.2	0.2	0.2	0-25	10	20	20	0	20	0-20	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										776.06	633.99	248.29	0	16	0.2	0.2	6.13	46.78	0	0.2	0.2	0	1.55	10	20	20	0	0.1	0.82	0.2	0	0	0	0	0	25	0	0	0	0	0.2										0	690.23	563.87	220.83	0	14.23	0.18	0.18	5.45	41.6	0	0.18	0.18	0	1.38	10	20	20	0	0.09	0.82	0.2	0	0	0	0	0	25	0	0	0	0	0.18										0	23.11	1.12	0.65	-	0.47	1.9	0.61	1.32	0.99	-	0.28	0.41	-	0.15	3.38	5	0.42	-	4.36	1.88	7.62	-	-	-	-	-	0.01	-	-	-	-	0.41	-	-	-	-	-	-	-	-	-	54.1	23.11	1.12	0.65	-	0.47	1.9	0.61	1.32	0.99	-	0.28	0.41	-	0.15	3.38	5	0.42	-	4.36	1.88	7.62	-	-	-	-	-	0.01	-	-	-	-	0.41	-	-	-	-	-	-	-	-	-	54.1
H2667_014_0	2006	OP Facility - Other										3600	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	435.98	22.22	53.76	11.03	898.84	15.17	10.39	3558.05	370.13	8893.84	0.98	2.41	0	644.32	4695.46	2538.68	328.4	0	53.94	25162.42	22.26	0	9.62	0	88.1	0	11.24	0	0	0	0	2.2										135	135	100 for day 11-25	0	100	0	0	50	200	0	0.2	0.2	0.2	0-25	10	20	20	0	20	0-20	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										582.91	462.64	248.29	0	15	0.2	0.2	5.5	46.11	0	0.2	0.2	0	0.51	10	20	20	0	0.09	0.68	0.2	0	0	0	0	0	25	0	0	0	0	0.2										0	517.24	410.52	220.32	0	13.31	0.18	0.18	4.88	40.91	0	0.18	0.18	0	0.46	10	20	20	0	0.08	0.68	0.2	0	0	0	0	0	25	0	0	0	0	0.18										0	18.79	0.76	0.99	-	1	2.69	1.84	1.45	1.26	-	0.17	0.43	-	0.02	3.91	4.23	0.55	-	4.41	1.42	4.45	-	-	-	-	-	0.02	-	-	-	-	0.39	-	-	-	-	-	-	-	-	-	48.8	18.79	0.76	0.99	-	1	2.69	1.84	1.45	1.26	-	0.17	0.43	-	0.02	3.91	4.23	0.55	-	4.41	1.42	4.45	-	-	-	-	-	0.02	-	-	-	-	0.39	-	-	-	-	-	-	-	-	-	48.8
H2667_015_0	2006	OP Facility - Other										0	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	319.24	25.99	32.16	7.98	260.26	10.3	18.89	3318.13	28.56	709.37	1.3	1.56	0	1954.11	3656.22	2275.07	146.92	0	57.72	28933.62	42.44	0	102.6	0	3.88	0	0	0	0	0	0	1.5										150	150	125 for day 11-16	0	100	0	0	50	150	0	0.2	0.2	0.2	0-30	15	30	30	0	20	0-30	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										467.55	416.29	368.15	0	25	0.2	0.2	6	31.08	0	0.15	0.2	0	3.91	15	30	30	0	0.08	0.46	0.2	0	0	0	0	0	0	0	0	0	0	0.1										0	467.55	416.29	368.15	0	25	0.2	0.2	6	31.08	0	0.15	0.2	0	3.91	15	30	30	0	0.08	0.46	0.2	0	0	0	0	0	0	0	0	0	0	0.1										0	12.44	0.9	0.99	-	0.54	2.06	3.78	1.66	0.07	-	0.2	0.31	-	0.64	4.57	5.69	0.37	-	4.65	1.11	8.49	-	-	-	-	-	-	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	48.6	12.44	0.9	0.99	-	0.54	2.06	3.78	1.66	0.07	-	0.2	0.31	-	0.64	4.57	5.69	0.37	-	4.65	1.11	8.49	-	-	-	-	-	-	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	48.6
H2667_803_0	2006	OP Facility - Other										0	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	301.73	35.13	1.87	6.92	157.43	8.66	15.61	2363.75	28.79	595.35	1.43	1.07	0	1765.71	3491.07	2182.97	76.77	0	55.03	29850.1	47.74	0	82.6	0	0	0	0	0	0	0	0	0.72										150	150	125 for day 11-16	0	100	0	0	50	150	0	0.2	0.2	0.2	0-30	15	30	30	0	20	0-30	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										1295.24	1028.09	883.56	0	25	0.2	0.2	6	4	0	0.15	0.2	0	3.22	30	30	30	0	0.11	0.43	0.2	0	0	0	0	0	0	0	0	0	0	0.2										0	1295.24	1028.09	883.56	0	25	0.2	0.2	6	4	0	0.15	0.2	0	3.22	30	30	30	0	0.11	0.43	0.2	0	0	0	0	0	0	0	0	0	0	0.2										0	32.57	3.01	0.14	-	0.33	1.73	3.12	1.18	0.01	-	0.22	0.21	-	0.47	8.73	5.46	0.19	-	5.81	1.08	9.55	-	-	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	-	-	-	73.95	32.57	3.01	0.14	-	0.33	1.73	3.12	1.18	0.01	-	0.22	0.21	-	0.47	8.73	5.46	0.19	-	5.81	1.08	9.55	-	-	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	-	-	-	73.95
H2667_804_0	2006	OP Facility - Other										5000	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	299.57	22.39	22.06	9.2	322.59	8.71	4.23	2229.28	396.83	5406.48	1.25	2.68	0	1258.73	3507.7	3396.99	248.69	0	49.6	29111.81	40.07	0	3.86	1.52	131.65	0	32.74	0	0	0	0	2.86										200	200	0	0	100	0	0	50	200	0	0.2	0.2	0.2	0-25	20	20	20	0	20	0-20	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										837.21	685.39	0	0	16	0.2	0.2	6.13	45.29	0	0.2	0.2	0	1.16	20	20	20	0	0.1	0.74	0.2	0	0	0	0	0	25	0	0	0	0	0.2										0	793	649.2	0	0	15.16	0.19	0.19	5.8	42.9	0	0.19	0.19	0	1.1	20	20	20	0	0.1	0.74	0.2	0	0	0	0	0	25	0	0	0	0	0.19										0	19.8	1.21	-	-	0.41	1.65	0.8	1.08	1.42	-	0.24	0.51	-	0.12	5.85	5.66	0.41	-	4.84	1.8	8.01	-	-	-	-	-	0.07	-	-	-	-	0.54	-	-	-	-	-	-	-	-	-	54.41	19.8	1.21	-	-	0.41	1.65	0.8	1.08	1.42	-	0.24	0.51	-	0.12	5.85	5.66	0.41	-	4.84	1.8	8.01	-	-	-	-	-	0.07	-	-	-	-	0.54	-	-	-	-	-	-	-	-	-	54.41
H2667_805_0	2006	OP Facility - Other										0	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	301.73	35.13	1.87	6.92	157.43	8.66	15.61	2363.75	28.79	595.35	1.43	1.07	0	1765.71	3491.07	2182.97	76.77	0	55.03	29850.1	47.74	0	82.6	0	0	0	0	0	0	0	0	0.72										150	150	125 for day 11-16	0	100	0	0	50	150	0	0.2	0.2	0.2	0-30	15	30	30	0	20	0-30	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										1295.24	1028.09	883.56	0	25	0.2	0.2	6	4	0	0.15	0.2	0	3.22	30	30	30	0	0.11	0.43	0.2	0	0	0	0	0	0	0	0	0	0	0.2										0	1295.24	1028.09	883.56	0	25	0.2	0.2	6	4	0	0.15	0.2	0	3.22	30	30	30	0	0.11	0.43	0.2	0	0	0	0	0	0	0	0	0	0	0.2										0	32.57	3.01	0.14	-	0.33	1.73	3.12	1.18	0.01	-	0.22	0.21	-	0.47	8.73	5.46	0.19	-	5.81	1.08	9.55	-	-	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	-	-	-	73.95	32.57	3.01	0.14	-	0.33	1.73	3.12	1.18	0.01	-	0.22	0.21	-	0.47	8.73	5.46	0.19	-	5.81	1.08	9.55	-	-	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	-	-	-	73.95
H2667_806_0	2006	OP Facility - Other										5000	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	299.57	22.39	22.06	9.2	322.59	8.71	4.23	2229.28	396.83	5406.48	1.25	2.68	0	1258.73	3507.7	3396.99	248.69	0	49.6	29111.81	40.07	0	3.86	1.52	131.65	0	32.74	0	0	0	0	2.86										200	200	0	0	100	0	0	50	200	0	0.2	0.2	0.2	0-25	20	20	20	0	20	0-20	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										837.21	685.39	0	0	16	0.2	0.2	6.13	45.29	0	0.2	0.2	0	1.16	20	20	20	0	0.1	0.74	0.2	0	0	0	0	0	25	0	0	0	0	0.2										0	793	649.2	0	0	15.16	0.19	0.19	5.8	42.9	0	0.19	0.19	0	1.1	20	20	20	0	0.1	0.74	0.2	0	0	0	0	0	25	0	0	0	0	0.19										0	19.8	1.21	-	-	0.41	1.65	0.8	1.08	1.42	-	0.24	0.51	-	0.12	5.85	5.66	0.41	-	4.84	1.8	8.01	-	-	-	-	-	0.07	-	-	-	-	0.54	-	-	-	-	-	-	-	-	-	54.41	19.8	1.21	-	-	0.41	1.65	0.8	1.08	1.42	-	0.24	0.51	-	0.12	5.85	5.66	0.41	-	4.84	1.8	8.01	-	-	-	-	-	0.07	-	-	-	-	0.54	-	-	-	-	-	-	-	-	-	54.41
H2667_807_0	2006	OP Facility - Other										0	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	301.73	35.13	1.87	6.92	157.43	8.66	15.61	2363.75	28.79	595.35	1.43	1.07	0	1765.71	3491.07	2182.97	76.77	0	55.03	29850.1	47.74	0	82.6	0	0	0	0	0	0	0	0	0.72										150	150	125 for day 11-16	0	100	0	0	50	150	0	0.2	0.2	0.2	0-30	15	30	30	0	20	0-30	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										1295.24	1028.09	883.56	0	25	0.2	0.2	6	4	0	0.15	0.2	0	3.22	30	30	30	0	0.11	0.43	0.2	0	0	0	0	0	0	0	0	0	0	0.2										0	1295.24	1028.09	883.56	0	25	0.2	0.2	6	4	0	0.15	0.2	0	3.22	30	30	30	0	0.11	0.43	0.2	0	0	0	0	0	0	0	0	0	0	0.2										0	32.57	3.01	0.14	-	0.33	1.73	3.12	1.18	0.01	-	0.22	0.21	-	0.47	8.73	5.46	0.19	-	5.81	1.08	9.55	-	-	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	-	-	-	73.95	32.57	3.01	0.14	-	0.33	1.73	3.12	1.18	0.01	-	0.22	0.21	-	0.47	8.73	5.46	0.19	-	5.81	1.08	9.55	-	-	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	-	-	-	73.95
H2667_808_0	2006	OP Facility - Other										0	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	301.73	35.13	1.87	6.92	157.43	8.66	15.61	2363.75	28.79	595.35	1.43	1.07	0	1765.71	3491.07	2182.97	76.77	0	55.03	29850.1	47.74	0	82.6	0	0	0	0	0	0	0	0	0.72										150	150	125 for day 11-16	0	100	0	0	50	150	0	0.2	0.2	0.2	0-30	15	30	30	0	20	0-30	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										1295.24	1028.09	883.56	0	25	0.2	0.2	6	4	0	0.15	0.2	0	3.22	30	30	30	0	0.11	0.43	0.2	0	0	0	0	0	0	0	0	0	0	0.2										0	1295.24	1028.09	883.56	0	25	0.2	0.2	6	4	0	0.15	0.2	0	3.22	30	30	30	0	0.11	0.43	0.2	0	0	0	0	0	0	0	0	0	0	0.2										0	32.57	3.01	0.14	-	0.33	1.73	3.12	1.18	0.01	-	0.22	0.21	-	0.47	8.73	5.46	0.19	-	5.81	1.08	9.55	-	-	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	-	-	-	73.95	32.57	3.01	0.14	-	0.33	1.73	3.12	1.18	0.01	-	0.22	0.21	-	0.47	8.73	5.46	0.19	-	5.81	1.08	9.55	-	-	-	-	-	-	-	-	-	-	0.14	-	-	-	-	-	-	-	-	-	73.95
H2667_809_0	2006	OP Facility - Other										5000	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	299.57	22.39	22.06	9.2	322.59	8.71	4.23	2229.28	396.83	5406.48	1.25	2.68	0	1258.73	3507.7	3396.99	248.69	0	49.6	29111.81	40.07	0	3.86	1.52	131.65	0	32.74	0	0	0	0	2.86										200	200	0	0	100	0	0	50	200	0	0.2	0.2	0.2	0-25	20	20	20	0	20	0-20	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										837.21	685.39	0	0	16	0.2	0.2	6.13	45.29	0	0.2	0.2	0	1.16	20	20	20	0	0.1	0.74	0.2	0	0	0	0	0	25	0	0	0	0	0.2										0	793	649.2	0	0	15.16	0.19	0.19	5.8	42.9	0	0.19	0.19	0	1.1	20	20	20	0	0.1	0.74	0.2	0	0	0	0	0	25	0	0	0	0	0.19										0	19.8	1.21	-	-	0.41	1.65	0.8	1.08	1.42	-	0.24	0.51	-	0.12	5.85	5.66	0.41	-	4.84	1.8	8.01	-	-	-	-	-	0.07	-	-	-	-	0.54	-	-	-	-	-	-	-	-	-	54.41	19.8	1.21	-	-	0.41	1.65	0.8	1.08	1.42	-	0.24	0.51	-	0.12	5.85	5.66	0.41	-	4.84	1.8	8.01	-	-	-	-	-	0.07	-	-	-	-	0.54	-	-	-	-	-	-	-	-	-	54.41
H2667_810_0	2006	OP Facility - Other										5000	Other Coin										A	A	A	Coin	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	299.57	22.39	22.06	9.2	322.59	8.71	4.23	2229.28	396.83	5406.48	1.25	2.68	0	1258.73	3507.7	3396.99	248.69	0	49.6	29111.81	40.07	0	3.86	1.52	131.65	0	32.74	0	0	0	0	2.86										200	200	0	0	100	0	0	50	200	0	0.2	0.2	0.2	0-25	20	20	20	0	20	0-20	0.2	0.2	0	0	0	0	25	25	N/A	N/A	N/A	0.2										837.21	685.39	0	0	16	0.2	0.2	6.13	45.29	0	0.2	0.2	0	1.16	20	20	20	0	0.1	0.74	0.2	0	0	0	0	0	25	0	0	0	0	0.2										0	793	649.2	0	0	15.16	0.19	0.19	5.8	42.9	0	0.19	0.19	0	1.1	20	20	20	0	0.1	0.74	0.2	0	0	0	0	0	25	0	0	0	0	0.19										0	19.8	1.21	-	-	0.41	1.65	0.8	1.08	1.42	-	0.24	0.51	-	0.12	5.85	5.66	0.41	-	4.84	1.8	8.01	-	-	-	-	-	0.07	-	-	-	-	0.54	-	-	-	-	-	-	-	-	-	54.41	19.8	1.21	-	-	0.41	1.65	0.8	1.08	1.42	-	0.24	0.51	-	0.12	5.85	5.66	0.41	-	4.84	1.8	8.01	-	-	-	-	-	0.07	-	-	-	-	0.54	-	-	-	-	-	-	-	-	-	54.41
H2672_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other						2500	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	1655.29	53.01	674.24	0	180.1	12.97	1.04	455.46	585.41	0	379.71	0	0	145.05	4304.3	3655.11	207.85	743.76	0	0.19	3.12	0	0	0	53.32	0	0.52	0	0	0	148.77	0	0	0	0	1.29						220 per day 1-5	100 per day	125 per day 8+		100 per trip	0	0	50	175		VARIES			30	15	30	VARIES	30		15	0.2				30		30				15					30						158.4	96.49	81.16	0	100	0.2	0.2	50	175	0	104.02	0	0	29.93	15	30	29.91	29.87	0	15	0.2	0	0	0	30	0	8.63	0	0	0	15	0	0	0	0	30							147.23	96.49	81.16	0	100	0.2	0.2	50	175	0	104.02	0	0	29.93	15	30	29.91	29.87	0	15	0.2	0	0	0	30	0	8.63	0	0	0	15	0	0	0	0	30							20.31	0.43	4.56	-	1.5	2.59	0.21	1.9	8.54	-	3.29	-	-	0.36	5.38	9.14	0.52	1.85	-	0	0.62	-	-	-	0.13	-	0	-	-	-	0.19	-	-	-	-	0	-	-	-	-	-	61.52	20.31	0.43	4.56	-	1.5	2.59	0.21	1.9	8.54	-	3.29	-	-	0.36	5.38	9.14	0.52	1.85	-	0	0.62	-	-	-	0.13	-	0	-	-	-	0.19	-	-	-	-	0	-	-	-	-	-	61.52
H2672_003_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other						4000	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	1598.37	51.94	654.76	0	174.23	11.92	0.96	439.57	564.5	0	324.78	0	0	139.93	4152.35	3529.04	202.99	719.09	0	0.19	3.03	0	0	0	50.3	0	0.5	0	0	0	143.27	0	0	0	0	1.27						220 per day 1-10	175 per day	75 per day		150 per trip	0	0	50	200		VARIES			30	10	VARIES	VARIES	VARIES		10	0.2				20		20				25					30						180.18	165.78	75	0	150	0.2	0.2	50	200	0	105.48	0	0	30	10	20.09	39.81	29.87	0	10	0.2	0	0	0	20	0	8.2	0	0	0	24.99	0	0	0	0	30							168.96	165.78	70.33	0	150	0.2	0.2	50	200	0	105.48	0	0	30	10	20.09	39.81	29.87	0	10	0.2	0	0	0	20	0	8.2	0	0	0	24.99	0	0	0	0	30							22.5	0.72	3.84	-	2.18	2.38	0.19	1.83	9.41	-	2.85	-	-	0.35	3.46	5.91	0.67	1.79	-	0	0.61	-	-	-	0.08	-	0	-	-	-	0.3	-	-	-	-	0	-	-	-	-	-	59.08	22.5	0.72	3.84	-	2.18	2.38	0.19	1.83	9.41	-	2.85	-	-	0.35	3.46	5.91	0.67	1.79	-	0	0.61	-	-	-	0.08	-	0	-	-	-	0.3	-	-	-	-	0	-	-	-	-	-	59.08
H2672_006_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other						2000	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	1704.95	54.6	694.47	0	185.5	13.35	1.07	469.12	602.97	0	347.25	0	0	149.4	4433.43	3764.77	214.28	766.07	0	0.2	3.21	0	0	0	54.02	0	0.54	0	0	0	153.24	0	0	0	0	1.33						275 per day 1-5	100 per day	75 per day 8+		100 per trip	0	0	50	175		VARIES			30	15	30	VARIES	30		15	0.2				30		30				30					30						201.58	96.49	48.7	0	100	0.2	0.2	50	175	0	132.44	0	0	29.95	15	30	29.9	29.87	0	15	0.2	0	0	0	30	0	8.63	0	0	0	29.83	0	0	0	0	30							196.69	96.49	48.7	0	100	0.2	0.2	50	175	0	132.44	0	0	29.95	15	30	29.9	29.87	0	15	0.2	0	0	0	30	0	8.63	0	0	0	29.83	0	0	0	0	30							27.95	0.44	2.82	-	1.55	2.67	0.21	1.95	8.79	-	3.83	-	-	0.37	5.54	9.41	0.53	1.91	-	0	0.64	-	-	-	0.14	-	0	-	-	-	0.38	-	-	-	-	0	-	-	-	-	-	69.14	27.95	0.44	2.82	-	1.55	2.67	0.21	1.95	8.79	-	3.83	-	-	0.37	5.54	9.41	0.53	1.91	-	0	0.64	-	-	-	0.14	-	0	-	-	-	0.38	-	-	-	-	0	-	-	-	-	-	69.14
H2672_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	P	P	Coin	V	V	Coin	V	V																																																-	238.48	3.07	19.19	0	7.36	12.49	1.36	415.55	51.31	3.65	23.79	0.26	0.06	14.77	41.23	105.9	3.01	6.04	32.91	1.86	39.31	0.15	0	0	0	0	0	0	0	0	0	0	0	3.27	0	1.1																																															0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93	18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93
H2672_802_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	P	P	Coin	V	V	Coin	V	V																																																-	238.48	3.07	19.19	0	7.36	12.49	1.36	415.55	51.31	3.65	23.79	0.26	0.06	14.77	41.23	105.9	3.01	6.04	32.91	1.86	39.31	0.15	0	0	0	0	0	0	0	0	0	0	0	3.27	0	1.1																																															0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93	18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93
H2672_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	P	P	Coin	V	V	Coin	V	V																																																-	238.48	3.07	19.19	0	7.36	12.49	1.36	415.55	51.31	3.65	23.79	0.26	0.06	14.77	41.23	105.9	3.01	6.04	32.91	1.86	39.31	0.15	0	0	0	0	0	0	0	0	0	0	0	3.27	0	1.1																																															0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93	18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93
H2672_804_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	P	P	Coin	V	V	Coin	V	V																																																-	238.48	3.07	19.19	0	7.36	12.49	1.36	415.55	51.31	3.65	23.79	0.26	0.06	14.77	41.23	105.9	3.01	6.04	32.91	1.86	39.31	0.15	0	0	0	0	0	0	0	0	0	0	0	3.27	0	1.1																																															0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93	18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93
H2672_805_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	P	P	Coin	V	V	Coin	V	V																																																-	238.48	3.07	19.19	0	7.36	12.49	1.36	415.55	51.31	3.65	23.79	0.26	0.06	14.77	41.23	105.9	3.01	6.04	32.91	1.86	39.31	0.15	0	0	0	0	0	0	0	0	0	0	0	3.27	0	1.1																																															0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93	18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93
H2672_806_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	P	P	Coin	V	V	Coin	V	V																																																-	238.48	3.07	19.19	0	7.36	12.49	1.36	415.55	51.31	3.65	23.79	0.26	0.06	14.77	41.23	105.9	3.01	6.04	32.91	1.86	39.31	0.15	0	0	0	0	0	0	0	0	0	0	0	3.27	0	1.1																																															0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							0.08	0.08	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0.23	0	50							18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93	18.61	0.24	3.09	-	1.72	2.91	0.32	1.73	11.96	0.85	5.54	0.06	0.01	3.44	9.61	24.67	0.7	1.41	7.67	0.43	9.16	0.03	-	-	-	-	-	-	-	-	-	-	-	0.76	-	0	-	-	-	-	-	104.93
H2701_001_0	2006																						A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	P	V	Coin	V	T	P	V	P	V	P	O	V	V																																																					-	287.47	3.99	1170.21	0	218.5	44616.85	250.71	482.32	469.68	3047.7	1550.31	0	24.68	2361.18	0	0	159.89	201.27	0	7939.84	6.77	574.49	0	0	294.88	0	126.45	0	0	0	0											0 / admit	150 Copay	15 / day	0 copay	100 copay	20 coinsurance	20 coinsurance	50 copay	15 copay	15 copay	15 copay		15 copay	15 copay			15 copay	15 copay		15 copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	15 copay			15 copay		15 copay															0	0	15	0	100	0.85	11.29	41.53	15	15	15	0	15	15	0	0	15	15	0	14.99	20	15	0	0	15	0	15	0	0	0	0												0	0	15	0	100	0.85	11.29	41.53	15	15	15	0	15	15	0	0	15	15	0	14.99	20	15	0	0	15	0	15	0	0	0	0												-	-	1.46	-	1.82	3.17	0.24	1.67	0.59	3.81	1.94	-	0.03	2.95	-	-	0.2	0.25	-	9.92	1.35	0.72	-	-	0.37	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.64	-	-	1.46	-	1.82	3.17	0.24	1.67	0.59	3.81	1.94	-	0.03	2.95	-	-	0.2	0.25	-	9.92	1.35	0.72	-	-	0.37	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.64
H2802_001_0	2006											4800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	P	O																																																					-	2026.74	147.34	1210.73	0	104.97	14.15	7.28	402.69	52.53	8297.62	37.24	0	0.17	0.9	3831.37	4155.83	611.85	1.56	0	0	35.23	1313.26			31.24	49.11	216.38			0												280	280	150	0	150	20	20	35.00/50.00	20	10	20-Oct	20 (included in g.)	30	20/40/30	0.00/15.00	25	40/30	20	0	0	30	0.00/25.00			25	15	25			0												280	280	150		150	0.2	0.2	48	0.2	4	0.2		0.3	0.21	15	25	37.5	0.2			0.3	25			25	15	25																176.9	176.9	94.77		94.77	0.13	0.15	30.39	0.13	2.53	0.13		0.19	0.12	15	25	37.5	0.13			0.19	25			25	15	25																29.88	2.17	9.56	-	0.83	1.79	1.07	1.02	6.64	1.75	4.73	-	0.03	0.11	4.79	8.66	1.91	0.2	-	-	6.68	2.74	-	-	0.07	0.06	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.13	29.88	2.17	9.56	-	0.83	1.79	1.07	1.02	6.64	1.75	4.73	-	0.03	0.11	4.79	8.66	1.91	0.2	-	-	6.68	2.74	-	-	0.07	0.06	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.13
H2802_004_0	2006											4200											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	P	O																																																					-	2026.74	147.34	1210.73	0	104.97	14.15	7.28	402.69	52.53	8297.62	37.24	0	0.17	0.9	3831.37	4155.83	611.85	1.56	0	0	35.23	1313.26	0	0	31.24	49.11	216.38	0	0	0	0											265	265	150	0	150	20	20	35.00/50.00	20	10	20-Oct	20 (included in g.)	20	20/40/30	0.00/10.00	15	40/30	20	0	0	20	0.00/15.00			15	15	15			0												265	265	150	0	150	0.2	0.2	48	0.2	4	0.2	0	0.2	0.2	10	15	37.5	0.2	0	0	0.2	15			15	15	15			0													162.62	162.62	92.05	0	92.05	0.12	0.15	29.52	0.12	2.45	0.12	0	0.12	0.11	10	15	37.5	0.12	0	0	0.12	15	0	0	15	15	15	0	0	0	0												27.47	2	9.29	-	0.81	1.74	1.06	0.99	6.45	1.7	4.59	-	0.02	0.1	3.19	5.19	1.91	0.19	-	-	4.32	1.64	-	-	0.04	0.06	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.02	27.47	2	9.29	-	0.81	1.74	1.06	0.99	6.45	1.7	4.59	-	0.02	0.1	3.19	5.19	1.91	0.19	-	-	4.32	1.64	-	-	0.04	0.06	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.02
H2802_005_0	2006	OP Facility - Emergency	OP Facility - Other									3250											D	D	D	P	P	Coin	Coin	V	Coin	V	V	V	Coin	Coin	P	Coin	V	Coin		Coin	Coin	Coin	P		P	P	Coin					V	Coin																																																			-	2611.13	185.65			1937.11	20.06	7.56	194.41	12.17	3335.54	173.21		0.17	7.91		130.14	14.92	0.02		11.8	3.9	7.79					1.23					107.74	2									195/day 1-25	175/day 1-28			150/trip	20	20	50	20	10	10	40	20	20		20	40/30	20		20	20	20					20					25	20									195	175			50	0.2	0.2	50	0.2	10	10	40	0.2	0.2		0.2	35	0.2		0.2	0.2	0.2					0.2					25	0.2										166.42	149.35			42.67	0.17	0.17	42.67	0.17	8.53	8.53	34.14	0.17	0.17		0.17	29.87	0.17		0.17	0.17	0.17					0.17					21.34	0.17										36.21	2.31	-	-	6.89	3.42	1.29	0.69	2.08	2.37	0.12	-	0.03	1.35	-	22.21	0.04	0	-	2.01	0.67	1.33	-	-	-	-	0.21	-	-	-	-	0.19	0.34	-	-	-	-	-	-	-	-	83.77	36.21	2.31	-	-	6.89	3.42	1.29	0.69	2.08	2.37	0.12	-	0.03	1.35	-	22.21	0.04	0	-	2.01	0.67	1.33	-	-	-	-	0.21	-	-	-	-	0.19	0.34	-	-	-	-	-	-	-	-	83.77
H2803_001_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	P	O																																																					-	1408.28	144.56	501.75	0	61.17	9.25	3.73	448.15	43.81	5946.51	25.62	0	0.02	0.47	3305.99	3386.93	605.72	1.83	0	0	25.27	860.85	0	0	54.97	49.04	240.7	0	22.16	0	0											265	265	150	0	150	20	20	35.00/50.00	20	10	20-Oct	20 (included in g.)	25	20/40/30	20.00/0.00	25	40/30	20	0	0	25	0.00/25.00			25	15	25		See PBP	0												265	265	150		150	0.2	0.2	44	0.2	4	0.17	0	0.25	0.21	20	25	37.5	0.2	0	0	0.25	25			25	15	25		0.11													4300	186.49	186.49	105.56	0	105.56	0.14	0.17	30.62	0.14	2.81	0.12	0	0.18	0.12	20	25	37.5	0.14	0	0	0.18	25	0	0	25	15	25	0	0.08	0	0												21.89	2.25	4.41	-	0.54	1.3	0.65	1.14	6.17	1.39	3.02	-	0	0.06	5.51	7.06	1.89	0.26	-	-	4.45	1.79	-	-	0.11	0.06	0.5	-	1.77	-	-	-	-	-	-	-	-	-	-	-	-	66.22	21.89	2.25	4.41	-	0.54	1.3	0.65	1.14	6.17	1.39	3.02	-	0	0.06	5.51	7.06	1.89	0.26	-	-	4.45	1.79	-	-	0.11	0.06	0.5	-	1.77	-	-	-	-	-	-	-	-	-	-	-	-	66.22
H2803_002_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	P	O																																																					-	1164.98	119.59	415.07	0	50.6	7.59	3.09	370.72	36.22	4919.17	21.19	0	0.03	0.41	2734.83	2801.79	501.07	1.51	0	0	25.27	712.12	0	0	54.97	49.04	199.12	0	18.33	0	0											265	265	150	0	150	20	20	35.00/50.00	20	10	20-Oct	20 (included in g.)	25	20/40/30	20.00/0.00	25	40/30	20	0	0	25	0.00/25.00			25	15	25		See PBP	0												265	265	150		150	0.2	0.2	44	0.2	4	0.17	0	0.25	0.21	20	25	37.5	0.2	0	0	0.25	25			25	15	25		0.11													4200	195.45	195.45	110.63	0	110.63	0.15	0.18	32.09	0.15	2.95	0.12	0	0.18	0.12	20	25	37.5	0.15	0	0	0.18	25	0	0	25	15	25	0	0.08	0	0												18.97	1.95	3.83	-	0.47	1.12	0.54	0.99	5.34	1.21	2.62	-	0.01	0.05	4.56	5.84	1.57	0.22	-	-	4.66	1.48	-	-	0.11	0.06	0.41	-	1.54	-	-	-	-	-	-	-	-	-	-	-	-	57.55	18.97	1.95	3.83	-	0.47	1.12	0.54	0.99	5.34	1.21	2.62	-	0.01	0.05	4.56	5.84	1.57	0.22	-	-	4.66	1.48	-	-	0.11	0.06	0.41	-	1.54	-	-	-	-	-	-	-	-	-	-	-	-	57.55
H2803_005_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	P	O																																																					-	1408.28	144.56	501.75	0	61.17	9.25	3.73	448.15	43.81	5946.51	25.62	0	0.02	0.47	3305.99	3386.93	605.72	1.83	0	0	25.27	860.85	0	0	54.97	49.04	240.7	0	22.16	0	0											265	265	150	0	150	20	20	35.00/50.00	20	10	20-Oct	20 (included in g.)	20	20/40/30	15.00/0.00	15	40/30	20	0	0	20	0.00/15.00			15	15	15		See PBP	0												265	265	150		150	0.2	0.2	44	0.2	4	0.13	0	0.2	0.2	15	15	37.5	0.2	0	0	0.2	15			15	15	15		0.11													3400	173.55	173.55	98.23	0	98.23	0.13	0.17	28.49	0.13	2.62	0.09	0	0.13	0.11	15	15	37.5	0.13	0	0	0.13	15	0	0	15	15	15	0	0.07	0	0												20.37	2.09	4.11	-	0.5	1.21	0.63	1.06	5.74	1.3	2.25	-	0	0.05	4.13	4.23	1.89	0.24	-	-	3.31	1.08	-	-	0.07	0.06	0.3	-	1.65	-	-	-	-	-	-	-	-	-	-	-	-	56.27	20.37	2.09	4.11	-	0.5	1.21	0.63	1.06	5.74	1.3	2.25	-	0	0.05	4.13	4.23	1.89	0.24	-	-	3.31	1.08	-	-	0.07	0.06	0.3	-	1.65	-	-	-	-	-	-	-	-	-	-	-	-	56.27
H2803_006_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	P	O																																																					-	1164.98	119.59	415.07	0	50.6	7.59	3.09	370.72	36.22	4919.17	21.19	0	0.03	0.41	2734.83	2801.79	501.07	1.51	0	0	25.27	712.12	0	0	54.97	49.04	199.12	0	18.33	0	0											265	265	150	0	150	20	20	35.00/50.00	20	10	20-Oct	20 (included in g.)	20	20/40/30	15.00/0.00	15	40/30	20	0	0	20	0.00/15.00			15	15	15		See PBP	0												265	265	150		150	0.2	0.2	44	0.2	4	0.13	0	0.2	0.2	15	15	37.5	0.2	0	0	0.2	15			15	15	15		0.11													3400	184.75	184.75	104.58	0	104.58	0.14	0.17	30.33	0.14	2.79	0.09	0	0.14	0.11	15	15	37.5	0.14	0	0	0.14	15	0	0	15	0	15	0	0.08	0	0												17.94	1.84	3.62	-	0.44	1.06	0.53	0.94	5.05	1.14	1.98	-	0	0.04	3.42	3.5	1.57	0.21	-	-	3.52	0.89	-	-	0.07	-	0.25	-	1.45	-	-	-	-	-	-	-	-	-	-	-	-	49.47	17.94	1.84	3.62	-	0.44	1.06	0.53	0.94	5.05	1.14	1.98	-	0	0.04	3.42	3.5	1.57	0.21	-	-	3.52	0.89	-	-	0.07	-	0.25	-	1.45	-	-	-	-	-	-	-	-	-	-	-	-	49.47
H2803_010_0	2006											600											D	D	D	V	T	Coin	Coin	V	P	O	P	Coin	Coin	P	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	Coin	P	O											4500																																										-	1399.98	143.71	498.79	0	60.81	9.2	3.71	445.5	836.05	5911.44	3454.97	0	0.02	18.63	3286.49	3366.95	602.14	453.57	0	0	25.27	855.77	0	0	54.97	0	239.28	0	22.03	0	0											25	25	15	0	100	20	20	40	15	0	0/10	15.00 (incl in g.)	20	10/15/8/4	2.00/0.00	4	04-Aug	10	0	0	20	0/4/5	0		4.00/5.00	0	4	0	See PBP	0												25	25	15		100	0.2	0.2	40	15	0	6.5	0	0.2	10	2	4	7	10	0	0	0.2	4			4	0	4		0.11														17.75	17.75	10.65	0	70.98	0.14	0.17	28.39	10.65	0	4.61	0	0.14	7.07	2	4	7	7.1	0	0	0.14	4	0	0	4	0	4	0	0.08	0	0												2.07	0.21	0.44	-	0.36	1.31	0.64	1.05	0.74	-	1.33	-	0	0.01	0.55	1.12	0.35	0.27	-	-	3.59	0.29	-	-	0.02	-	0.08	-	1.78	-	-	-	-	-	-	-	-	-	-	-	-	16.21	2.07	0.21	0.44	-	0.36	1.31	0.64	1.05	0.74	-	1.33	-	0	0.01	0.55	1.12	0.35	0.27	-	-	3.59	0.29	-	-	0.02	-	0.08	-	1.78	-	-	-	-	-	-	-	-	-	-	-	-	16.21
H2803_801_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	P	O																																																					-	1300.47	133.5	463.34	0	56.48	8.52	3.44	413.84	40.44	5491.28	23.66	0	0.02	0.45	3052.9	3127.64	559.34	1.69	0	0	25.27	794.94	0	0	54.97	0	222.28	0	20.46	0	0											265	265	150	0	150	25	25	35.00/50.00	25	10	25-Oct	25 (included in g.)	25	25/40/30	20.00/0.00	25	40/30	25	0	0	25	0.00/25.00			25		25		See PBP	0												265	265	150		150	0.25	0.25	44	0.25	8	0.2	0	0.25	0.24	20	25	37.5	0.25	0	0	0.25	25			25		25		0.11													3850	179.14	179.14	101.4	0	101.4	0.17	0.21	29.41	0.17	5.41	0.14	0	0.17	0.13	20	25	37.5	0.17	0	0	0.17	25	0	0	25	0	25	0	0.08	0	0												19.41	1.99	3.92	-	0.48	1.44	0.73	1.01	6.83	2.47	3.21	-	0	0.06	5.09	6.52	1.75	0.29	-	-	4.27	1.66	-	-	0.11	-	0.46	-	1.57	-	-	-	-	-	-	-	-	-	-	-	-	63.29	19.41	1.99	3.92	-	0.48	1.44	0.73	1.01	6.83	2.47	3.21	-	0	0.06	5.09	6.52	1.75	0.29	-	-	4.27	1.66	-	-	0.11	-	0.46	-	1.57	-	-	-	-	-	-	-	-	-	-	-	-	63.29
H2905_001_0	2006	OP Facility - Emergency	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies	Other Medicare Part B	Other Medicare Part B	OP Facility - Surgery	OP Facility - Other	OP Facility - Other			3500	Urgent Care	Diabetic Supplies	Training	Eye exams	Glasses	ASC	Complex diag	PET scans			A	A	D		T	Coin	Coin	V	V		Coin					V	V	V	V	V	Coin											V	Coin	V	V	Coin	V	P	V			7500																																										-	315.41	1.45	138.5		108.14	23.04	3.03	2157.75	659.7		11.86					1473.34	270.9	4459.5	1502.1		6.24											2157.75	0.3	215.28	101.7	0.76	131.94	45.29	3.8			500/Stay	500/Stay	50/Day > 20		100 Trip	0	0	50/visit	50/visit		0.2					25/visit	25/visit	25/visit	25/visit		0.25											25/visit	0.2	25/visit	25/visit	0.2	50/visit	50	200			500	500	50		100	0.25	0.25	50	50		0.2					25	25	25	25		0.25											25	0.2	25	25	0.2	50	50	200			11000	494.65	494.65	49.47		98.93	0.25	0.25	49.47	49.47		0.2					24.73	24.73	24.73	24.73		0.25											24.73	0.2	24.73	24.73	0.2	49.47	49.47	197.86				13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46	13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46
H2905_801_0	2006	OP Facility - Emergency	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies	Other Medicare Part B	Other Medicare Part B	OP Facility - Surgery	OP Facility - Other	OP Facility - Other			3500	Urgent Care	Diabetic Supplies	Training	Eye exams	Glasses	ASC	Complex diag	PET scans			A	A	D		T	Coin	Coin	V	V		Coin					V	V	V	V	V	Coin											V	Coin	V	V	Coin	V	P	V			7500																																										-	315.41	1.45	138.5		108.14	23.04	3.03	2157.75	659.7		11.86					1473.34	270.9	4459.5	1502.1		6.24											2157.75	0.3	215.28	101.7	0.76	131.94	45.29	3.8			500/Stay	500/Stay	50/Day > 20		100 Trip	0	0	50/visit	50/visit		0.2					25/visit	25/visit	25/visit	25/visit		0.25											25/visit	0.2	25/visit	25/visit	0.2	50/visit	50	200			500	500	50		100	0.25	0.25	50	50		0.2					25	25	25	25		0.25											25	0.2	25	25	0.2	50	50	200			11000	494.65	494.65	49.47		98.93	0.25	0.25	49.47	49.47		0.2					24.73	24.73	24.73	24.73		0.25											24.73	0.2	24.73	24.73	0.2	49.47	49.47	197.86			0	13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46	13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46
H2905_802_0	2006	OP Facility - Emergency	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies	Other Medicare Part B	Other Medicare Part B	OP Facility - Surgery	OP Facility - Other	OP Facility - Other			3500	Urgent Care	Diabetic Supplies	Training	Eye exams	Glasses	ASC	Complex diag	PET scans			A	A	D		T	Coin	Coin	V	V		Coin					V	V	V	V	V	Coin											V	Coin	V	V	Coin	V	P	V			7500																																										-	315.41	1.45	138.5		108.14	23.04	3.03	2157.75	659.7		11.86					1473.34	270.9	4459.5	1502.1		6.24											2157.75	0.3	215.28	101.7	0.76	131.94	45.29	3.8			500/Stay	500/Stay	50/Day > 20		100 Trip	0	0	50/visit	50/visit		0.2					25/visit	25/visit	25/visit	25/visit		0.25											25/visit	0.2	25/visit	25/visit	0.2	50/visit	50	200			500	500	50		100	0.25	0.25	50	50		0.2					25	25	25	25		0.25											25	0.2	25	25	0.2	50	50	200			11000	494.65	494.65	49.47		98.93	0.25	0.25	49.47	49.47		0.2					24.73	24.73	24.73	24.73		0.25											24.73	0.2	24.73	24.73	0.2	49.47	49.47	197.86				13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46	13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46
H2905_803_0	2006	OP Facility - Emergency	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies	Other Medicare Part B	Other Medicare Part B	OP Facility - Surgery	OP Facility - Other	OP Facility - Other			3500	Urgent Care	Diabetic Supplies	Training	Eye exams	Glasses	ASC	Complex diag	PET scans			A	A	D		T	Coin	Coin	V	V		Coin					V	V	V	V	V	Coin											V	Coin	V	V	Coin	V	P	V			7500																																										-	315.41	1.45	138.5		108.14	23.04	3.03	2157.75	659.7		11.86					1473.34	270.9	4459.5	1502.1		6.24											2157.75	0.3	215.28	101.7	0.76	131.94	45.29	3.8			500/Stay	500/Stay	50/Day > 20		100 Trip	0	0	50/visit	50/visit		0.2					25/visit	25/visit	25/visit	25/visit		0.25											25/visit	0.2	25/visit	25/visit	0.2	50/visit	50	200			500	500	50		100	0.25	0.25	50	50		0.2					25	25	25	25		0.25											25	0.2	25	25	0.2	50	50	200			11000	494.65	494.65	49.47		98.93	0.25	0.25	49.47	49.47		0.2					24.73	24.73	24.73	24.73		0.25											24.73	0.2	24.73	24.73	0.2	49.47	49.47	197.86			0	13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46	13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46
H2905_804_0	2006	OP Facility - Emergency	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies	Other Medicare Part B	Other Medicare Part B	OP Facility - Surgery	OP Facility - Other	OP Facility - Other			3500	Urgent Care	Diabetic Supplies	Training	Eye exams	Glasses	ASC	Complex diag	PET scans			A	A	D		T	Coin	Coin	V	V		Coin					V	V	V	V	V	Coin											V	Coin	V	V	Coin	V	P	V			7500																																										-	315.41	1.45	138.5		108.14	23.04	3.03	2157.75	659.7		11.86					1473.34	270.9	4459.5	1502.1		6.24											2157.75	0.3	215.28	101.7	0.76	131.94	45.29	3.8			500/Stay	500/Stay	50/Day > 20		100 Trip	0	0	50/visit	50/visit		0.2					25/visit	25/visit	25/visit	25/visit		0.25											25/visit	0.2	25/visit	25/visit	0.2	50/visit	50	200			500	500	50		100	0.25	0.25	50	50		0.2					25	25	25	25		0.25											25	0.2	25	25	0.2	50	50	200			11000	494.65	494.65	49.47		98.93	0.25	0.25	49.47	49.47		0.2					24.73	24.73	24.73	24.73		0.25											24.73	0.2	24.73	24.73	0.2	49.47	49.47	197.86				13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46	13	0.06	0.57	-	0.89	5.7	0.75	8.89	2.72	-	2.35	-	-	-	-	3.04	0.56	9.19	3.1	-	1.54	-	-	-	-	-	-	-	-	-	-	4.45	0.06	0.44	0.21	0.15	0.54	0.19	0.06	-	-	58.46
H2906_001_0	2006											2500											A	A	A	V	T	Coin	Coin	V	P	Coin	Coin	P	Coin	Coin	V	V	V	Coin	V	V	Coin	Coin	T	Coin	V	Coin	Coin	Coin	P	V	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	230.64	1.2	42.08	55.23	176.09	13.92	5.68	376.63	208.47	2.84	2.6	96.24	0	19.79	5175.84	2232	153.24	2.74	788.56	463.22	5.64	3.35	1.84	0	0	0	0	0	0	28	0											100 per admit copay	100 per admit copay	0/admit & 30/day 35-100 0 custodial care	0	0	10 coinsurance	20 coinsurance	50 ER 25 UC	50 copay	10 Clin/Diag; 10 Therp.	10 X-rays	15 for partial hosp.	0.1	10 CORF 10 cardiac rehab	10 copay includes physical exams	15 copay	15 copay	10 coinsurance	0	15 copay	20 coinsurance	10 for MC Blood 20 MC Imm 15 MC Dental 15 MC vision 0 MC glasses 15 MC hearing	0	0	0	0	0	0	0	0	0											100	100	107.22	0	0	0.1	0.2	47.5	50	0.1	0.1	15	0.1	0.1	10	15	15	0.1	0	15	0.2	0.1	0	0	0	0	0	0	0	0	0											0	92	92	98.65	0	0	0.09	0.18	43.7	46	0.09	0.09	13.8	0.09	0.09	9.2	13.8	13.8	0.09	0	13.8	0.18	0.09	0	0	0	0	0	0	0	0	0											0	1.77	0.01	0.35	-	-	1.28	1.05	1.37	0.8	0.26	0.24	0.11	-	1.82	3.97	2.57	0.18	0.25	-	0.53	1.04	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.89	1.77	0.01	0.35	-	-	1.28	1.05	1.37	0.8	0.26	0.24	0.11	-	1.82	3.97	2.57	0.18	0.25	-	0.53	1.04	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.89
H2906_002_0	2006											2500											A	A	A	V	T	Coin	Coin	V	P	Coin	Coin	P	Coin	Coin	V	V	V	Coin	V	V	Coin	Coin	T	Coin	V	Coin	Coin	Coin	P	V	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	230.64	1.2	42.08	55.23	176.09	13.92	5.68	376.63	208.47	2.84	2.6	96.24	0	19.79	5175.84	2232	153.24	2.74	788.56	463.22	5.64	3.35	1.84	0	0	0	0	0	0	28	0											100 per admit copay	100 per admit copay	0/admit & 30/day 35-100 0 custodial care	0	0	10 coinsurance	20 coinsurance	50 ER 25 UC	50 copay	10 Clin/Diag; 10 Therp.	10 X-rays	15 for partial hosp.	0.1	10 CORF 10 cardiac rehab	10 copay includes physical exams	15 copay	15 copay	10 coinsurance	0	15 copay	20 coinsurance	10 for MC Blood 20 MC Imm 15 MC Dental 15 MC vision 0 MC glasses 15 MC hearing	0	0	0	0	0	0	0	0	0											100	100	107.22	0	0	0.1	0.2	47.5	50	0.1	0.1	15	0.1	0.1	10	15	15	0.1	0	15	0.2	0.1	0	0	0	0	0	0	0	0	0											0	92	92	98.65	0	0	0.09	0.18	43.7	46	0.09	0.09	13.8	0.09	0.09	9.2	13.8	13.8	0.09	0	13.8	0.18	0.09	0	0	0	0	0	0	0	0	0											0	1.77	0.01	0.35	-	-	1.28	1.05	1.37	0.8	0.26	0.24	0.11	-	1.82	3.97	2.57	0.18	0.25	-	0.53	1.04	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.89	1.77	0.01	0.35	-	-	1.28	1.05	1.37	0.8	0.26	0.24	0.11	-	1.82	3.97	2.57	0.18	0.25	-	0.53	1.04	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.89
H2906_003_0	2006											2500											A	A	A	V	T	Coin	Coin	V	P	Coin	Coin	P	Coin	Coin	V	V	V	Coin	V	V	Coin	Coin	T	Coin	V	Coin	Coin	Coin	P	V	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	249.6	1.36	45.52	59.78	190.59	15.07	6.15	407.65	225.64	3.08	2.81	104.15	0	21.42	5602.02	2415.8	165.88	2.96	853.44	501.36	6.1	3.63	2	25.54	292.28	0.45	0	0	0	30.32	0											100 per admit copay	100 per admit copay	0/admit & 30/day 35-100 0 custodial care	0	0	10 coinsurance	20 coinsurance	50 ER 25 UC	50 copay	10 Clin/Diag; 10 Therp.	10 X-rays	15 for partial hosp.	0.1	10 CORF 10 cardiac rehab	10 copay includes physical exams	15 copay	15 copay	10 coinsurance	0	15 copay	20 coinsurance	10 for MC Blood 20 MC Imm 15 MC Dental 15 MC vision 0 MC glasses 15 MC hearing	0	50 deductible 20 coin	15 routine care copay	0	0	0	0	0	0											100	100	107.56	0	0	0.1	0.2	47.5	50	0.1	0.1	15	0.1	0.1	10	15	15	0.1	0	15	0.2	0.1	0	0.3	15	0	0	0	0	0	0											0	92	92	98.95	0	0	0.09	0.18	43.7	46	0.09	0.09	13.8	0.09	0.09	9.2	13.8	13.8	0.09	0	13.8	0.18	0.09	0	0.28	13.8	0	0	0	0	0	0											0	1.91	0.01	0.38	-	-	1.39	1.13	1.48	0.86	0.28	0.26	0.12	-	1.97	4.29	2.78	0.19	0.27	-	0.58	1.12	0.33	-	7.05	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.75	1.91	0.01	0.38	-	-	1.39	1.13	1.48	0.86	0.28	0.26	0.12	-	1.97	4.29	2.78	0.19	0.27	-	0.58	1.12	0.33	-	7.05	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.75
H2931_002_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	OP Facility - Other							1500	Urgent care center	ASC	Complex diag	PET scans									D		Coin	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	Coin											V	V	P	V							0																																										-			127.25		15.55	21.15	4.53	1375.81	436.97	102.71	26.72	346.21	4.16	101.47	21651.56	10283.36	122.71	446.25	1257.6	5901.39	17.98											116.12	139.89	90	10									25/day		0	0	0	50	50	20	50	50	10	10	10	20	10	10	20	20	0.2											25	25	50	200									25		0.2	0.2	0.2	50	50	20	50	50	10	10	10	20	10	10	20	20	0.2											25	25	50	200							0			25		0.2	0.2	0.2	50	50	20	50	50	10	10	10	20	10	10	20	20	0.2											25	25	50	200								-	-	0.27	-	3.11	4.23	0.91	5.73	1.82	0.17	0.11	1.44	0	0.08	18.04	17.14	0.1	0.37	2.1	9.84	3.6	-	-	-	-	-	-	-	-	-	-	0.24	0.29	0.38	0.17	-	-	-	-	-	-	70.14	-	-	0.27	-	3.11	4.23	0.91	5.73	1.82	0.17	0.11	1.44	0	0.08	18.04	17.14	0.1	0.37	2.1	9.84	3.6	-	-	-	-	-	-	-	-	-	-	0.24	0.29	0.38	0.17	-	-	-	-	-	-	70.14
H2931_004_0	2006	OP Facility - Surgery										2500	ASC										A	A			Coin	Coin	Coin	V	V		Coin	V	V	V	V	V	V	Coin	Coin	Coin	S											V										0																																										-	209	2.09			11.69	18.71	3.02	2131.06	1529.92		10.42	0.21	6.93	663.63	6335.5	4823.41	222.96	1.74	15.35	4.1	1135.82											313.46										700/Stay	700/Stay			0	0	0	50	50		0.2	50	20	50	10	40	20	0	20	0.2	10											25										700	700			0.2	0.2	0.2	50	50		0.2	50	20	50	10	40	20	0.2	0.2	0.2	10											25										0	693.7	693.7			0.2	0.2	0.2	49.55	49.55		0.2	49.55	19.82	49.55	9.91	39.64	19.82	0.2	0.2	0.2	9.91											24.78											12.08	0.12	-	-	2.32	3.71	0.6	8.8	6.32	-	2.07	0	0.01	2.74	5.23	15.93	0.37	0.35	3.04	0.81	0.94	-	-	-	-	-	-	-	-	-	-	0.65	-	-	-	-	-	-	-	-	-	66.08	12.08	0.12	-	-	2.32	3.71	0.6	8.8	6.32	-	2.07	0	0.01	2.74	5.23	15.93	0.37	0.35	3.04	0.81	0.94	-	-	-	-	-	-	-	-	-	-	0.65	-	-	-	-	-	-	-	-	-	66.08
H2931_006_0	2006	OP Facility - Surgery	OP Facility - Other										ASC	Complex diag													Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	S											V	Coin																																																			-					10.18	17.39	7.24	2131.06	1510.37	16.96	9.45	0	3.11	3.6	5523.82	3985.51	222.96	3647.24	1519.96	3478.29	1135.82											333	0.39													20	20	20	50	50	0	0.2	0.2	0.2	0	10	40	20	40	20	20	10											25	0.5													0.2	0.2	0.2	50	50	0.2	0.2	0.2	0.2	0.2	10	40	20	40	0.2	20	10											25	0.5														0.2	0.2	0.2	49.75	49.75	0.2	0.2	0.2	0.2	0.2	9.95	39.8	19.9	39.8	0.2	19.9	9.95											24.88	0.5										-	-	-	-	2.03	3.46	1.44	8.84	6.26	3.38	1.88	0	0.62	0.72	4.58	13.22	0.37	12.1	0.03	5.77	0.94	-	-	-	-	-	-	-	-	-	-	0.69	0.2	-	-	-	-	-	-	-	-	66.5	-	-	-	-	2.03	3.46	1.44	8.84	6.26	3.38	1.88	0	0.62	0.72	4.58	13.22	0.37	12.1	0.03	5.77	0.94	-	-	-	-	-	-	-	-	-	-	0.69	0.2	-	-	-	-	-	-	-	-	66.5
H2931_014_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H2931_801_0	2006	OP Facility - Emergency	OP Facility - Other									1500	Urgent care center	PET scans													Coin	Coin	Coin	V	Coin			V	V	V	V	V	V	V	V	V	S											V	P									unlimited																																										-					11.58	23.41	1.49	1375.81	30.06			346.21	4.16	101.47	21651.56	10283.36	122.71	446.25	1257.6	5901.39	0											455.57	3.8													0	0	0	50	0			10	10	10	10	20	10	10	2000	20	7											25	200													0.2	0.2	0.2	50	0.2			10	10	10	10	20	10	10	20	20	7											25	200									unlimited					0.2	0.2	0.2	50	0.2			10	10	10	10	20	10	10	20	20	7											25	200										-	-	-	-	2.32	4.68	0.3	5.73	6.01	-	-	0.29	0	0.08	18.04	17.14	0.1	0.37	2.1	9.84	-	-	-	-	-	-	-	-	-	-	-	0.95	0.06	-	-	-	-	-	-	-	-	68.02	-	-	-	-	2.32	4.68	0.3	5.73	6.01	-	-	0.29	0	0.08	18.04	17.14	0.1	0.37	2.1	9.84	-	-	-	-	-	-	-	-	-	-	-	0.95	0.06	-	-	-	-	-	-	-	-	68.02
H2931_803_0	2006	OP Facility - Emergency	OP Facility - Other									1500	Urgent care center	PET scans													Coin	Coin	Coin	V	V		Coin	V	V	V	V	V	V	V	V	V	S											V	P									unlimited																																										-					11.75	25.89	2.61	868.43	460.88		4.95	1257.6	4.16	3725.51	17551.44	10283.36	122.71	446.25	1257.6	5901.39	148.03											455.57	3.8													0	0	0	50	50		0.2	25	25	25	10	20	10	10	1000	10	7											25	200													0.2	0.2	0.2	50	50		0.2	10	10	10	10	20	10	10	20	20	7											25	200									unlimited					0.2	0.2	0.2	50	50		0.2	10	10	10	10	20	10	10	20	20	7											25	200										-	-	-	-	2.35	5.18	0.52	3.62	1.92	-	0.99	1.05	0	3.1	14.63	17.14	0.1	0.37	2.1	9.84	0.09	-	-	-	-	-	-	-	-	-	-	0.95	0.06	-	-	-	-	-	-	-	-	64	-	-	-	-	2.35	5.18	0.52	3.62	1.92	-	0.99	1.05	0	3.1	14.63	17.14	0.1	0.37	2.1	9.84	0.09	-	-	-	-	-	-	-	-	-	-	0.95	0.06	-	-	-	-	-	-	-	-	64
H2931_804_0	2006	OP Facility - Emergency	OP Facility - Other									1500	Urgent care center	PET scans													Coin	Coin	Coin	V	Coin			V	V	V	V	V	V	V	V	V	S											V	P									unlimited																																										-					11.58	23.41	1.49	1375.81	30.06			346.21	4.16	101.47	21651.56	10283.36	122.71	446.25	1257.6	5901.39	0											455.57	3.8													0	0	0	50	0			10	10	10	10	20	10	10	2000	20	7											25	200													0.2	0.2	0.2	50	0.2			10	10	10	10	20	10	10	20	20	7											25	200									unlimited					0.2	0.2	0.2	50	0.2			10	10	10	10	20	10	10	20	20	7											25	200										-	-	-	-	2.32	4.68	0.3	5.73	6.01	-	-	0.29	0	0.08	18.04	17.14	0.1	0.37	2.1	9.84	-	-	-	-	-	-	-	-	-	-	-	0.95	0.06	-	-	-	-	-	-	-	-	68.02	-	-	-	-	2.32	4.68	0.3	5.73	6.01	-	-	0.29	0	0.08	18.04	17.14	0.1	0.37	2.1	9.84	-	-	-	-	-	-	-	-	-	-	-	0.95	0.06	-	-	-	-	-	-	-	-	68.02
H2931_805_0	2006	OP Facility - Emergency	OP Facility - Other									1500	Urgent care center	PET scans													Coin	Coin	Coin	V	V		Coin	V	V	V	V	V	V	V	V	V	S											V	P									unlimited																																										-					11.75	25.89	2.61	868.43	460.88		4.95	1257.6	4.16	3725.51	17551.44	10283.36	122.71	446.25	1257.6	5901.39	148.03											455.57	3.8													0	0	0	50	50		0.2	25	25	25	10	20	10	10	1000	10	7											25	200													0.2	0.2	0.2	50	50		0.2	10	10	10	10	20	10	10	20	20	7											25	200									unlimited					0.2	0.2	0.2	50	50		0.2	10	10	10	10	20	10	10	20	20	7											25	200										-	-	-	-	2.35	5.18	0.52	3.62	1.92	-	0.99	1.05	0	3.1	14.63	17.14	0.1	0.37	2.1	9.84	0.09	-	-	-	-	-	-	-	-	-	-	0.95	0.06	-	-	-	-	-	-	-	-	64	-	-	-	-	2.35	5.18	0.52	3.62	1.92	-	0.99	1.05	0	3.1	14.63	17.14	0.1	0.37	2.1	9.84	0.09	-	-	-	-	-	-	-	-	-	-	0.95	0.06	-	-	-	-	-	-	-	-	64
H2949_002_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1352.49	34.64	749.49	2266.48	274.49	16.08	118.33	340.74	282.08	0	13.6	0	81.66	678.33	5301.06	3826.54	166.14	256.7	3054.17	6747.17	31.47	0	0	0	89.66	250.09	0	0	0	0	266.71											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	23.17	49.12	50	0	0.2	0	0	47.05	5	10	30	30	15.04	0	0.2	0	0	0	25	20	0	0	0	0	0											1500	8.71	109.69	49	0	75	0.2	23.17	49.12	50	0	0.18	0	0	47.05	5	10	30	30	15.04	0	0.18	0	0	0	25	20	0	0	0	0	0												0.98	0.32	3.06	-	1.72	3.22	0.23	1.39	1.18	-	2.45	-	-	2.66	2.21	3.19	0.42	0.64	3.83	-	5.66	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.75	0.98	0.32	3.06	-	1.72	3.22	0.23	1.39	1.18	-	2.45	-	-	2.66	2.21	3.19	0.42	0.64	3.83	-	5.66	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.75
H2949_007_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1352.49	34.64	749.49	2266.48	274.49	15.69	118.33	340.74	282.08	0	13.27	0	81.66	678.33	5301.06	3826.54	166.14	256.7	3054.54	6747.17	32.11	0	0	0	89.66	250.09	0	0	0	0	266.71											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	22.61	49.12	50	0	0.2	0	0	47.05	5	10	30	30	14.94	0	0.2	0	0	0	25	20	0	0	0	0	0											1500	8.71	109.69	49	0	75	0.2	22.61	49.12	50	0	0.18	0	0	47.05	5	10	30	30	14.94	0	0.18	0	0	0	25	20	0	0	0	0	0												0.98	0.32	3.06	-	1.72	3.14	0.22	1.39	1.18	-	2.39	-	-	2.66	2.21	3.19	0.42	0.64	3.8	-	5.78	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.69	0.98	0.32	3.06	-	1.72	3.14	0.22	1.39	1.18	-	2.39	-	-	2.66	2.21	3.19	0.42	0.64	3.8	-	5.78	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.69
H2949_008_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1487.74	38.11	824.44	2493.13	301.94	18.12	130.16	374.81	310.29	0	15.33	0	89.83	746.16	6270.75	4903.71	182.75	282.37	3723.56	8247.84	32.11	0	0	0	98.63	275.1	180.41	39.03	0	0	293.39											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	23.74	49.12	0	0	0.2	0	0	4.42	0	0	30	30	14.77	0	0.2	0	0	0	25	20	25	0	0	0	0											1500	8.71	109.69	49	0	75	0.2	23.74	49.12	0	0	0.18	0	0	4.42	0	0	30	30	14.77	0	0.18	0	0	0	25	20	25	0	0	0	0												1.08	0.35	3.37	-	1.89	3.62	0.26	1.53	-	-	2.76	-	-	0.27	-	-	0.46	0.71	4.58	-	5.78	-	-	-	0.21	0.46	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.7	1.08	0.35	3.37	-	1.89	3.62	0.26	1.53	-	-	2.76	-	-	0.27	-	-	0.46	0.71	4.58	-	5.78	-	-	-	0.21	0.46	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.7
H2949_009_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1352.49	34.64	749.49	2266.48	274.49	16.41	118.33	340.74	282.08	0	13.88	0	81.66	678.33	5700.68	4457.92	166.14	256.7	3399.49	7498.03	32.11	0	0	0	89.66	250.09	0	0	0	0	266.71											0 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	109.69	49	0	75	0.2	23.64	49.12	0	0	0.2	0	0	4.42	0	0	30	30	14.69	0	0.2	0	0	0	25	20	0	0	0	0	0											1500	0	109.69	49	0	75	0.2	23.64	49.12	0	0	0.18	0	0	4.42	0	0	30	30	14.69	0	0.18	0	0	0	25	20	0	0	0	0	0												-	0.32	3.06	-	1.72	3.28	0.23	1.39	-	-	2.5	-	-	0.25	-	-	0.42	0.64	4.16	-	5.78	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.35	-	0.32	3.06	-	1.72	3.28	0.23	1.39	-	-	2.5	-	-	0.25	-	-	0.42	0.64	4.16	-	5.78	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.35
H2949_010_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1487.74	38.11	824.44	2493.13	301.94	17.34	130.16	374.81	310.29	0	14.67	0	89.83	746.16	6270.75	4903.71	182.75	282.37	3737.79	8247.84	32.11	0	0	0	98.63	275.1	180.41	39.03	0	0	293.39											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	22.71	49.12	0	0	0.2	0	0	4.42	0	0	30	30	14.55	0	0.2	0	0	0	25	20	25	0	0	0	0											1500	8.71	109.69	49	0	75	0.2	22.71	49.12	0	0	0.18	0	0	4.42	0	0	30	30	14.55	0	0.18	0	0	0	25	20	25	0	0	0	0												1.08	0.35	3.37	-	1.89	3.47	0.25	1.53	-	-	2.64	-	-	0.27	-	-	0.46	0.71	4.53	-	5.78	-	-	-	0.21	0.46	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.36	1.08	0.35	3.37	-	1.89	3.47	0.25	1.53	-	-	2.64	-	-	0.27	-	-	0.46	0.71	4.53	-	5.78	-	-	-	0.21	0.46	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.36
H2949_011_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1352.49	34.64	749.49	2266.48	274.49	15.69	118.33	340.74	282.08	0	13.27	0	81.66	678.33	5700.68	4457.92	166.14	256.7	3400.26	7498.03	32.11	0	0	0	89.66	250.09	0	0	0	0	266.71											0 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 15; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	109.69	49	0	75	0.2	22.61	49.12	0	0	0.2	0	0	4.42	0	0	30	30	14.53	0	0.2	0	0	0	25	20	0	0	0	0	0											1500	0	109.69	49	0	75	0.2	22.61	49.12	0	0	0.18	0	0	4.42	0	0	30	30	14.53	0	0.18	0	0	0	25	20	0	0	0	0	0												-	0.32	3.06	-	1.72	3.14	0.22	1.39	-	-	2.39	-	-	0.25	-	-	0.42	0.64	4.12	-	5.78	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.04	-	0.32	3.06	-	1.72	3.14	0.22	1.39	-	-	2.39	-	-	0.25	-	-	0.42	0.64	4.12	-	5.78	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.04
H2949_801_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.26	0.31	0.03	0.18	0.51		0.48		0.04	0.39	1.09	2.1	0.13	0.03	0.44	0.23	1.1	0																				7.31	1352.49	34.64	749.49	2192.78	10.95	13.11	1.17	11.01	30.7	0	20.59	0	1.54	16.76	46.83	90.08	2.22	1.46	18.82	9.66	47.32	0	0	0	0	0	0	0	0	0	258.04											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.09	0.32	3.5	-	2.19	2.62	0.23	2.2	6.14	-	4.12	-	0.31	3.35	9.37	18.02	1.11	0.29	3.76	1.93	9.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.02	12.09	0.32	3.5	-	2.44	2.93	0.26	2.38	6.65	-	4.6	-	0.34	3.74	10.46	20.12	1.24	0.33	4.2	2.16	10.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.33
H2949_802_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.26	0.31	0.03	0.18	0.51		0.48		0.04	0.39	1.09	2.1	0.13	0.03	0.44	0.23	1.1	0																				7.31	1352.49	34.64	749.49	2192.78	10.95	13.11	1.17	11.01	30.7	0	20.59	0	1.54	16.76	46.83	90.08	2.22	1.46	18.82	9.66	47.32	0	0	0	0	0	0	0	0	0	258.04											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.09	0.32	3.5	-	2.19	2.62	0.23	2.2	6.14	-	4.12	-	0.31	3.35	9.37	18.02	1.11	0.29	3.76	1.93	9.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.02	12.09	0.32	3.5	-	2.44	2.93	0.26	2.38	6.65	-	4.6	-	0.34	3.74	10.46	20.12	1.24	0.33	4.2	2.16	10.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.33
H2949_803_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.26	0.31	0.03	0.18	0.51		0.48		0.04	0.39	1.09	2.1	0.13	0.03	0.44	0.23	1.1	0																				7.31	1352.49	34.64	749.49	2192.78	10.95	13.11	1.17	11.01	30.7	0	20.59	0	1.54	16.76	46.83	90.08	2.22	1.46	18.82	9.66	47.32	0	0	0	0	0	0	0	0	0	258.04											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.09	0.32	3.5	-	2.19	2.62	0.23	2.2	6.14	-	4.12	-	0.31	3.35	9.37	18.02	1.11	0.29	3.76	1.93	9.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.02	12.09	0.32	3.5	-	2.44	2.93	0.26	2.38	6.65	-	4.6	-	0.34	3.74	10.46	20.12	1.24	0.33	4.2	2.16	10.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.33
H2949_804_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.26	0.31	0.03	0.18	0.51		0.48		0.04	0.39	1.09	2.1	0.13	0.03	0.44	0.23	1.1	0																				7.31	1352.49	34.64	749.49	2192.78	10.95	13.11	1.17	11.01	30.7	0	20.59	0	1.54	16.76	46.83	90.08	2.22	1.46	18.82	9.66	47.32	0	0	0	0	0	0	0	0	0	258.04											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	12.09	0.32	3.5	-	2.19	2.62	0.23	2.2	6.14	-	4.12	-	0.31	3.35	9.37	18.02	1.11	0.29	3.76	1.93	9.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.02	12.09	0.32	3.5	-	2.44	2.93	0.26	2.38	6.65	-	4.6	-	0.34	3.74	10.46	20.12	1.24	0.33	4.2	2.16	10.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.33
H2960_004_0	2006											4000											A	A	A	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	Coin	T	Coin	V	Coin	Coin	Coin	P	V	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	262.1	1.4	47.8	62.77	200.09	15.82	6.45	428	236.9	732	707.43	109.39	0	225	5881.6	2536.39	174.16	91.87	896.1	526.38	6.41	3.81	2.1	0	0	0	0	0	0	31.8	0											500 per admit copay	500 per admit copay	150/admit & 50/day for days 35-100 150 custodial care	150 for custodial care	100 copay	20 coinsurance	20 coinsurance	50 ER 30 UC	250 copay	40 Clin/Diag; 50 Therp.	40 X-rays	30 for partial hosp.	20 coinsurance	50 CORF 15 cardiac rehab	10 copay includes physical exams	30 copay	30 copay	25 copay	0	30 copay	20 coinsurance	20 for MC Blood & MC Imm 30 MC Dental 30 MC vision 20 MC glasses 30 MC hearing	0	0	0	0	0	0	0	0	0											500	500	330.75	150	100	0.2	0.2	48	250	45	40	30	0.2	46.11	10	30	30	25	0	30	0.2	0.2	0	0	0	0	0	0	0	0	0											0	485	485	320.83	145.5	97	0.19	0.19	46.56	242.5	43.65	38.8	29.1	0.19	44.73	9.7	29.1	29.1	24.25	0	29.1	0.19	0.19	0	0	0	0	0	0	0	0	0											0	10.59	0.06	1.28	0.76	1.62	3.07	1.25	1.66	4.79	2.66	2.29	0.27	-	0.84	4.75	6.15	0.42	0.19	-	1.28	1.24	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.9	10.59	0.06	1.28	0.76	1.62	3.07	1.25	1.66	4.79	2.66	2.29	0.27	-	0.84	4.75	6.15	0.42	0.19	-	1.28	1.24	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.9
H2960_009_0	2006											4000											A	A	A	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	Coin	T	Coin	V	Coin	Coin	Coin	P	V	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	262.1	1.4	47.8	62.77	200.09	15.82	6.45	428	236.9	732	707.43	109.39	0	225	5881.6	2536.39	174.16	91.87	896.1	526.38	6.41	3.81	2.1	0	0	0	0	0	0	31.8	0											500 per admit copay	500 per admit copay	150/admit & 50/day for days 35-100 150 custodial care	150 for custodial care	100 copay	20 coinsurance	20 coinsurance	50 ER 30 UC	250 copay	40 Clin/Diag; 50 Therp.	40 X-rays	30 for partial hosp.	20 coinsurance	50 CORF 15 cardiac rehab	10 copay includes physical exams	30 copay	30 copay	25 copay	0	30 copay	20 coinsurance	20 for MC Blood & MC Imm 30 MC Dental 30 MC vision 20 MC glasses 30 MC hearing	0	0	0	0	0	0	0	0	0											500	500	330.75	150	100	0.2	0.2	48	250	45	40	30	0.2	46.11	10	30	30	25	0	30	0.2	0.2	0	0	0	0	0	0	0	0	0											0	485	485	320.83	145.5	97	0.19	0.19	46.56	242.5	43.65	38.8	29.1	0.19	44.73	9.7	29.1	29.1	24.25	0	29.1	0.19	0.19	0	0	0	0	0	0	0	0	0											0	10.59	0.06	1.28	0.76	1.62	3.07	1.25	1.66	4.79	2.66	2.29	0.27	-	0.84	4.75	6.15	0.42	0.19	-	1.28	1.24	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.9	10.59	0.06	1.28	0.76	1.62	3.07	1.25	1.66	4.79	2.66	2.29	0.27	-	0.84	4.75	6.15	0.42	0.19	-	1.28	1.24	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.9
H2960_010_0	2006											4000											A	A	A	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	Coin	T	Coin	V	Coin	Coin	Coin	P	V	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	283.7	1.5	51.7	67.93	216.58	17.12	6.99	463.25	256.41	792.3	765.69	118.45	0	225	6365.92	2745.27	188.51	99.43	969.9	569.73	6.93	4.12	2.3	27.38	313.34	0.51	0	0	0	34.4	0											500 per admit copay	500 per admit copay	150/admit & 50/day for days 35-100 150 custodial care	150 for custodial care	100 copay	20 coinsurance	20 coinsurance	50 ER 30 UC	250 copay	40 Clin/Diag; 50 Therp.	40 X-rays	30 for partial hosp.	20 coinsurance	50 CORF 15 cardiac rehab	10 copay includes physical exams	30 copay	30 copay	25 copay	0	30 copay	20 coinsurance	20 for MC Blood & MC Imm 30 MC Dental 30 MC vision 20 MC glasses 30 MC hearing	0	50 deductible 20-50 coinsurance depending on services	15 routine care copay	0	0	0	0	0	0											500	500	331.04	150	100	0.2	0.2	48	250	45	40	30	0.2	46.11	10	30	30	25	0	30	0.2	0.2	0	0.3	15	0	0	0	0	0	0											0	485	485	321.11	145.5	97	0.19	0.19	46.56	242.5	43.65	38.8	29.1	0.19	44.73	9.7	29.1	29.1	24.25	0	29.1	0.19	0.19	0	0.29	14.55	0	0	0	0	0	0											0	11.47	0.06	1.38	0.82	1.75	3.32	1.36	1.8	5.18	2.88	2.48	0.29	-	0.84	5.15	6.66	0.46	0.2	-	1.38	1.35	0.8	-	7.97	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.96	11.47	0.06	1.38	0.82	1.75	3.32	1.36	1.8	5.18	2.88	2.48	0.29	-	0.84	5.15	6.66	0.46	0.2	-	1.38	1.35	0.8	-	7.97	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.96
H2961_002_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	OP Facility - Other							1500	Urgent care center	ASC	Complex diag	PET scans									D	V	Coin	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	Coin		T									V	V	P	V							0																																										-			127.25	1672	11.65	23.65	6.99	1998	656.67	1078.12	581.46	0.05	39.68	102.92	13945.27	9369.32	610.57	381.23	3.22	5939.04	19.55		1983.44									116.12	139.89	90	10									25/day >20	3PC5CGR3HS	20	20	20	50	50	20	50	50	10	10	10	20	10	10	20	20	20		5/Trip									25	25	50	200									25	3.8	0.2	0.2	0.2	50	50	20	50	50	10	10	10	20	10	10	20	20	0.2		5									25	25	50	200							0			25	3.8	0.2	0.2	0.2	50	50	20	50	50	10	10	10	20	10	10	20	20	0.2		5									25	25	50	200							0	-	-	0.27	0.53	2.33	4.73	1.4	8.33	2.74	1.8	2.42	0	0.03	0.09	11.62	15.62	0.51	0.32	0.01	9.9	3.91	-	0.83	-	-	-	-	-	-	-	-	0.24	0.29	0.38	0.17	-	-	-	-	-	-	68.43	-	-	0.27	0.53	2.33	4.73	1.4	8.33	2.74	1.8	2.42	0	0.03	0.09	11.62	15.62	0.51	0.32	0.01	9.9	3.91	-	0.83	-	-	-	-	-	-	-	-	0.24	0.29	0.38	0.17	-	-	-	-	-	-	68.43
H2961_011_0	2006											2500													D	V	Coin	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V	V	Coin	V	T																			0																																										-				1672	9.79	2.16	22.98	3300.06	5517.01	3.1	19.53	2571.27	8.63		8235.24	3534.88	248.94	4075.65	1566.87	1066.11	0.45		1752.58																						3PC5CR3HS	0	0	0	50	25	0	0.2	25	20		10	40	20	20	20	20	0.2		2																						3.8	0.2	0.2	0.2	50	25	0.2	0.2	25	20		10	40	20	20	20	20	0.2		2																			0				3.78	0.2	0.2	0.2	49.73	24.87	0.2	0.2	24.87	19.89		9.95	39.79	19.89	19.89	19.89	19.89	0.2		1.99																				-	-	-	0.53	1.95	0.43	4.57	13.68	11.43	0.62	3.88	5.33	0.01	-	6.83	11.72	0.41	6.76	2.6	1.77	0.09	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.89	-	-	-	0.53	1.95	0.43	4.57	13.68	11.43	0.62	3.88	5.33	0.01	-	6.83	11.72	0.41	6.76	2.6	1.77	0.09	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.89
H2961_801_0	2006	OP Facility - Emergency	OP Facility - Surgery									1500	Urgent care center	ASC												V	Coin	Coin	Coin	V	V		Coin	V	V	V	V	V	V	V	V	V	S		T									V	V									0																																										-				1525	7.71	24.25	0.98	702.44	581.7		3.8	0	0	414.53	11099.34	10160.47	72.14	1899.95	925.12	5181.49	148.03		1983.44									116.12	139.89												3PC5CGR3HS	0	0	0	50	50		0.2	25	25	25	10	20	10	10	10	10	7		5/Trip									25	25												3.8	0.2	0.2	0.2	50	50		0.2	25	25	25	10	20	10	10	10	10	7		5									25	25									0				3.8	0.2	0.2	0.2	50	50		0.2	25	25	25	10	20	10	10	10	10	7		5									25	25										-	-	-	0.48	1.54	4.85	0.2	2.93	2.42	-	0.76	-	-	0.86	9.25	16.93	0.06	1.58	0.77	4.32	0.09	-	0.83	-	-	-	-	-	-	-	-	0.24	0.29	-	-	-	-	-	-	-	-	48.41	-	-	-	0.48	1.54	4.85	0.2	2.93	2.42	-	0.76	-	-	0.86	9.25	16.93	0.06	1.58	0.77	4.32	0.09	-	0.83	-	-	-	-	-	-	-	-	0.24	0.29	-	-	-	-	-	-	-	-	48.41
H2961_805_0	2006	OP Facility - Emergency	OP Facility - Surgery									1500	Urgent care center	ASC												V	Coin	Coin	Coin	V	V		Coin	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	v	V				V	V									0																																										-				1525	11.75	25.89	2.61	726.8	460.88		4.95	1257.6	4.16	3725.51	17551.44	10283.36	122.71	446.25	1257.6	5901.39	148.03											116.12	139.89												3PC5CGR3HS	0	0	0	50	50		0.2	25	25	25	10	20	10	10	10	10	7											25	25												3.8	0.2	0.2	0.2	50	50		0.2	25	25	25	10	20	10	10	10	10	7											25	25									0				3.8	0.2	0.2	0.2	50	50		0.2	25	25	25	10	20	10	10	10	10	7											25	25										-	-	-	0.48	2.35	5.18	0.52	3.03	1.92	-	0.99	2.62	0.01	7.76	14.63	17.14	0.1	0.37	1.05	4.92	0.09	-	-	-	-	-	-	-	-	-	-	0.24	0.29	-	-	-	-	-	-	-	-	63.69	-	-	-	0.48	2.35	5.18	0.52	3.03	1.92	-	0.99	2.62	0.01	7.76	14.63	17.14	0.1	0.37	1.05	4.92	0.09	-	-	-	-	-	-	-	-	-	-	0.24	0.29	-	-	-	-	-	-	-	-	63.69
H2961_806_0	2006	OP Facility - Emergency	OP Facility - Surgery									1500	Urgent care center	ASC												V	Coin	Coin	Coin	V	V		Coin	V	V	V	V	V	V	V	V	V	S		T									V	V									0																																										-				1525	7.71	24.25	0.98	702.44	581.7		3.8	0	0	414.53	11099.34	10160.47	72.14	1899.95	925.12	5181.49	148.03		1983.44									116.12	139.89												3PC5CGR3HS	0	0	0	50	50		0.2	25	25	25	10	20	10	10	10	10	7		5/Trip									25	25												3.8	0.2	0.2	0.2	50	50		0.2	25	25	25	10	20	10	10	10	10	7		5									25	25									0				3.8	0.2	0.2	0.2	50	50		0.2	25	25	25	10	20	10	10	10	10	7		5									25	25										-	-	-	0.48	1.54	4.85	0.2	2.93	2.42	-	0.76	-	-	0.86	9.25	16.93	0.06	1.58	0.77	4.32	0.09	-	0.83	-	-	-	-	-	-	-	-	0.24	0.29	-	-	-	-	-	-	-	-	48.41	-	-	-	0.48	1.54	4.85	0.2	2.93	2.42	-	0.76	-	-	0.86	9.25	16.93	0.06	1.58	0.77	4.32	0.09	-	0.83	-	-	-	-	-	-	-	-	0.24	0.29	-	-	-	-	-	-	-	-	48.41
H2961_807_0	2006	OP Facility - Emergency	OP Facility - Surgery									1500	Urgent care center	ASC												V	Coin	Coin	Coin	V	V		Coin	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	v	V				V	V									0																																										-				1525	11.75	25.89	2.61	726.8	460.88		4.95	1257.6	4.16	3725.51	17551.44	10283.36	122.71	446.25	1257.6	5901.39	148.03											116.12	139.89												3PC5CGR3HS	0	0	0	50	50		0.2	25	25	25	10	20	10	10	10	10	7											25	25												3.8	0.2	0.2	0.2	50	50		0.2	25	25	25	10	20	10	10	10	10	7											25	25									0				3.8	0.2	0.2	0.2	50	50		0.2	25	25	25	10	20	10	10	10	10	7											25	25										-	-	-	0.48	2.35	5.18	0.52	3.03	1.92	-	0.99	2.62	0.01	7.76	14.63	17.14	0.1	0.37	1.05	4.92	0.09	-	-	-	-	-	-	-	-	-	-	0.24	0.29	-	-	-	-	-	-	-	-	63.69	-	-	-	0.48	2.35	5.18	0.52	3.03	1.92	-	0.99	2.62	0.01	7.76	14.63	17.14	0.1	0.37	1.05	4.92	0.09	-	-	-	-	-	-	-	-	-	-	0.24	0.29	-	-	-	-	-	-	-	-	63.69
H3107_004_0	2006											0											D	D	D		Coin			V	P		Coin			V	V	V	Coin	V		V																						0																																										-	2076.03	66.47	1431.72		6.6			209.5	320.51		40.71			463.32	6052.1	6253.69	1.9	359.92		120.28																						125/day up to 1750 max per admit	125/day up to 1750 max per admit	0 for 1st 5 days; 125/day from days 6-100		20			50	300 per visit		20 coins			25	15	25	50	25		250 IP surgery 200 Am Surg Phys																						115.88	74.92	99.53		20			49.92	299.37		6.7			23.93	14.95	24.94	49.1	24.64		236.7																						0	115.88	74.92	99.53		20			49.92	299.37		6.7			23.93	14.95	24.94	49.1	24.64		236.7																							20.05	0.41	11.87	-	1.32	-	-	0.87	8	-	2.71	-	-	0.92	7.54	13	0.93	0.74	-	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.74	20.05	0.41	11.87	-	1.32	-	-	0.87	8	-	2.71	-	-	0.92	7.54	13	0.93	0.74	-	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.74
H3107_005_0	2006											0											Ded	Ded	Ded	Ded	Ded	Ded	Ded	V	Ded				Ded	V	V	V	Coin	V		Ded	Ded																					0	36.9	0.38	4.27	0.07	0.88	0.36	0.16	0	2.68				1.15	0.14	0	7.55	0	0		4.77	2.39																					61.72								210.45						465.4	6052.17	6253.69	1.91	359.92																								Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	50	Apply to Deductible				Apply to Deductible	20	10	20	50	20		Apply to Deductible	Apply to Deductible																												49.92						19.22	9.59	18.54	0.49	20																								0								49.92						19.22	9.59	18.54	0.49	20																								2325	-	-	-	-	-	-	-	0.88	-	-	-	-	-	0.75	4.84	9.66	0.93	0.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.65	36.9	0.38	4.27	0.07	0.88	0.36	0.16	0.88	2.68	-	-	-	1.15	0.89	4.84	17.21	0.93	0.6	-	4.77	2.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.37
H3107_006_0	2006											0																		V						V	V	V	Coin	V																								0	36.15	0.38	4.19	0.07	0.87	0.35	0.16	0	2.62				1.13	0.14	0	7.4	0	0		4.68	2.34																					60.47								206.96						457.7	6051.86	6253.69	1.88	359.92																								Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	50	Apply to Deductible				Apply to Deductible	25	15	25	50	25		Apply to Deductible	Apply to Deductible																												49.92						23.93	14.35	23.29	0.5	24.64																								0								49.92						23.93	14.35	23.29	0.5	24.64																								2350	-	-	-	-	-	-	-	0.86	-	-	-	-	-	0.91	7.24	12.14	0.93	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.82	36.15	0.38	4.19	0.07	0.87	0.35	0.16	0.86	2.62	-	-	-	1.13	1.05	7.24	19.54	0.93	0.74	-	4.68	2.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.29
H3107_008_0	2006											0											D	D	D					V	P					V	V	V	Coin	V																								0																																										-	2095.75	66.44	1431.72					210.32	321.76					465.13	6052.16	6253.69	1.91	359.92																								80/day up to 800 max per admit	80/day up to 800 max per admit	0 for 1st 10 days; 75/day from days 11-100					50	100 per surgery					20	10	20	50 coins	20																								55.35	35.94	49.16					49.92	99.79					19.15	9.96	19.96	0.49	19.71																								0	55.35	35.94	49.16					49.92	99.79					19.15	9.96	19.96	0.49	19.71																									9.67	0.2	5.87	-	-	-	-	0.87	2.68	-	-	-	-	0.74	5.03	10.4	0.93	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.98	9.67	0.2	5.87	-	-	-	-	0.87	2.68	-	-	-	-	0.74	5.03	10.4	0.93	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.98
H3107_801_0	2006											0											D	D	D		Coin			V	P		Coin			V	V	V	Coin	V		V																						0																																										-	2053.88	65.12	1431.72		6.6			205.26	314.02		40.16			453.94	6051.7	6253.69	1.9	359.92		120.28																						125/day up to 1750 max per admit	125/day up to 1750 max per admit	0 for 1st 5 days; 125/day from days 6-100		20			50	300 per visit		20 coins			25	15	25	50	25		250 IP surgery 200 Am Surg Phys																						114.74	74.92	99.53		0.2			49.92	299.37		0.07			23.93	14.95	24.94	0.49	24.64		236.7																						0	114.74	74.92	99.53		0.2			49.92	299.37		0.07			23.93	14.95	24.94	0.49	24.64		236.7																							19.64	0.41	11.87	-	1.32	-	-	0.85	7.83	-	2.67	-	-	0.91	7.54	13	0.93	0.74	-	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.09	19.64	0.41	11.87	-	1.32	-	-	0.85	7.83	-	2.67	-	-	0.91	7.54	13	0.93	0.74	-	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.09
H3107_802_0	2006											0											Ded	Ded	Ded	Ded	Ded	Ded	Ded	V	Ded				Ded	V	V	V	Coin	V		Ded	Ded																					0	34.06	0.35	3.95	0.07	0.82	0.33	0.15	0	2.47				1.06	0.13	0	6.97	0	0		4.41	2.2																					56.98								204.59						452.45	6051.64	6253.69	1.9	359.92																								Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	50	Apply to Deductible				Apply to Deductible	20	10	20	50	20		Apply to Deductible	Apply to Deductible																												49.92						19.22	9.59	18.54	0.49	20																								0								49.92						19.22	9.59	18.54	0.49	20																								2300	-	-	-	-	-	-	-	0.85	-	-	-	-	-	0.72	4.83	9.66	0.93	0.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.61	34.06	0.35	3.95	0.07	0.82	0.33	0.15	0.85	2.47	-	-	-	1.06	0.86	4.83	16.63	0.93	0.6	-	4.41	2.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.58
H3112_001_0	2006																						BP	BP	D		coin	coin	coin	V	coin	coin	V	coin	coin	coin	v	coin	v	v	coin	coin	s	coin			v		v																																																									-	230.8	2.8	714.63		11.67	16.31	1.81	524	41.56	15.4	217	46.21	15.4	61.61	4235.8	58.87	111.8	144.7	13.38	187.31	85.7	0.43			185		12															912/ben pd + c/s days 61+	912/ben pd + c/s days 61+	114/d days 21-100		20 coins	20 coins	20 coins	20 to max of 50 (assumed 50)	20 coins	20 coins	20	20 coins	20 coins	20 coins	10	20 coins	20	20	20 coins	20 coins	25	20 coins			20		20																						50																																			912	912	114		0.2	0.2	0.2	50	0.2	0.2	20	0.2	0.2	0.2	10	0.2	20	20	0.2	0.2	25	0.2			20		20																17.54	0.21	6.79	-	2.33	3.26	0.36	2.18	8.31	3.08	0.36	9.24	3.08	12.32	3.53	11.77	0.19	0.24	2.68	37.46	0.18	0.09	-	-	0.31	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	125.55	17.54	0.21	6.79	-	2.33	3.26	0.36	2.18	8.31	3.08	0.36	9.24	3.08	12.32	3.53	11.77	0.19	0.24	2.68	37.46	0.18	0.09	-	-	0.31	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	125.55
H3113_001_0	2006	Professional	Professional	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency					1750	Specialist excl. MH	Other	Other	Other	Other						D	D	D	P	P	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	P	P		P	P	P					V	V	V	P	V	V																																															-	2552.91	181.51			2089.84	23.35	8.8		120.38	3598.53	186.86	29.26	0.2	0.08	3.56	1503.89	77	0.4			3.9	1413.18					222.76					0.24	140.87	265.67	0.08	0.16						175 per day	150 per day			50 per Trip	0	0		0/100 SNF/Non-SNF	0/10/25 SNF/Non-SNF	0/25 SNF/Non-SNF	0/100 SNF/Non-SNF	0.2	35	0/25 SNF/Non-SNF	0/25 SNF/Non-SNF	0/35/25 SNF/Non-SNF	0/25 SNF/Non-SNF			0.2	0/25 SNF/Non-SNF			0/25 SNF/Non-SNF		0/25 SNF/Non-SNF					25	0/25 SNF/Non-SNF	0/100 SNF/Non-SNF	0/35/25 SNF/Non-SNF	0/25 SNF/Non-SNF						175	150			16.67	0.2	0.2		5	0.75	1.25	5	0.2	35	1.25	1.25	1.5	1.25			0.2	1.25			1.25		1.25					25	1.25	5	1.5	1.25							151	129.42			14.38	0.17	0.17		4.31	0.65	1.08	4.31	0.17	30.2	1.08	1.08	1.29	1.08			0.17	1.08			1.25		1.25					21.57	1.08	4.31	1.29	1.08							32.12	1.96	-	-	2.5	4.03	1.52	-	0.04	0.19	0.02	0.01	0.03	0	0	0.14	0.01	0	-	-	0.67	0.13	-	-	-	-	0.02	-	-	-	-	0	0.01	0.1	0	0	-	-	-	-	-	43.51	32.12	1.96	-	-	2.5	4.03	1.52	-	0.04	0.19	0.02	0.01	0.03	0	0	0.14	0.01	0	-	-	0.67	0.13	-	-	-	-	0.02	-	-	-	-	0	0.01	0.1	0	0	-	-	-	-	-	43.51
H3152_022_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1765.87		1803.98	1485.57	328.34	10.81		229.95	51.54	247.94	185.69		86.29	59.61	5383.24	5819.92	0.67	439.2	27.39	614.11	285.6																					750 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	30	53.94		30	30	15	30	30	30	3000	30	45																					122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						18	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.62	0.83	-	0.22	0.15	6.73	14.55	0	1.1	0.07	1.54	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.78	18	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.62	0.83	-	0.22	0.15	6.73	14.55	0	1.1	0.07	1.54	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.78
H3152_029_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	1353.26	13.67	1175.65	906.52	139.67	2.38	0.02	182.52	49.95	369.12	369.61	0.57	59.1	69.04	4689.97	5566.42	3.8	245.29	542.39	0	285.6	475.05																				75/day 10 Days		0/day 1-5 75 6-14 125 15-100																																							40.82	40.82	86.25	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20																					40.82	40.82	86.25	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20																					4.6	0.05	8.45	1.51	1.16	0.48	0	0.71	0.42	0.62	0.93	0	0.1	0.12	3.91	9.28	0.01	0.41	0.9	-	1.07	0.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.51	4.6	0.05	8.45	1.51	1.16	0.48	0	0.71	0.42	0.62	0.93	0	0.1	0.12	3.91	9.28	0.01	0.41	0.9	-	1.07	0.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.51
H3152_038_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	1350.85	13.64	905.41	1306.14	120.67	2.23	0.02	146.48	48.7	260.24	260.88	0.4	11.1	29.44	3690.72	4307.22	3.8	122.85	248.14	0	285.6	457.22																				750/stay		0/day 1-5 75 6-14 125 15-100																																							122.95	122.95	86.25	35	100	0.2	0.2	48.05	100	35	40.13	35	35	35	25	35	35	35	35	0	45	35																					122.95	122.95	86.25	35	100	0.2	0.2	48.05	100	35	40.13	35	35	35	25	35	35	35	35		45	35																					13.84	0.14	6.51	3.81	1.01	0.45	0	0.59	0.41	0.76	0.87	0	0.03	0.09	7.69	12.56	0.01	0.36	0.72	-	1.07	1.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.25	13.84	0.14	6.51	3.81	1.01	0.45	0	0.59	0.41	0.76	0.87	0	0.03	0.09	7.69	12.56	0.01	0.36	0.72	-	1.07	1.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.25
H3152_040_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	1365.57	13.79	1175.65	936.41	139.67	2.38	0.02	182.52	49.95	373.29	359.4	0.58	59.77	69.82	4909.99	5687.43	3.8	250.62	554.18	0	285.6	475.05																				50/day 1-5 Days		0/Day 1-10 75/day 11-100																																							30.34	30.34	47.6	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20																					30.34	30.34	47.6	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20																					3.45	0.03	4.66	1.56	1.16	0.48	0	0.71	0.42	0.62	0.91	0	0.1	0.12	4.09	9.48	0.01	0.42	0.92	-	1.07	0.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.01	3.45	0.03	4.66	1.56	1.16	0.48	0	0.71	0.42	0.62	0.91	0	0.1	0.12	4.09	9.48	0.01	0.42	0.92	-	1.07	0.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.01
H3152_041_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1765.87		1803.98	1485.57	328.34	10.81		229.95	51.54	247.94	185.69		86.29	59.61	5383.24	5819.92	0.67	439.2	27.39	614.11	285.6																					750 per admission		0 1-10 75/day 11-100	20	100	0		48	100	30	43.68		30	30	15	30	30	30	3000	30	45																					122.35		47.6	20	100	0.2		48	100	30	43.68		30	30	15	30	30	30	30	30	45																						122.35		47.6	20	100	0.2		48	100	30	43.68		30	30	15	30	30	30	30	30	45																						18	-	7.16	2.48	2.74	2.16	-	0.92	0.43	0.62	0.68	-	0.22	0.15	6.73	14.55	0	1.1	0.07	1.54	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.6	18	-	7.16	2.48	2.74	2.16	-	0.92	0.43	0.62	0.68	-	0.22	0.15	6.73	14.55	0	1.1	0.07	1.54	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.6
H3152_044_0	2006											4000											Coin		D	V	T	Coin		P	Coin	P	P		P	P	V	V	V	V	V	V	S																						16.3					0.53			0.41																																	17.25	331.28		1803.98	1485.57	328.34	10.81		229.95	8.35	250.75	187.71		87.26	60.29	5453.99	5946.44	0.68	448.75	27.98	627.46	285.6																					0.15		0 1-7 75 8-14 125 15-100	20	100	0		48	0	20	47.36		20	20	10	20	20	20	2000	20	45																					0.15		81.02	20	100	0.2		48	0.15	20	47.36		20	20	10	20	20	20	20	20	45																						0.11		81.02	20	100	0.15		48	0.11	20	47.36		20	20	10	20	20	20	20	20	45																					500	37.93	-	12.18	2.48	2.74	1.65	-	0.92	0.96	0.42	0.74	-	0.15	0.1	4.54	9.91	0	0.75	0.05	1.05	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.62	54.24	-	12.18	2.48	2.74	2.18	-	0.92	1.37	0.42	0.74	-	0.15	0.1	4.54	9.91	0	0.75	0.05	1.05	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.87
H3152_045_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	1637.87	16.54	1110.46	1104	168.67	2.75	0.03	205.39	101.75	362.8	410.4	0.4	179.31	22.07	5416.23	6131.93	3.8	293.08	427.7	0	285.6	599.77																				0		0/Day 1-10 75/day 11-100																																							0	0	47.6	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	0	20	20	20	20	0	45	20																					0	0	47.6	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	0	20	20	20	20		45	20																					-	-	4.41	1.84	1.41	0.55	0.01	0.8	0.85	0.6	1.03	0	0.3	0.04	-	10.22	0.01	0.49	0.71	-	1.07	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.33	-	-	4.41	1.84	1.41	0.55	0.01	0.8	0.85	0.6	1.03	0	0.3	0.04	-	10.22	0.01	0.49	0.71	-	1.07	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.33
H3152_046_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	1629.51	16.46	1110.46	1104	168.67	2.75	0.03	205.39	101.75	362.8	410.4	0.4	179.31	22.07	4814.43	6131.93	3.8	293.08	427.7	0	285.6	599.77																				50/day 10 Days		0/day 1-5 75 6-14 125 15-100																																							40.82	40.82	86.25	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20																					40.82	40.82	86.25	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20																					5.54	0.06	7.98	1.84	1.41	0.55	0.01	0.8	0.85	0.6	1.03	0	0.3	0.04	4.01	10.22	0.01	0.49	0.71	-	1.07	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.51	5.54	0.06	7.98	1.84	1.41	0.55	0.01	0.8	0.85	0.6	1.03	0	0.3	0.04	4.01	10.22	0.01	0.49	0.71	-	1.07	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.51
H3152_047_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	1637.87	16.54	1110.46	1104	168.67	2.75	0.03	205.39	101.75	362.8	410.4	0.4	179.31	22.07	4814.43	6131.93	3.8	293.08	427.7		285.6	599.77																				0		0/day 1-5 75 6-14 125 15-100																																							0	0	86.25	20	100	0	0	46.75	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20	0																				0	0	86.25	20	100	0	0	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20																					-	-	7.98	1.84	1.41	-	-	0.8	0.85	0.6	1.03	0	0.3	0.04	4.01	10.22	0.01	0.49	0.71	-	1.07	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.36	-	-	7.98	1.84	1.41	-	-	0.8	0.85	0.6	1.03	0	0.3	0.04	4.01	10.22	0.01	0.49	0.71	-	1.07	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.36
H3152_048_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	1637.87	16.54	1110.46	1068.77	168.67	2.75	0.03	205.39	101.75	345.13	411.66	0.4	170.58	20.99	5416.23	6197.17	3.8	296.19	432.25		285.6	599.77																				0		0/day 1-5 75 6-14 125 15-100																																							0	0	86.25	30	100	0	0	46.75	100	15	26.97	15	15	15	0	15	15	15	15		45	15																					0	0	86.25	30	100	0	0	46.75	100	15	26.97	15	15	15	0	15	15	15	15		45	15																					-	-	7.98	2.67	1.41	-	-	0.8	0.85	0.43	0.93	0	0.21	0.03	-	7.75	0	0.37	0.54	-	1.07	0.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.79	-	-	7.98	2.67	1.41	-	-	0.8	0.85	0.43	0.93	0	0.21	0.03	-	7.75	0	0.37	0.54	-	1.07	0.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.79
H3152_049_0	2006											4000											Coin		D	V	T	Coin		P	Coin	P	P		P	P	V	V	V	V	V	V	S																						16.09					0.94			0.22																																	17.25	284.4		818.02	1934.26	268.01	10.48		274.54	3.98	463.42	277.61		95.31	20.79	4005.79	8267.59	0.48	792.73	36.16	34.9	285.6																					0.15		0 1-7 75 8-14 125 15-100	20	100	0		48	0	20	47.36		20	20	10	20	20	20	2000	20	45																					0.15		81.02	20	100	0.2		48	0.15	20	47.36		20	20	10	20	20	20	20	20	45																						0.11		81.02	20	100	0.15		48	0.11	20	47.36		20	20	10	20	20	20	20	20	45																					500	32.57	-	5.52	3.22	2.23	1.6	-	1.1	0.46	0.77	1.1	-	0.16	0.03	3.34	13.78	0	1.32	0.06	0.06	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	68.39	48.65	-	5.52	3.22	2.23	2.54	-	1.1	0.68	0.77	1.1	-	0.16	0.03	3.34	13.78	0	1.32	0.06	0.06	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.64
H3152_050_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1664.19		818.02	1934.26	268.01	10.72		274.54	32.43	460.83	277.61		94.78	20.67	4506.51	8179.64	0.48	784.29	35.78	34.53	285.6																					150/day 8 days		0 1-10 75/day 11-100	20	100	0		48	100	25	37.1		25	25	0	25	25	25	2500	25	45																					113.69		47.6	20	100	0.2		48	100	25	37.1		25	25	0	25	25	25	25	25	45																						113.69		47.6	20	100	0.2		48	100	25	37.1		25	25	0	25	25	25	25	25	45																						15.77	-	3.24	3.22	2.23	2.14	-	1.1	0.27	0.96	0.86	-	0.2	0.04	-	17.04	0	1.63	0.07	0.07	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.93	15.77	-	3.24	3.22	2.23	2.14	-	1.1	0.27	0.96	0.86	-	0.2	0.04	-	17.04	0	1.63	0.07	0.07	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.93
H3152_051_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1664.19		818.02	1934.26	268.01	10.72		274.54	32.43	460.83	277.61		94.78	20.67	4506.51	8179.64	0.48	784.29	35.78	34.53	285.6																					150/day 8 days		0 1-7 75 8-14 125 15-100	20	100	0		48	100	25	50.65		25	25	0	25	25	25	2500	25	45																					113.69		81.02	20	100	0.2		48	100	25	50.65		25	25	0	25	25	25	25	25	45																						113.69		81.02	20	100	0.2		48	100	25	50.65		25	25	0	25	25	25	25	25	45																						15.77	-	5.52	3.22	2.23	2.14	-	1.1	0.27	0.96	1.17	-	0.2	0.04	-	17.04	0	1.63	0.07	0.07	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.53	15.77	-	5.52	3.22	2.23	2.14	-	1.1	0.27	0.96	1.17	-	0.2	0.04	-	17.04	0	1.63	0.07	0.07	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.53
H3152_052_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1677.54		818.02	1934.26	268.01	10.88		274.54	32.43	463.42	277.61		95.31	20.79	4005.79	8267.59	0.48	792.73	36.16	34.9	285.6																					250 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	20	47.36		20	20	10	20	20	20	2000	20	45																					40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						5.7	-	5.52	3.22	2.23	2.18	-	1.1	0.27	0.77	1.1	-	0.16	0.03	3.34	13.78	0	1.32	0.06	0.06	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.92	5.7	-	5.52	3.22	2.23	2.18	-	1.1	0.27	0.77	1.1	-	0.16	0.03	3.34	13.78	0	1.32	0.06	0.06	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.92
H3152_053_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1782.47		1803.98	1485.57	328.34	10.81		229.95	51.54	250.75	187.71		87.26	60.29	5453.99	5946.44	0.68	448.75	27.98	627.46	285.6																					250 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	20	47.36		20	20	10	20	20	20	2000	20	45																					40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						6.06	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.42	0.74	-	0.15	0.1	4.54	9.91	0	0.75	0.05	1.05	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.73	6.06	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.42	0.74	-	0.15	0.1	4.54	9.91	0	0.75	0.05	1.05	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.73
H3152_061_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	2374.55	23.99	1175.65	906.52	139.67	2.38	0.02	182.52	49.95	369.12	369.61	0.57	59.1	69.04	4689.97	5566.42	3.8	245.29	542.39	0	285.6	475.05																				50/day 1-10		0/day 1-5 75 6-14 125 15-100																																							40.82	40.82	86.25	30	100	0.2	0.2	46.75	100	30	36.84	30	30	30	20	30	30	30	30	0	45	30																					40.82	40.82	86.25	30	100	0.2	0.2	46.75	100	30	36.84	30	30	30	20	30	30	30	30		45	30																					8.08	0.08	8.45	2.27	1.16	0.48	0	0.71	0.42	0.92	1.13	0	0.15	0.17	7.82	13.92	0.01	0.61	1.36	-	1.07	1.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50	8.08	0.08	8.45	2.27	1.16	0.48	0	0.71	0.42	0.92	1.13	0	0.15	0.17	7.82	13.92	0.01	0.61	1.36	-	1.07	1.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50
H3152_062_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	1368.31	13.82	1175.65	906.52	139.67	2.38	0.02	182.52	49.95	373.29	359.4	0.58	59.77	69.82	4909.99	5687.43	3.8	250.62	554.18		285.6	475.05																				0		0/day 1-5 75 6-14 125 15-100																																							0	0	86.25	30	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20																					0	0	86.25	30	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20																					-	-	8.45	2.27	1.16	0.48	0	0.71	0.42	0.62	0.91	0	0.1	0.12	4.09	9.48	0.01	0.42	0.92	-	1.07	0.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.01	-	-	8.45	2.27	1.16	0.48	0	0.71	0.42	0.62	0.91	0	0.1	0.12	4.09	9.48	0.01	0.42	0.92	-	1.07	0.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.01
H3152_067_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P																																																						-	3454.57	34.89	1798.02	2340.49	357.58	5.82	0.06	435.42	215.7	769.13	870.05	0.4	380.14	46.79	10206.59	12999.7	3.8	621.32	906.73	0	605.47	1271.5						0				0	0	0	0	0	0	0	0	0	0	50/day 10 Days		0/day 1-5 75 6-14 125 15-100																																							40.82	40.82	86.25	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		40.82	40.82	86.25	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20								0		0	0	0	0	0	0	0	0	0	0		11.75	0.12	12.92	3.9	2.98	1.16	0.01	1.7	1.8	1.28	2.19	0	0.63	0.08	8.51	21.67	0.01	1.04	1.51	-	2.27	2.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.65	11.75	0.12	12.92	3.9	2.98	1.16	0.01	1.7	1.8	1.28	2.19	0	0.63	0.08	8.51	21.67	0.01	1.04	1.51	-	2.27	2.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.65
H3152_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1480.23	14.95	1232.62	1061.09	203.98	2.58	0.03	189.23	58.68	301.13	279.42	0.21	72.67	48.33	4347.18	5238.24	0.28	272.39	482.31	0	285.6	478.25						0														200 1-7 days	200 1-7 days	100 Days 1-100							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35	0	67.5	35	0	0	0	0	0	0	0	0													143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35		67.5	35								0													17.72	0.18	10.27	3.09	2.55	0.77	0.01	0.79	0.73	0.33	2.88	0	0.21	0.14	12.68	15.28	0	0.79	1.41	-	1.61	1.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.85	17.72	0.18	10.27	3.09	2.55	0.77	0.01	0.79	0.73	0.33	2.88	0	0.21	0.14	12.68	15.28	0	0.79	1.41	-	1.61	1.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.85
H3152_804_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1480.23	14.95	1232.62	1061.09	203.98	2.58	0.03	189.23	58.68	301.13	279.42	0.21	72.67	48.33	4347.18	5238.24	0.28	272.39	482.31	0	285.6	478.25						0														200 1-7 days	200 1-7 days	100 Days 1-100							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35	0	67.5	35	0	0	0	0	0	0	0	0													143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35		67.5	35								0													17.72	0.18	10.27	3.09	2.55	0.77	0.01	0.79	0.73	0.33	2.88	0	0.21	0.14	12.68	15.28	0	0.79	1.41	-	1.61	1.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.85	17.72	0.18	10.27	3.09	2.55	0.77	0.01	0.79	0.73	0.33	2.88	0	0.21	0.14	12.68	15.28	0	0.79	1.41	-	1.61	1.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.85
H3152_805_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1480.23	14.95	1232.62	1061.09	203.98	2.58	0.03	189.23	58.68	301.13	279.42	0.21	72.67	48.33	4347.18	5238.24	0.28	272.39	482.31	0	285.6	478.25						0														200 1-7 days	200 1-7 days	100 Days 1-100							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35	0	67.5	35	0	0	0	0	0	0	0	0													143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35		67.5	35								0													17.72	0.18	10.27	3.09	2.55	0.77	0.01	0.79	0.73	0.33	2.88	0	0.21	0.14	12.68	15.28	0	0.79	1.41	-	1.61	1.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.85	17.72	0.18	10.27	3.09	2.55	0.77	0.01	0.79	0.73	0.33	2.88	0	0.21	0.14	12.68	15.28	0	0.79	1.41	-	1.61	1.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.85
H3154_004_0	2006	Professional										3000	Routine Physicals										A		D	P		Coin		V	Coin					Coin	V	V			V													V										No																																										-	340.23		1138.44	11.07		9.63		171.25	16.55					70.21	3855.98	5989.36			506.53													68.99										425.50/Admit		0/day days 0-20 50/day days 21-100	20/day	75/Trip	15 coinsurance		50 copay waived upon admit w/I 24hrs.; AE to 31.87/visit	15 coinsurance					15 coinsurance	10/visit;.  Util displayed = FFS Util/28 since 72 of PCPs are capped	20/visit includes PT/SP/OT OP consultations Podiatry Chiro. Psychiatry			20 copay on Diagnostic x-ray and radiology																							425.5		17	20		0.15		31.87	0.15					0.15	10	20			20													10										No	357.56		14.29	0		0.13		26.78	0.13					0.13	8.4	16.81			16.81													8.4										0	10.14	-	1.36	-	-	1.21	-	0.38	2.09	-	-	-	-	8.85	2.7	8.39	-	-	0.71	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	35.87	10.14	-	1.36	-	-	1.21	-	0.38	2.09	-	-	-	-	8.85	2.7	8.39	-	-	0.71	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	35.87
H3154_005_0	2006	Professional										No	Routine Physicals										A							V							V	V																V										5000																																										-	365.02		0	0				188.13							3846.84	7796.46																97.86										400/admission							50 copay waived upon admit w/I 24hrs.; AE to 28.99/visit							15/visit;.  Util displayed = FFS Util/28 since 72 of PCPs are capped	25/visit includes PT/SP/OT OP consultations Podiatry Chiro. Psychiatry																15/physical										400		0	0				28.99							15	25																15										No	400		0	0				28.99							15	25																15										0	12.17	-	-	-	-	-	-	0.45	-	-	-	-	-	-	4.81	16.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.12	-	-	-	-	-	-	-	-	-	33.8	12.17	-	-	-	-	-	-	0.45	-	-	-	-	-	-	4.81	16.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.12	-	-	-	-	-	-	-	-	-	33.8
H3154_006_0	2006	Professional										No	Routine Physicals										A							V							V	V																V										5000																																										-	365.02		0	0				188.13							3846.84	7796.46																97.86										400/admission							50 copay waived upon admit w/I 24hrs.; AE to 28.99/visit							15/visit;.  Util displayed = FFS Util/28 since 72 of PCPs are capped	25/visit includes PT/SP/OT OP consultations Podiatry Chiro. Psychiatry																15/physical										400		0	0				28.99							15	25																15										No	400		0	0				28.99							15	25																15										0	12.17	-	-	-	-	-	-	0.45	-	-	-	-	-	-	4.81	16.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.12	-	-	-	-	-	-	-	-	-	33.8	12.17	-	-	-	-	-	-	0.45	-	-	-	-	-	-	4.81	16.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.12	-	-	-	-	-	-	-	-	-	33.8
H3154_801_0	2006	Professional										No	Routine Physicals										A							V							V	V																V										3000																																										-	314.83		0	0				157.19							4137.3	8689.53																135.92										750 Inpatient deductible; AE to 451.55/admit copay							50 copay waived upon admit w/I 24hrs.; AE to 29.46/visit							15/visit;.  Util displayed = FFS Util/28 since 72 of PCPs are capped	20/visit includes PT/SP/OT OP consultations Podiatry Chiro. Psychiatry																15/physical										451.55		0	0				29.46							15	20																15										No	451.55		0	0				29.46							15	20																15										0	11.85	-	-	-	-	-	-	0.39	-	-	-	-	-	-	5.17	14.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	32.06	11.85	-	-	-	-	-	-	0.39	-	-	-	-	-	-	5.17	14.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	32.06
H3154_802_0	2006	Professional										No	Routine Physicals										A							V							V	V																V										3000																																										-	314.83		0	0				157.19							4137.3	8689.53																135.92										750 Inpatient deductible; AE to 451.55/admit copay							50 copay waived upon admit w/I 24hrs.; AE to 29.46/visit							15/visit;.  Util displayed = FFS Util/28 since 72 of PCPs are capped	20/visit includes PT/SP/OT OP consultations Podiatry Chiro. Psychiatry																15/physical										451.55		0	0				29.46							15	20																15										No	451.55		0	0				29.46							15	20																15										0	11.85	-	-	-	-	-	-	0.39	-	-	-	-	-	-	5.17	14.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	32.06	11.85	-	-	-	-	-	-	0.39	-	-	-	-	-	-	5.17	14.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	32.06
H3154_805_0	2006	Professional										No	Routine Physicals										A							V							V	V																V										3000																																										-	314.83		0	0				157.19							4137.3	8689.53																135.92										750 Inpatient deductible; AE to 451.55/admit copay							50 copay waived upon admit w/I 24hrs.; AE to 29.46/visit							15/visit;.  Util displayed = FFS Util/28 since 72 of PCPs are capped	20/visit includes PT/SP/OT OP consultations Podiatry Chiro. Psychiatry																15/physical										451.55		0	0				29.46							15	20																15										No	451.55		0	0				29.46							15	20																15										0	11.85	-	-	-	-	-	-	0.39	-	-	-	-	-	-	5.17	14.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	32.06	11.85	-	-	-	-	-	-	0.39	-	-	-	-	-	-	5.17	14.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	32.06
H3156_021_0	2006											3000											D	D	D		T	Coin	Coin	V	P						V	V	V	V	V	V				V	V		V															5000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1339.52	28.13	1271.03	0	290.38	20.5	1.43	298.73	250.04	0	0	0	0	0	6039.66	7024.74	297.43	371.9	695.56	0	119.63	0	0	128.7	224.19	0	163.34	0	0	0	0											100/day 500 max/stay; 200/day 1000 max/stay	100/day 500 max/stay; 200/day 1000 max/stay	25 Copay/Day		50 Copay/Trip	20 Coinsurance	20 Coinsurance	50/Visit; 15 Urgent Care	75/Visit; 150/Visit						15 Copay/Visit	25 Copay/Visit	25 Copay/Visit	25 Copay/Visit	25 Copay/Visit	25 Copay/Visit				10 Copay/Visit	25 Copay/Visit		25 Copay/Visit															110	110	25	0	50	0.2	0.2	44.15	82.5	0	0	0	0	0	15	25	25	25	25	0	25	0	0	10	25	0	25	0	0	0	0											8000	104.55	104.55	23.76	0	47.52	0.19	0.19	41.96	78.41	0	0	0	0	0	14.26	23.76	23.76	23.76	23.76	0	23.76	0	0	9.5	23.76	0	23.76	0	0	0	0											0	11.67	0.25	2.52	-	1.15	3.9	0.27	1.04	1.63	-	-	-	-	-	7.18	13.91	0.59	0.74	1.38	-	0.24	-	-	0.1	0.44	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.32	11.67	0.25	2.52	-	1.15	3.9	0.27	1.04	1.63	-	-	-	-	-	7.18	13.91	0.59	0.74	1.38	-	0.24	-	-	0.1	0.44	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.32
H3156_024_0	2006											3000											D	D	D		T	Coin	Coin	V	P						V	V	V	V	V	V				V	V		V															5000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1337.98	28.1	1270.28	0	290.19	20.55	1.43	299.83	251.13	0	0	0	0	0	6042.09	7028.83	297.79	372.35	694.95	0	119.77	0	0	128.7	224.28	0	163.4	0	0	0	0											100/day 500 max/stay; 200/day 1000 max/stay	100/day 500 max/stay; 200/day 1000 max/stay	25 Copay/Day		50 Copay/Trip	20 Coinsurance	20 Coinsurance	50/Visit; 15 Urgent Care	75/Visit; 150/Visit						15 Copay/Visit	25 Copay/Visit	25 Copay/Visit	25 Copay/Visit	25 Copay/Visit	25 Copay/Visit				10 Copay/Visit	25 Copay/Visit		25 Copay/Visit															110	110	25	0	50	0.2	0.2	44.17	82.5	0	0	0	0	0	15	25	25	25	25	0	25	0	0	10	25	0	25	0	0	0	0											8000	104.54	104.54	23.76	0	47.52	0.19	0.19	41.98	78.41	0	0	0	0	0	14.26	23.76	23.76	23.76	23.76	0	23.76	0	0	9.5	23.76	0	23.76	0	0	0	0											0	11.66	0.24	2.52	-	1.15	3.91	0.27	1.05	1.64	-	-	-	-	-	7.18	13.92	0.59	0.74	1.38	-	0.24	-	-	0.1	0.44	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.34	11.66	0.24	2.52	-	1.15	3.91	0.27	1.05	1.64	-	-	-	-	-	7.18	13.92	0.59	0.74	1.38	-	0.24	-	-	0.1	0.44	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.34
H3156_801_0	2006											N/A											Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	338.74		37.83	10.82	19.88	14.05		7.04	35.91	46.97					294.55						73.58	0.73																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.06		0.16	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23	0.23																					0.06		0.16	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23	0.23																					21.38	-	6.02	-	4.63	3.27	-	1.64	8.37	10.94	-	-	-	-	68.63	-	-	-	-	-	17.15	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	142.21	21.38	-	6.02	-	4.63	3.27	-	1.64	8.37	10.94	-	-	-	-	68.63	-	-	-	-	-	17.15	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	142.21
H3156_802_0	2006											N/A											Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	338.74		37.83	10.82	19.88	14.05		7.04	35.91	46.97					294.55						73.58	0.73																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.06		0.16	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23	0.23																					0.06		0.16	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23	0.23																					21.38	-	6.02	-	4.63	3.27	-	1.64	8.37	10.94	-	-	-	-	68.63	-	-	-	-	-	17.15	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	142.21	21.38	-	6.02	-	4.63	3.27	-	1.64	8.37	10.94	-	-	-	-	68.63	-	-	-	-	-	17.15	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	142.21
H3164_003_0	2006											-											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	P											-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	375.93	19.57	50.42	26.93	14.04	16.35	7.3	510.6	30.03	13.22	40.73	0	1.42	18.61	59.54	144.79	9.52	3.18	20.08	21.1	10.78	2.61	17.95	0	3.25	0	0.67	0.32	0	0	20.35																																																				0.06	0.06	0.15	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											-	0.06	0.06	0.15	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	22.02	1.15	7.39	-	3.27	3.81	1.7	2.13	7	3.08	9.49	-	0.33	4.34	13.87	33.74	2.22	0.74	4.68	4.92	2.51	0.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	128.98	22.02	1.15	7.39	-	3.27	3.81	1.7	2.13	7	3.08	9.49	-	0.33	4.34	13.87	33.74	2.22	0.74	4.68	4.92	2.51	0.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	128.98
H3204_001_0	2006																						Ded	Ded	D		T	O	O	V	V					V	V	V	V	V				O		V	V		V																																																									-	136.64	3.09	287.25		188.08	69.75	627.78	283.94	442.76					323	3679.53	3693.69	271.19	222.86				74.6		0.39	519.76		29.86																																							25 - 30																																																											350	350	100		50	20	20	50	100					10	15	30	30	15				20		30	25.5		30																3.99	0.09	2.39	-	0.78	0.12	1.05	1.18	3.69	-	-	-	-	0.27	4.6	9.23	0.68	0.28	-	-	-	0.12	-	0	1.1	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.65	3.99	0.09	2.39	-	0.78	0.12	1.05	1.18	3.69	-	-	-	-	0.27	4.6	9.23	0.68	0.28	-	-	-	0.12	-	0	1.1	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.65
H3204_007_0	2006																						Ded	Ded			T			V	V						V	V	V	V						V	V		V																																																									-	136.64	3.09			188.08			283.94	442.76						3679.53	3693.69	271.19	222.86						0.39	519.76		29.86																														20-Oct									20 - 30																																																											100	250			50			50	75						10	19.08	20	10						20	21		20																1.14	0.06	-	-	0.78	-	-	1.18	2.77	-	-	-	-	-	3.07	5.87	0.45	0.19	-	-	-	-	-	0	0.91	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.48	1.14	0.06	-	-	0.78	-	-	1.18	2.77	-	-	-	-	-	3.07	5.87	0.45	0.19	-	-	-	-	-	0	0.91	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.48
H3204_008_0	2006																						Ded	Ded			T			V	V						V	V	V	V						V	V		V																																																									-	136.64	3.09			188.08			283.94	442.76						3679.53	3693.69	271.19	222.86						0.39	519.76		29.86																														20-Oct									20 - 30																																																											100	250			50			50	75						10	19.08	20	10						20	21		20																1.14	0.06	-	-	0.78	-	-	1.18	2.77	-	-	-	-	-	3.07	5.87	0.45	0.19	-	-	-	-	-	0	0.91	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.48	1.14	0.06	-	-	0.78	-	-	1.18	2.77	-	-	-	-	-	3.07	5.87	0.45	0.19	-	-	-	-	-	0	0.91	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.48
H3204_801_0	2006																						Ded	Ded			T			V	V						V	V	V	V						V	V		V																																																									-	121.61	2.75			167.39			252.7	394.05						3274.78	3287.38	241.36	198.35						0.35	462.59		26.58																														20-Oct									20 - 30																																																											100	250			50			50	75						10	19.08	20	10						20	21		20																1.01	0.06	-	-	0.7	-	-	1.05	2.46	-	-	-	-	-	2.73	5.23	0.4	0.17	-	-	-	-	-	0	0.81	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.66	1.01	0.06	-	-	0.7	-	-	1.05	2.46	-	-	-	-	-	2.73	5.23	0.4	0.17	-	-	-	-	-	0	0.81	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.66
H3204_802_0	2006																						Ded	Ded			T			V	V						V	V	V	V						V	V		V																																																									-	121.61	2.75			167.39			252.7	394.05						3274.78	3287.38	241.36	198.35						0.35	462.59		26.58																														20-Oct									20 - 30																																																											100	250			50			50	75						10	19.08	20	10						20	21		20																1.01	0.06	-	-	0.7	-	-	1.05	2.46	-	-	-	-	-	2.73	5.23	0.4	0.17	-	-	-	-	-	0	0.81	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.66	1.01	0.06	-	-	0.7	-	-	1.05	2.46	-	-	-	-	-	2.73	5.23	0.4	0.17	-	-	-	-	-	0	0.81	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.66
H3204_803_0	2006																						Ded	Ded			T			V	V						V	V	V	V						V	V		V																																																									-	121.61	2.75			167.39			252.7	394.05						3274.78	3287.38	241.36	198.35						0.35	462.59		26.58																														20-Oct									20 - 30																																																											100	250			50			50	75						10	19.08	20	10						20	21		20																1.01	0.06	-	-	0.7	-	-	1.05	2.46	-	-	-	-	-	2.73	5.23	0.4	0.17	-	-	-	-	-	0	0.81	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.66	1.01	0.06	-	-	0.7	-	-	1.05	2.46	-	-	-	-	-	2.73	5.23	0.4	0.17	-	-	-	-	-	0	0.81	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.66
H3204_804_0	2006																						Ded	Ded			T			V	V						V	V	V	V						V	V		V																																																									-	121.61	2.75			167.39			252.7	394.05						3274.78	3287.38	241.36	198.35						0.35	462.59		26.58																														20-Oct									20 - 30																																																											100	250			50			50	75						10	19.08	20	10						20	21		20																1.01	0.06	-	-	0.7	-	-	1.05	2.46	-	-	-	-	-	2.73	5.23	0.4	0.17	-	-	-	-	-	0	0.81	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.66	1.01	0.06	-	-	0.7	-	-	1.05	2.46	-	-	-	-	-	2.73	5.23	0.4	0.17	-	-	-	-	-	0	0.81	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.66
H3206_001_0	2006																						Ded	Ded			T			V	V					V	V	V	V	V		V		O			V		V																																																									-	208.62	2.97			249.3			548.1	371.7					352.8	3798.7	3416.6	155.7	585.9		1070.1		521.1			305.1		130.5																																																																																																		250	250			50			41.63	75					75	10	20	20	10		10.7		21			21		20																4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1	4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1
H3206_002_0	2006																						Ded	Ded			T			V	V					V	V	V	V	V		V		O			V		V																																																									-	208.62	2.97			249.3			548.1	371.7					352.8	3798.7	3416.6	155.7	585.9		1070.1		521.1			305.1		130.5																																																																																																		250	250			50			41.63	75					75	10	20	20	10		10.7		21			21		20																4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1	4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1
H3206_003_0	2006																						Ded	Ded			T			V	V					V	V	V	V	V		V		O			V		V																																																									-	208.62	2.97			249.3			548.1	371.7					352.8	3798.7	3416.6	155.7	585.9		1070.1		521.1			305.1		130.5																																																																																																		250	250			50			41.63	75					75	10	20	20	10		10.7		21			21		20																4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1	4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1
H3206_801_0	2006																						Ded	Ded			T			V	V					V	V	V	V	V		V		O			V		V																																																									-	208.62	2.97			249.3			548.1	371.7					352.8	3798.7	3416.6	155.7	585.9		1070.1		521.1			305.1		130.5																																																																																																		250	250			50			41.63	75					75	10	20	20	10		10.7		21			21		20																4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1	4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1
H3206_802_0	2006																						Ded	Ded			T			V	V					V	V	V	V	V		V		O			V		V																																																									-	208.62	2.97			249.3			548.1	371.7					352.8	3798.7	3416.6	155.7	585.9		1070.1		521.1			305.1		130.5																																																																																																		250	250			50			41.63	75					75	10	20	20	10		10.7		21			21		20																4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1	4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1
H3206_803_0	2006																						Ded	Ded			T			V	V					V	V	V	V	V		V		O			V		V																																																									-	208.62	2.97			249.3			548.1	371.7					352.8	3798.7	3416.6	155.7	585.9		1070.1		521.1			305.1		130.5																																																																																																		250	250			50			41.63	75					75	10	20	20	10		10.7		21			21		20																4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1	4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1
H3206_804_0	2006																						Ded	Ded			T			V	V					V	V	V	V	V		V		O			V		V																																																									-	208.62	2.97			249.3			548.1	371.7					352.8	3798.7	3416.6	155.7	585.9		1070.1		521.1			305.1		130.5																																																																																																		250	250			50			41.63	75					75	10	20	20	10		10.7		21			21		20																4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1	4.35	0.06	-	-	1.04	-	-	1.9	2.32	-	-	-	-	2.21	3.17	5.69	0.26	0.49	-	0.95	-	0.91	-	-	0.53	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.1
H3207_001_0	2006	DME/Prosthetics/Supplies											Diabetic Monitoring Supplies & Medicare Covered Eyewear										D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	P	V	Coin	O	V	O	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	1070.06	26.27	580.83	1460.12	207.51	7.15	1.74	262.31	231.26	483.33	515.03	17.88	27.52	370.59	7763.87	13994.76	179.64	131.08	2964.92	0	10.89	0	0	0	86.83	190.74	144.85	0	0	78.64	0	0.47										100 per admit Unlimited days	100 per day for days 1-5 Medicare Limits Apply	0 per day for days 0-100 Medicare Limits Apply	0 per visit copayment	50 per trip	10 per Item	10 per Item	50 per ER visit 20 per Urgent Care visit	75 per visit copayment	0 Copayment	50 per MRI MRA PET CT and NM; 10 Therapeutic Radiology; 0 for OP X-Rays	0 Copayment	75 per monthly bill copayment	5 OP Rehab 75 CORF 10 Partial Hosp.	10 per visit Copayment	20 per visit Copayment	10 per visit Copayment	5 per visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	Not Covered	Not Covered	Not Covered	30 per visit Copayment	150 Maximum 2-Year Benefit	20 per visit Copayment	Not Covered	Not Covered	No Cost Sharing	Not Covered	No Cost Sharing										19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.73	4.53	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.73	4.53	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											1.76	0.13	-	-	0.86	0.72	0.17	1.06	1.45	-	0.64	-	0.17	0.12	3.06	5.28	0.15	0.05	-	-	-	-	-	-	0.22	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.08	1.76	0.13	-	-	0.86	0.72	0.17	1.06	1.45	-	0.64	-	0.17	0.12	3.06	5.28	0.15	0.05	-	-	-	-	-	-	0.22	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.08
H3207_002_0	2006	DME/Prosthetics/Supplies											Diabetic Monitoring Supplies & Medicare Covered Eyewear										D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	P	V	Coin	O	V	O	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	1198.68	29.42	650.64	1795.94	255.23	10.93	2.66	264.13	232.87	486.69	518.6	18.01	27.71	373.16	8129.43	14957.87	188.03	137.2	3103.34	0	10.78	0	0	0	106.8	291.42	178.17	0	0	96.73	0	0.72										100 per admit Unlimited days	100 per day for days 1-5 Medicare Limits Apply	0 per day for days 0-100 Medicare Limits Apply	0 per visit copayment	50 per trip	10 per Item	10 per Item	50 per ER visit 20 per Urgent Care visit	75 per visit copayment	0 Copayment	50 per MRI MRA PET CT and NM; 10 Therapeutic Radiology; 0 for OP X-Rays	0 Copayment	75 per monthly bill copayment	5 OP Rehab 75 CORF 10 Partial Hosp.	10 per visit Copayment	20 per visit Copayment	10 per visit Copayment	5 per visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	Not Covered	Not Covered	Not Covered	30 per visit Copayment	150 Maximum 2-Year Benefit	20 per visit Copayment	Not Covered	Not Covered	No Cost Sharing	Not Covered	No Cost Sharing										19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.74	4.44	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.74	4.44	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											1.97	0.14	-	-	1.06	1.09	0.27	1.07	1.46	-	0.65	-	0.17	0.12	3.21	5.53	0.16	0.06	-	-	-	-	-	-	0.27	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.51	1.97	0.14	-	-	1.06	1.09	0.27	1.07	1.46	-	0.65	-	0.17	0.12	3.21	5.53	0.16	0.06	-	-	-	-	-	-	0.27	-	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.51
H3207_003_0	2006	DME/Prosthetics/Supplies											Diabetic Monitoring Supplies & Medicare Covered Eyewear										D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	P	V	Coin	O	V	O	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	1145.65	28.12	621.85	1875	266.47	11.85	2.88	281.5	248.18	518.69	552.7	19.19	29.53	397.7	7304.21	13033.41	168.87	123.22	2787.17	0	10.84	0	0	0	111.5	316.08	186.01	0	0	100.98	0	0.78										100 per admit Unlimited days	100 per day for days 1-5 Medicare Limits Apply	0 per day for days 0-100 Medicare Limits Apply	0 per visit copayment	50 per trip	10 per Item	10 per Item	50 per ER visit 20 per Urgent Care visit	75 per visit copayment	0 Copayment	50 per MRI MRA PET CT and NM; 10 Therapeutic Radiology; 0 for OP X-Rays	0 Copayment	75 per monthly bill copayment	5 OP Rehab 75 CORF 10 Partial Hosp.	10 per visit Copayment	20 per visit Copayment	10 per visit Copayment	5 per visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	Not Covered	Not Covered	Not Covered	30 per visit Copayment	150 Maximum 2-Year Benefit	20 per visit Copayment	Not Covered	Not Covered	No Cost Sharing	Not Covered	No Cost Sharing										19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.74	4.57	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.74	4.57	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											1.89	0.13	-	-	1.11	1.19	0.29	1.14	1.55	-	0.69	-	0.18	0.12	2.88	4.97	0.14	0.05	-	-	-	-	-	-	0.28	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.92	1.89	0.13	-	-	1.11	1.19	0.29	1.14	1.55	-	0.69	-	0.18	0.12	2.88	4.97	0.14	0.05	-	-	-	-	-	-	0.28	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.92
H3207_004_0	2006	DME/Prosthetics/Supplies											Diabetic Monitoring Supplies & Medicare Covered Eyewear										D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	P	V	Coin	O	V	O	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	1070.06	26.27	580.83	1460.12	207.51	7.15	1.74	262.31	231.26	483.33	515.03	17.88	27.52	370.59	7763.87	13994.76	179.64	131.08	2964.92	0	10.89	0	0	0	86.83	190.74	144.85	0	0	78.64	0	0.47										100 per admit Unlimited days	100 per day for days 1-5 Medicare Limits Apply	0 per day for days 0-100 Medicare Limits Apply	0 per visit copayment	50 per trip	10 per Item	10 per Item	50 per ER visit 20 per Urgent Care visit	75 per visit copayment	0 Copayment	50 per MRI MRA PET CT and NM; 10 Therapeutic Radiology; 0 for OP X-Rays	0 Copayment	75 per monthly bill copayment	5 OP Rehab 75 CORF 10 Partial Hosp.	10 per visit Copayment	20 per visit Copayment	10 per visit Copayment	5 per visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	Not Covered	Not Covered	Not Covered	30 per visit Copayment	150 Maximum 2-Year Benefit	20 per visit Copayment	Not Covered	Not Covered	No Cost Sharing	Not Covered	No Cost Sharing										19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.73	4.53	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.73	4.53	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											1.76	0.13	-	-	0.86	0.72	0.17	1.06	1.45	-	0.64	-	0.17	0.12	3.06	5.28	0.15	0.05	-	-	-	-	-	-	0.22	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.08	1.76	0.13	-	-	0.86	0.72	0.17	1.06	1.45	-	0.64	-	0.17	0.12	3.06	5.28	0.15	0.05	-	-	-	-	-	-	0.22	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.08
H3207_802_0	2006	DME/Prosthetics/Supplies											Diabetic Monitoring Supplies & Medicare Covered Eyewear										D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	V	V	P	V	Coin	O	V	O	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	1155.9	28.37	627.42	1578.04	224.27	8.47	2.06	267.03	235.43	492.04	524.31	18.2	28.01	377.27	8303.68	14816.6	178.33	130.12	2943.18	0	0	0	0	0	93.84	225.85	156.55	0	0	84.99	0	0.56										100 per admit Unlimited days	100 per day for days 1-5 Medicare Limits Apply	0 per day for days 0-100 Medicare Limits Apply	0 per visit copayment	50 per trip	10 per Item	10 per Item	50 per ER visit 20 per Urgent Care visit	75 per visit copayment	0 Copayment	50 per MRI MRA PET CT and NM; 10 Therapeutic Radiology; 0 for OP X-Rays	0 Copayment	75 per monthly bill copayment	5 OP Rehab 75 CORF 10 Partial Hosp.	10 per visit Copayment	20 per visit Copayment	10 per visit Copayment	5 per visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	Not Covered	Not Covered	Not Covered	30 per visit Copayment	150 Maximum 2-Year Benefit	20 per visit Copayment	Not Covered	Not Covered	No Cost Sharing	Not Covered	No Cost Sharing										19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.4	4.25	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											19.75	57.42	0	0	50	0.1	0.1	48.5	75	0	14.95	0	75	3.73	4.4	4.25	10	5	0	0	0	0	0	0	30	0	20	0	0	0	0	0											1.9	0.14	-	-	0.93	0.85	0.21	1.08	1.47	-	0.65	-	0.18	0.12	3.04	5.25	0.15	0.05	-	-	-	-	-	-	0.23	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.51	1.9	0.14	-	-	0.93	0.85	0.21	1.08	1.47	-	0.65	-	0.18	0.12	3.04	5.25	0.15	0.05	-	-	-	-	-	-	0.23	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.51
H3208_001_0	2006											2700											A		D	V	T	Coin	0	V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin				V		V				V											5000																																										-	231.93		676.8	1441.8	316.39	18.04	0	584.91	363.27	373.91	725.35	44.09		1217.03	4390.26	3828.69	177.62	222.1	8.97	4.29	2.88				687.84		115.06				672.52											100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance	0	50 emrg/20 Urgent	50 per visits	50 per visits	50 per visits	25 per visits		50 per visits	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance				25 per visit		25 per visist				15/25											394.68		20	10	100	0.1	0	47.92	50	50	50	25		50	15	25	25	25	0.1	0.1	0.1	0			25		25				20											7700	377.08		19.11	9.55	95.54	0.1	0	45.78	47.77	47.77	47.77	23.89		47.77	14.33	23.89	23.89	23.89	0.1	0.1	0.1	0			23.89		23.89				19.11												7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	1.37	-	0.23	-	-	-	1.07	-	-	-	-	-	-	-	-	-	-	44.63	7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	1.37	-	0.23	-	-	-	1.07	-	-	-	-	-	-	-	-	-	-	44.63
H3208_801_0	2006											2700											A		D	V	T	Coin		V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin																					5000																																										-	231.93		676.8	1441.8	316.39	18.04		584.91	363.27	373.91	725.35	44.09		1217.03	4390.26	3828.69	177.62	222.1	8.97	4.29	2.88																					100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance		50 emrg/20 Urgent	50 per visits	50 per visits	50 per visits	25 per visits		50 per visits	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance																					394.68		20	10	100	0.1		47.92	50	50	50	25		50	15	25	25	25	0.1	0.1	0.1																					7700	377.08		19.11	9.55	95.54	0.1		45.78	47.77	47.77	47.77	23.89		47.77	14.33	23.89	23.89	23.89	0.1	0.1	0.1																						7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.96	7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.96
H3208_802_0	2006											2700											A		D	V	T	Coin		V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin																					5000																																										-	231.93		676.8	1441.8	316.39	18.04		584.91	363.27	373.91	725.35	44.09		1217.03	4390.26	3828.69	177.62	222.1	8.97	4.29	2.88																					100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance		50 emrg/20 Urgent	50 per visits	50 per visits	50 per visits	25 per visits		50 per visits	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance																					394.68		20	10	100	0.1		47.92	50	50	50	25		50	15	25	25	25	0.1	0.1	0.1																					7700	377.08		19.11	9.55	95.54	0.1		45.78	47.77	47.77	47.77	23.89		47.77	14.33	23.89	23.89	23.89	0.1	0.1	0.1																						7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.96	7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.96
H3208_803_0	2006											2700											A		D	V	T	Coin		V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin																					5000																																										-	231.93		676.8	1441.8	316.39	18.04		584.91	363.27	373.91	725.35	44.09		1217.03	4390.26	3828.69	177.62	222.1	8.97	4.29	2.88																					100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance		50 emrg/20 Urgent	50 per visits	50 per visits	50 per visits	25 per visits		50 per visits	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance																					394.68		20	10	100	0.1		47.92	50	50	50	25		50	15	25	25	25	0.1	0.1	0.1																					7700	377.08		19.11	9.55	95.54	0.1		45.78	47.77	47.77	47.77	23.89		47.77	14.33	23.89	23.89	23.89	0.1	0.1	0.1																						7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.96	7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.96
H3208_804_0	2006											2700											A		D	V	T	Coin		V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin																					5000																																										-	231.93		676.8	1441.8	316.39	18.04		584.91	363.27	373.91	725.35	44.09		1217.03	4390.26	3828.69	177.62	222.1	8.97	4.29	2.88																					100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance		50 emrg/20 Urgent	50 per visits	50 per visits	50 per visits	25 per visits		50 per visits	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance																					394.68		20	10	100	0.1		47.92	50	50	50	25		50	15	25	25	25	0.1	0.1	0.1																					7700	377.08		19.11	9.55	95.54	0.1		45.78	47.77	47.77	47.77	23.89		47.77	14.33	23.89	23.89	23.89	0.1	0.1	0.1																						7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.96	7.29	-	1.08	1.15	2.52	1.72	-	2.23	1.45	1.49	2.89	0.09	-	4.84	5.24	7.62	0.35	0.44	0.86	0.41	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.96
H3209_001_0	2006											200											D	D	D	P	P	P	P	V	V	P	P	V	P	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	2262.09				1635.14																																					25 first 8 days				15 per trip																																					25				5																																						11.76				2.35																																						2.22	-	-	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.54	2.22	-	-	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.54
H3209_002_0	2006											400	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		P			T	V	V	P	V	P																																																								-	2164.08	496.97	839.26		276.35	24.3	21.4	770.98	309.18	1566.36	770.74	52.79	2.38	2005.69	109.64	3594.39	1033.54	649.53		808.64																						75 per Day	75 per Day	114 per Day		100	20	20	35	25	10	10	50	20	50		25	35 indiv/25 group	10		25																						75	75	60.08		100	0.2	0.2	35	25	10	10	50	0.2	46.38	25	25	32.5	13.61		25																							22.32	22.32	17.88		29.76	0.06	0.06	10.42	7.44	2.98	2.98	14.88	0.06	13.8	25	7.44	9.67	4.05		7.44																							4.03	0.92	1.25	-	0.69	1.45	1.27	0.67	0.19	0.39	0.19	0.07	0.14	2.31	0.23	2.23	0.83	0.22	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.57	4.03	0.92	1.25	-	0.69	1.45	1.27	0.67	0.19	0.39	0.19	0.07	0.14	2.31	0.23	2.23	0.83	0.22	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.57
H3251_002_0	2006																						D	D	D	V	T	O	O	P	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T		V	V	V				V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	262.39	6.27	61.31	182.55	280.63	1904.68	0	2950.91	1171.34	22098.25	1494.21	62.87	6.31	2041.95	5515.43	5366.88	104.87	156.21	2562.33	4215.8	2753.31	0.83	0		317.14	57.5	53.45				383.9											200 Copay / Adm	200 Copay / Adm	Various Copays	Various Copays	75 Copay	Various Copays		50 Copay	50 Copay		Copays for MRI CT			Various Copays	5 Copay	20 Copay	20 Copay	20 Copay	Various Copays	Various Copays	Various Copays				20 Copay	Various Copays	20 Copay				Various Copays											74.03	442.85	10.2	0.66	75	0.49	0	4.26	17.9	0	18.43	0.16	0	4.98	2.18	7.84	12.08	9.21	0.93	4.25	0.2	0	0	0	24.36	10.01	14.17	0	0	0	7.66												74.03	442.85	10.2	0.66	75	0.49		4.26	17.9	0	18.43	0.16	0	4.98	2.18	7.84	12.08	9.21	0.93	4.25	0.2	0			24.36	10.01	14.17				7.66												1.62	0.23	0.05	0.01	1.75	0.08	-	1.05	1.75	0	2.29	0	-	0.85	1	3.51	0.11	0.12	0.2	1.49	0.05	-	-	-	0.64	0.05	0.06	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	17.15	1.62	0.23	0.05	0.01	1.75	0.08	-	1.05	1.75	0	2.29	0	-	0.85	1	3.51	0.11	0.12	0.2	1.49	0.05	-	-	-	0.64	0.05	0.06	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	17.15
H3251_018_0	2006																						D	D	D	V	T	O		P	P	P	P	P	P	P	V	V	V	V	V	V	S	O			V	V	V				V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	265.68	6.41	58.18	178.62	267.61	1871.14		3003.43	1133.5	21398.5	1375.16	62.53	5.6	1911.3	5465.71	5261.07	104.66	242.65	2523.65	4116.28	2702.06	0.74			336.52	56.85	53.72				366.8											250 Copay / Adm	250 Copay / Adm	Various Copays	Various Copays	100 Copay	Various Copays		50 Copay	100 Copay		CT 50; MRI 100 Copay			Various Copays	15 Copay	20 Copay	20 Copay	20 Copay	Various Copays	Various Copays	Various Copays				20-30 Copay	Various Copays	20 Copay				Various Copays											80.54	437.45	10.01	0.71	11.69	0.49	0	4.26	18.12	0	4.46	0.23	0	5.28	3.01	8.06	12.08	9.32	0.99	4.22	0.25	0	0	0	23.76	9.73	14.78	0	0	0	7.91												80.54	437.45	10.01	0.71	11.69	0.49		4.26	18.12	0	4.46	0.23	0	5.28	3.01	8.06	12.08	9.32	0.99	4.22	0.25	0			23.76	9.73	14.78				7.91												1.78	0.23	0.05	0.01	0.26	0.08	-	1.07	1.71	0	0.51	0	-	0.84	1.37	3.53	0.11	0.19	0.21	1.45	0.06	-	-	-	0.67	0.05	0.07	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	14.48	1.78	0.23	0.05	0.01	0.26	0.08	-	1.07	1.71	0	0.51	0	-	0.84	1.37	3.53	0.11	0.19	0.21	1.45	0.06	-	-	-	0.67	0.05	0.07	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	14.48
H3251_021_0	2006																						D	D	D	V	T	O	O	P	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T		V	V	V				V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	262.39	6.27	61.31	182.55	280.63	1904.68	0	2950.91	1171.34	22098.25	1494.21	62.87	6.31	2041.95	5515.43	5366.88	104.87	156.21	2562.33	4215.8	2753.31	0.83	0		317.14	57.5	53.45				383.9											200 Copay / Adm	200 Copay / Adm	Various Copays	Various Copays	75 Copay	Various Copays		50 Copay	50 Copay		Copays for MRI CT			Various Copays	5 Copay	20 Copay	20 Copay	20 Copay	Various Copays	Various Copays	Various Copays				20 Copay	Various Copays	20 Copay				Various Copays											74.03	442.85	10.2	0.66	75	0.49	0	4.26	17.9	0	18.43	0.16	0	4.98	2.18	7.84	12.08	9.21	0.93	4.25	0.2	0	0	0	24.36	10.01	14.17	0	0	0	7.66												74.03	442.85	10.2	0.66	75	0.49		4.26	17.9	0	18.43	0.16	0	4.98	2.18	7.84	12.08	9.21	0.93	4.25	0.2	0			24.36	10.01	14.17				7.66												1.62	0.23	0.05	0.01	1.75	0.08	-	1.05	1.75	0	2.29	0	-	0.85	1	3.51	0.11	0.12	0.2	1.49	0.05	-	-	-	0.64	0.05	0.06	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	17.15	1.62	0.23	0.05	0.01	1.75	0.08	-	1.05	1.75	0	2.29	0	-	0.85	1	3.51	0.11	0.12	0.2	1.49	0.05	-	-	-	0.64	0.05	0.06	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	17.15
H3251_022_0	2006																						D	D	D	V	T	O		P	P	P	P	P	P	P	V	V	V	V	V	V	S	O			V	V	V				V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	265.68	6.41	58.18	178.62	267.61	1871.14		3003.43	1133.5	21398.5	1375.16	62.53	5.6	1911.3	5465.71	5261.07	104.66	242.65	2523.65	4116.28	2702.06	0.74			336.52	56.85	53.72				366.8											250 Copay / Adm	250 Copay / Adm	Various Copays	Various Copays	100 Copay	Various Copays		50 Copay	100 Copay		CT 50; MRI 100 Copay			Various Copays	15 Copay	20 Copay	20 Copay	20 Copay	Various Copays	Various Copays	Various Copays				20-30 Copay	Various Copays	20 Copay				Various Copays											80.54	437.45	10.01	0.71	11.69	0.49	0	4.26	18.12	0	4.46	0.23	0	5.28	3.01	8.06	12.08	9.32	0.99	4.22	0.25	0	0	0	23.76	9.73	14.78	0	0	0	7.91												80.54	437.45	10.01	0.71	11.69	0.49		4.26	18.12	0	4.46	0.23	0	5.28	3.01	8.06	12.08	9.32	0.99	4.22	0.25	0			23.76	9.73	14.78				7.91												1.78	0.23	0.05	0.01	0.26	0.08	-	1.07	1.71	0	0.51	0	-	0.84	1.37	3.53	0.11	0.19	0.21	1.45	0.06	-	-	-	0.67	0.05	0.07	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	14.48	1.78	0.23	0.05	0.01	0.26	0.08	-	1.07	1.71	0	0.51	0	-	0.84	1.37	3.53	0.11	0.19	0.21	1.45	0.06	-	-	-	0.67	0.05	0.07	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	14.48
H3251_801_0	2006																						D	D	D	V	T	O		P	P	P	P	P	P	P	V	V	V	V	V	V	S	O			V	V	V				V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	262.39	6.27	61.31	182.55	280.63	1904.68	0	2950.91	1171.34	22098.25	1494.21	62.87	6.31	2041.95	5515.43	5366.88	104.87	156.21	2562.33	4215.8	2753.31	0.83	0		317.14	57.5	53.45				383.9											200 Copay / Adm	200 Copay / Adm	Various Copays	Various Copays	50 Copay	Various Copays		50 Copay	50 Copay		Copays for MRI CT			Various Copays	5 Copay	20 Copay	20 Copay	20 Copay	Various Copays	Various Copays	Various Copays				20 Copay	Various Copays	20 Copay				Various Copays											74.03	442.85	10.2	0.66	12.08	0.49	0	4.26	17.9	0	12.74	0.16	0	4.98	2.18	7.84	12.08	9.21	0.93	4.25	0.2	0	0	0	24.36	10.01	14.17	0	0	0	7.66												74.03	442.85	10.2	0.66	12.08	0.49		4.26	17.9	0	12.74	0.16	0	4.98	2.18	7.84	12.08	9.21	0.93	4.25	0.2	0			24.36	10.01	14.17				7.66												1.62	0.23	0.05	0.01	0.28	0.08	-	1.05	1.75	0	1.59	0	-	0.85	1	3.51	0.11	0.12	0.2	1.49	0.05	-	-	-	0.64	0.05	0.06	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	14.97	1.62	0.23	0.05	0.01	0.28	0.08	-	1.05	1.75	0	1.59	0	-	0.85	1	3.51	0.11	0.12	0.2	1.49	0.05	-	-	-	0.64	0.05	0.06	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	14.97
H3305_007_0	2006	OP Facility - Other											MH Substance Abuse										A	A	Coin	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	Coin	P	P	P	Coin	O	T	P	P	P	P	P	O	O	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	282.74	3.38	34.68	1331.5	405.86	1	1.05	290.63	325.09	6040.16	585.57	65.79	16.01	772.16	7901.61	13135.91	0.86	909.82	3820.83	0	2.71	0	3.25	0.24	461.42	206.16	66.33	12.15	0	0	0.18	0.62										100 per admit 300 - OOP Max Unlimited Days	100 per admit 300 - OOP Max Unlimited Days	0 for days 0-10 25 for days 11-100	No Copay for visits 1-20 20 per Visit for Visits 21+	50 per trip	20 Coinsurance	20 Coinsurance	50 per ER Visit 20 per Urgent Care Visit	75 per Visit includes ASC	No Cost Sharing	20 per Visit for X-rays only	No Cost Sharing	No Cost Sharing	20 OP Rehab Only	15 per Visit	20 per Specialist Visit 15 per Pelvic Exam	20 for 1st OP MH visit 50 thereafter	20 per Visit	No Cost Sharing	No Cost Sharing	20 Coinsurance	No Cost Sharing	No Cost Sharing	240 Maximum Annual Benefit	15 per Visit	80 Maximum Annual Benefit	20 per Visit	600 Maximum 3-Year Benefit	Not Applicable	No Cost Sharing	Travel Benefit	20 for 1st OP MH visit 50 thereafter; 50 OP SA										85.72	85.72	0.13	4.66	50	0.2	0.2	48.59	75	0	18.31	0	0	7.44	8.51	8.4	0.44	20	0	0	0.2	0	0	0	15	0	20	0	0	0	0.3	0.42											85.72	85.72	0.13	4.66	50	0.2	0.2	48.59	75	0	18.31	0	0	7.44	8.51	8.4	0.44	20	0	0	0.2	0	0	0	15	0	20	0	0	0	0.3	0.42											2.02	0.02	4.49	0.52	1.69	0.2	0.21	1.18	2.03	-	0.89	-	-	0.48	5.6	9.19	0.38	1.52	-	-	0.54	-	-	-	0.58	-	0.11	-	-	-	0.06	0.26	-	-	-	-	-	-	-	-	-	31.97	2.02	0.02	4.49	0.52	1.69	0.2	0.21	1.18	2.03	-	0.89	-	-	0.48	5.6	9.19	0.38	1.52	-	-	0.54	-	-	-	0.58	-	0.11	-	-	-	0.06	0.26	-	-	-	-	-	-	-	-	-	31.97
H3305_011_0	2006	OP Facility - Other											MH Substance Abuse										A	A	Coin	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	Coin	P	P	P	Coin	O	T	P	P	P	P	P	O	O	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	282.74	3.38	34.68	1331.5	405.86	1	1.05	290.63	325.09	6040.16	585.57	65.79	16.01	772.16	7901.61	13135.91	0.86	909.82	3820.83	0	2.71	0	3.25	0.24	461.42	206.16	66.33	12.15	0	0	0.18	0.62										100 per admit 300 - OOP Max Unlimited Days	100 per admit 300 - OOP Max Unlimited Days	0 for days 0-10 25 for days 11-100	No Copay for visits 1-20 20 per Visit for Visits 21+	50 per trip	20 Coinsurance	20 Coinsurance	50 per ER Visit 20 per Urgent Care Visit	75 per Visit includes ASC	No Cost Sharing	20 per Visit for X-rays only	No Cost Sharing	No Cost Sharing	20 OP Rehab Only	15 per Visit	20 per Specialist Visit 15 per Pelvic Exam	20 for 1st OP MH visit 50 thereafter	20 per Visit	No Cost Sharing	No Cost Sharing	20 Coinsurance	No Cost Sharing	No Cost Sharing	240 Maximum Annual Benefit	15 per Visit	80 Maximum Annual Benefit	20 per Visit	600 Maximum 3-Year Benefit	Not Applicable	No Cost Sharing	Travel Benefit	20 for 1st OP MH visit 50 thereafter; 50 OP SA										85.72	85.72	0.13	4.66	50	0.2	0.2	48.59	75	0	18.31	0	0	7.44	8.51	8.4	0.44	20	0	0	0.2	0	0	0	15	0	20	0	0	0	0.3	0.42											85.72	85.72	0.13	4.66	50	0.2	0.2	48.59	75	0	18.31	0	0	7.44	8.51	8.4	0.44	20	0	0	0.2	0	0	0	15	0	20	0	0	0	0.3	0.42											2.02	0.02	4.49	0.52	1.69	0.2	0.21	1.18	2.03	-	0.89	-	-	0.48	5.6	9.19	0.38	1.52	-	-	0.54	-	-	-	0.58	-	0.11	-	-	-	0.06	0.26	-	-	-	-	-	-	-	-	-	31.97	2.02	0.02	4.49	0.52	1.69	0.2	0.21	1.18	2.03	-	0.89	-	-	0.48	5.6	9.19	0.38	1.52	-	-	0.54	-	-	-	0.58	-	0.11	-	-	-	0.06	0.26	-	-	-	-	-	-	-	-	-	31.97
H3305_801_0	2006	OP Facility - Other											MH Substance Abuse										A	A	Coin	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	Coin	P	P	P	Coin	Coin	T	P	V	P	V	P	O	O	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	270.84	3.29	36.11	1353.66	401.77	0.52	1.48	267.84	329.15	6643.39	419.66	66.71	12.65	798.38	8130.02	14107.13	1.08	1125.35	3833.9	0	1.51	0	3.31	0	508.34	0	70.32	0	0	0	0.25	0.54										100 per admit 300 OOP Max Unlimited Days	100 per admit 300 OOP Max	0 for days 0-10 25 for days 11-100	No Copay for visits 1-20 20 per Visit for Visits 21+	35 per trip	20 Coinsurance	20 Coinsurance	50 per ER Visit 20 per Urgent Care Visit	No Cost Sharing Includes ASC	No Cost Sharing	20 per Visit for X-rays only	No Cost Sharing	No Cost Sharing	20 OP Rehab includes Cardiac Rehab	15 per Visit	20 per Specialist Visit 15 per Pelvic Exam	20 for 1st OP MH visit 50 thereafter	20 per Visit	No Cost Sharing	No Cost Sharing	20 Coinsurance	No Cost Sharing	No Cost Sharing	Not Covered rider available	15 per Visit	Not Covered rider available	20 per Visit	Not Covered rider available	Not Applicable	Check with PBP	Travel Benefit	20 for 1st OP MH visit 50 thereafter 50 for Substance Abuse										85.72	85.72	0.13	4.66	35	0.2	0.2	48.27	0	0	17.23	0	0	8.38	8.37	8.79	0.44	20	0	0	0.2	0	0	0	15	0	20	0	0	0	0.3	0.42											85.72	85.72	0.13	4.66	35	0.2	0.2	48.27	0	0	17.23	0	0	8.38	8.37	8.79	0.44	20	0	0	0.2	0	0	0	15	0	20	0	0	0	0.3	0.42										0	1.93	0.02	4.67	0.53	1.17	0.1	0.3	1.08	-	-	0.6	-	-	0.56	5.67	10.34	0.47	1.88	-	-	0.3	-	-	-	0.64	-	0.12	-	-	-	0.08	0.23	-	-	-	-	-	-	-	-	-	30.68	1.93	0.02	4.67	0.53	1.17	0.1	0.3	1.08	-	-	0.6	-	-	0.56	5.67	10.34	0.47	1.88	-	-	0.3	-	-	-	0.64	-	0.12	-	-	-	0.08	0.23	-	-	-	-	-	-	-	-	-	30.68
H3305_803_0	2006	OP Facility - Other											MH Substance Abuse										A	A	Coin	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	Coin	P	P	P	Coin	Coin	T	P	V	P	V	P	O	O	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	270.84	3.29	36.11	1353.66	401.77	0.52	1.48	267.84	329.15	6643.39	419.66	66.71	12.65	798.38	8130.02	14107.13	1.08	1125.35	3833.9	0	1.51	0	3.31	0	508.34	0	70.32	0	0	0	0.25	0.54										100 per admit 300 OOP Max Unlimited Days	100 per admit 300 OOP Max	0 for days 0-10 25 for days 11-100	No Copay for visits 1-20 20 per Visit for Visits 21+	35 per trip	20 Coinsurance	20 Coinsurance	50 per ER Visit 20 per Urgent Care Visit	No Cost Sharing Includes ASC	No Cost Sharing	20 per Visit for X-rays only	No Cost Sharing	No Cost Sharing	20 OP Rehab includes Cardiac Rehab	15 per Visit	20 per Specialist Visit 15 per Pelvic Exam	20 for 1st OP MH visit 50 thereafter	20 per Visit	No Cost Sharing	No Cost Sharing	20 Coinsurance	No Cost Sharing	No Cost Sharing	Not Covered rider available	15 per Visit	Not Covered rider available	20 per Visit	Not Covered rider available	Not Applicable	Check with PBP	Travel Benefit	20 for 1st OP MH visit 50 thereafter 50 for Substance Abuse										85.72	85.72	0.13	4.66	35	0.2	0.2	48.27	0	0	17.23	0	0	8.38	8.37	8.79	0.44	20	0	0	0.2	0	0	0	15	0	20	0	0	0	0.3	0.42											85.72	85.72	0.13	4.66	35	0.2	0.2	48.27	0	0	17.23	0	0	8.38	8.37	8.79	0.44	20	0	0	0.2	0	0	0	15	0	20	0	0	0	0.3	0.42										0	1.93	0.02	4.67	0.53	1.17	0.1	0.3	1.08	-	-	0.6	-	-	0.56	5.67	10.34	0.47	1.88	-	-	0.3	-	-	-	0.64	-	0.12	-	-	-	0.08	0.23	-	-	-	-	-	-	-	-	-	30.68	1.93	0.02	4.67	0.53	1.17	0.1	0.3	1.08	-	-	0.6	-	-	0.56	5.67	10.34	0.47	1.88	-	-	0.3	-	-	-	0.64	-	0.12	-	-	-	0.08	0.23	-	-	-	-	-	-	-	-	-	30.68
H3307_002_0	2006											0											D	D	D		Coin			V	P		Coin			V	V	V	Coin	V		V																						0																																										-	2038.31	65.59	1464.98		7.2			185.22	191.02		9.78			352.5	5700.47	5935.94	1.96	359.54		118.3																						125/day up to 875 max per admit	125/day up to 875 max per admit	0 for 1st 5 days; 125/day from days 6-100						300 per surgery					25	15	25	50	25		250 IP surgery 200 Am Surg Phys																						89.81	60.52	96.85		20			50	299.48		20			23.96	14.95	24.82	50	24.72		222.05																						0	89.81	60.52	96.85		20			50	299.48		20			23.96	14.95	24.82	50	24.72		222.05																							15.26	0.33	11.82	-	1.44	-	-	0.77	4.77	-	1.96	-	-	0.7	7.1	12.28	0.98	0.74	-	2.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.34	15.26	0.33	11.82	-	1.44	-	-	0.77	4.77	-	1.96	-	-	0.7	7.1	12.28	0.98	0.74	-	2.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.34
H3307_011_0	2006											0											Ded	Ded	Ded	Ded	Ded	Ded	Ded	V	Ded				Ded	V	V	V	Coin	V		Ded	Ded																					0	25.17	0.29	3.25	0.01	0.55	0.03	0.02	0	1.82				0.07	0.01	0	2.6	0.02	0		3	0.44																					37.27								183.14						341.96	5592.68	5812.84	1.91	353.5																								Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible		Apply to Deductible				Apply to Deductible	20	10	20	50	20		Apply to Deductible	Apply to Deductible																												50						18.84	9.51	20	49.3	19.51																								0								50						18.84	9.51	20	49.3	19.51																								1500	-	-	-	-	-	-	-	0.76	-	-	-	-	-	0.54	4.43	9.69	0.94	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.94	25.17	0.29	3.25	0.01	0.55	0.03	0.02	0.76	1.82	-	-	-	0.07	0.55	4.43	12.29	0.97	0.57	-	3	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.21
H3307_012_0	2006											0											D	D	D		Coin			V	P		Coin			V	V	V	Coin	V		V																						0																																										-	1919.41	60.85	1431.72		6.59			207.36	317.23		44.7			458.58	6051.83	6253.69	1.7	359.92		120.28																						125/day up to 1500 max per admit	125/day up to 1500 max per admit	0 for 1st 5 days; 125/day from days 6-100		20			50	300 per visit		20 coins			25	15	25	50	25		250 IP surgery 200 Am Surg Phys																						107.26	70.04	99.53		20			49.92	299.37		6.4			23.93	14.95	24.96	49.3	24.64		132.87																						0	107.26	70.04	99.53		20			49.92	299.37		6.4			23.93	14.95	24.96	49.3	24.64		247.45																							17.16	0.36	11.87	-	1.32	-	-	0.86	7.91	-	2.87	-	-	0.91	7.54	13.01	0.84	0.74	-	2.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.87	17.16	0.36	11.87	-	1.32	-	-	0.86	7.91	-	2.87	-	-	0.91	7.54	13.01	0.84	0.74	-	2.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.87
H3307_013_0	2006											0											Ded	Ded	Ded	Ded	Ded	Ded	Ded	V	Ded				Ded	V	V	V	Coin	V		Ded	Ded																					0	36.54	0.38	4.23	0.07	0.88	0.35	0.16	0	2.65				1.14	0.14	0	7.48	0	0		4.73	2.37																					61.13								207.2						458.22	6051.82	6253.69	2.24	359.92																								Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	50	Apply to Deductible				Apply to Deductible	20	10	20	50	20		Apply to Deductible	Apply to Deductible																												49.92						19.22	9.59	18.54	49.3	20																								0								49.92						19.22	9.59	18.54	49.3	20																								2250	-	-	-	-	-	-	-	0.86	-	-	-	-	-	0.73	4.83	9.66	1.1	0.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.79	36.54	0.38	4.23	0.07	0.88	0.35	0.16	0.86	2.65	-	-	-	1.14	0.88	4.83	17.14	1.1	0.6	-	4.73	2.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.92
H3307_015_0	2006											0																		V						V		V	Coin	V						Coin																		0																																										-								117.02						279.9		6429.73	1	1832.18						13.6																															5 copay		5 copay		5 copay						coins varying by class of service from 0 to 70																									50						4.86		4.94	0.5	4.96						0.57																		0								50						4.82		4.94	50	4.93						0.57																			-	-	-	-	-	-	-	0.49	-	-	-	-	-	0.11	-	2.65	0.5	0.75	-	-	-	-	-	7.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.22	-	-	-	-	-	-	-	0.49	-	-	-	-	-	0.11	-	2.65	0.5	0.75	-	-	-	-	-	7.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.22
H3307_018_0	2006											0											D	D	D					V	P					V	V	V	Coin	V																								0																																										-	2049.88	67.75	1488.86					181.81	187.49					346	5595.87	5827.02	1.92	352.95																								80/day up to 640 max per admit	80/day up to 640 max per admit	0 for 1st 10 days; 75/day from days 11-100						100 per surgery					20	10	20	50 coins	20																								54.13	35.01	48.35					50	99.83					18.83	9.89	19.65	0.49	19.51																								0	54.13	35.01	48.35					50	99.83					18.83	9.89	19.65	0.49	19.51																									9.25	0.2	6	-	-	-	-	0.76	1.56	-	-	-	-	0.54	4.61	9.54	0.95	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.98	9.25	0.2	6	-	-	-	-	0.76	1.56	-	-	-	-	0.54	4.61	9.54	0.95	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.98
H3307_019_0	2006											0											D	D	D					V	P					V	V	V	Coin	V																								0																																										-	1919.41	60.85	1431.72					207.36	317.23					458.58	6051.83	6253.69	1.91	359.92																								80/day up to 800 max per admit	80/day up to 800 max per admit	0 for 1st 10 days; 75/day from days 11-100					50	100 per surgery					20	10	20	50 coins	20																								55.35	35.94	49.16					49.92	99.79					19.15	9.97	19.97	0.49	19.71																								0	55.35	35.94	49.16					49.92	99.79					19.15	9.97	19.97	0.49	19.71																									8.85	0.18	5.87	-	-	-	-	0.86	2.64	-	-	-	-	0.73	5.03	10.4	0.93	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.09	8.85	0.18	5.87	-	-	-	-	0.86	2.64	-	-	-	-	0.73	5.03	10.4	0.93	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.09
H3307_020_0	2006											0																		V						V		V	V	V																								0																																										-								153.73						125.77		3840.06	239.68	629.57																																																																								50						10		10	20	10																								0								50						10		10	20	10																									-	-	-	-	-	-	-	0.64	-	-	-	-	-	0.1	-	3.2	0.4	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.87	-	-	-	-	-	-	-	0.64	-	-	-	-	-	0.1	-	3.2	0.4	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.87
H3307_802_0	2006											0											D	D	D		Coin			V	P		Coin			V	V	V	Coin	V		V																						0																																										-	2079.46	68.43	1508.1		7.31			193.84	211.79		13.89			379.84	5811.93	6057.37	2.01	345.38		120.34																						125/day up to 1000 max per admit	125/day up to 1000 max per admit	0 for 1st 5 days; 125/day from days 6-100		20			50	300 per visit		20 coins			25	15	25	50	25		250 IP surgery 200 Am Surg Phys																						95.34	61.98	96.16		0.2			49.99	299.44		0.19			23.9	14.96	24.83	0.49	24.74		212.54																						0	95.34	61.98	96.16		0.2			49.99	299.44		0.19			23.9	14.96	24.83	0.49	24.74		212.54																							16.52	0.35	12.09	-	1.46	-	-	0.81	5.28	-	2.58	-	-	0.76	7.25	12.54	0.99	0.71	-	2.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.46	16.52	0.35	12.09	-	1.46	-	-	0.81	5.28	-	2.58	-	-	0.76	7.25	12.54	0.99	0.71	-	2.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.46
H3307_803_0	2006											0											Ded	Ded	Ded	Ded	Ded	Ded	Ded	V	Ded				Ded	V	V	V	Coin	V		Ded	Ded																					0	26.03	0.29	3.21	0.03	0.59	0.12	0.06	0	1.89				0.38	0.05	0	3.8	0.01	0		3.22	0.96																					40.65								199.78						412.97	5854.81	6079.46	2.1	348.05																								Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	Apply to Deductible	50	Apply to Deductible				Apply to Deductible	20	10	20	50 coins	20		Apply to Deductible	Apply to Deductible																												49.96						19.16	9.57	19.5	0.42	20																								0								49.96						19.16	9.57	19.5	0.42	20																								1525	-	-	-	-	-	-	-	0.83	-	-	-	-	-	0.66	4.67	9.88	0.89	0.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.52	26.03	0.29	3.21	0.03	0.59	0.12	0.06	0.83	1.89	-	-	-	0.38	0.71	4.67	13.68	0.91	0.58	-	3.22	0.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.17
H3312_002_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1677.4	16.94	1115.41	950.03	175.51	2.46	0.02	202.9	18.48	321.45	241.97	0.69	109.31	28.46	5130.26	7832.81	1.2	703.9	471.6	0	285.6	842.19						0														50/day 400 max	50/day 400 max	0/day 1-8 75/day 9-15 125/d 16-100																																							37.9	37.9	77.39	0	25	0	0	46.1	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20																					37.9	37.9	77.39	0	25	0	0	46.1	100	20	30.26	20	20	20	10	20	20	20	20		45	20								0													5.3	0.05	7.19	-	0.37	-	-	0.78	0.15	0.54	0.61	0	0.18	0.05	4.28	13.05	0	1.17	0.79	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.99	5.3	0.05	7.19	-	0.37	-	-	0.78	0.15	0.54	0.61	0	0.18	0.05	4.28	13.05	0	1.17	0.79	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.99
H3312_018_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1604.04	16.2	1248.21	1232.8	218.12	2.01	0.02	231.75	46.68	810.12	238.2	0.38	62.59	39.56	3808.94	9532.55	0.38	648.53	578.71	0	285.6	690.72						0														750	75000	0/day 1-8 75/d 9-15 125/d 16-100																																							122.35	122.35	77.39	30	100	0.2	0.2	46.75	100	35	40.13	35	35	35	30	35	35	35	35	0	45	30																					122.35	122.35	77.39	30	100	0.2	0.2	46.75	100	35	40.13	35	35	35	30	35	35	35	35		45	30								0													16.35	0.17	8.05	3.08	1.82	0.4	0	0.9	0.39	2.36	0.8	0	0.18	0.12	9.52	27.8	0	1.89	1.69	-	1.07	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.33	16.35	0.17	8.05	3.08	1.82	0.4	0	0.9	0.39	2.36	0.8	0	0.18	0.12	9.52	27.8	0	1.89	1.69	-	1.07	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.33
H3312_025_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1740.68	17.58	1459.83	1010.02	195.5	2.89	0.03	172.26	36.05	316.31	316.13	0.38	261.68	21.03	3771.69	8191.69	3.83	969.53	514.78	0	285.6	842.92						0														0	0	0/day 1-8 75/d 9-15 125/d 16-100																																							0	0	77.39	0	100	0	0	46.1	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20																					0	0	77.39	0	100	0	0	46.1	100	20	30.26	20	20	20	10	20	20	20	20		45	20								0													-	-	9.41	-	1.63	-	-	0.66	0.3	0.53	0.8	0	0.44	0.04	3.14	13.65	0.01	1.62	0.86	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.55	-	-	9.41	-	1.63	-	-	0.66	0.3	0.53	0.8	0	0.44	0.04	3.14	13.65	0.01	1.62	0.86	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.55
H3312_028_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1684.31	17.01	1117.66	950.03	175.51	2.46	0.02	202.9	18.48	321.45	241.97	0.69	109.31	28.46	5771.54	7832.81	1.2	703.9	471.6	0	285.6	842.19						0														0	0	0/day 1-8 75/day 9-15 125/d 16-100																																							0	0	77.39	0	25	0	0	46.1	100	20	30.26	20	20	20	0	20	20	20	20	0	45	20																					0	0	77.39	0	25	0	0	46.1	100	20	30.26	20	20	20	0	20	20	20	20		45	20								0													-	-	7.21	-	0.37	-	-	0.78	0.15	0.54	0.61	0	0.18	0.05	-	13.05	0	1.17	0.79	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.37	-	-	7.21	-	0.37	-	-	0.78	0.15	0.54	0.61	0	0.18	0.05	-	13.05	0	1.17	0.79	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.37
H3312_036_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1684.31	17.01	1115.41	921.53	175.51	2.46	0.02	234.87	19.25	330.43	243.7	0.71	112.36	29.26	5771.54	8082.79	1.24	726.37	486.65	0	285.6	842.19						0														0	0	0  1-10 days 75 11-100 days																																							0	0	47.6	10	20	0	0	18.7	0	10	23.68	10	10	10	0	10	10	10	10	0	45	10																					0	0	47.6	10	20	0	0	18.7	0	10	23.68	10	10	10	0	10	10	10	10		45	10								0													-	-	4.42	0.77	0.29	-	-	0.37	-	0.28	0.48	0	0.09	0.02	-	6.74	0	0.61	0.41	-	1.07	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.25	-	-	4.42	0.77	0.29	-	-	0.37	-	0.28	0.48	0	0.09	0.02	-	6.74	0	0.61	0.41	-	1.07	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.25
H3312_037_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1684.31	17.01	1117.66	950.03	175.51	2.46	0.02	202.9	18.48	321.45	241.97	0.69	109.31	28.46	5130.26	7832.81	1.2	703.9	471.6	0	285.6	842.19						0														0	0	0/day 1-8 75/day 9-15 125/d 16-100																																							0	0	77.39	0	100	0	0	46.1	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20																					0	0	77.39	0	100	0	0	46.1	100	20	30.26	20	20	20	10	20	20	20	20		45	20								0													-	-	7.21	-	1.46	-	-	0.78	0.15	0.54	0.61	0	0.18	0.05	4.28	13.05	0	1.17	0.79	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.75	-	-	7.21	-	1.46	-	-	0.78	0.15	0.54	0.61	0	0.18	0.05	4.28	13.05	0	1.17	0.79	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.75
H3312_040_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1604.04	16.2	1248.21	1273.44	218.12	2.01	0.02	231.75	46.68	810.12	238.2	0.38	62.59	39.56	4061.31	9532.55	0.38	648.53	578.71	0	285.6	690.72						0														750	75000	0/day 1-10 75/day 11-100																																							122.35	122.35	47.6	20	100	0.2	0.2	46.75	100	35	40.13	35	35	35	20	35	35	35	35	0	45	35																					122.35	122.35	47.6	20	100	0.2	0.2	46.75	100	35	40.13	35	35	35	20	35	35	35	35		45	35								0													16.35	0.17	4.95	2.12	1.82	0.4	0	0.9	0.39	2.36	0.8	0	0.18	0.12	6.77	27.8	0	1.89	1.69	-	1.07	2.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.81	16.35	0.17	4.95	2.12	1.82	0.4	0	0.9	0.39	2.36	0.8	0	0.18	0.12	6.77	27.8	0	1.89	1.69	-	1.07	2.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.81
H3312_043_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1733.55	17.51	1456.89	1010.02	195.5	2.89	0.03	172.26	36.05	316.31	316.13	0.38	261.68	21.03	3771.69	8191.69	3.83	969.53	514.78	0	285.6	842.92						0														50/day 400 max	50/day 400 max	0/day 1-8 75/d 9-15 125/d 16-100																																							37.9	37.9	77.39	0	25	0	0	46.1	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20																					37.9	37.9	77.39	0	25	0	0	46.1	100	20	30.26	20	20	20	10	20	20	20	20		45	20								0													5.47	0.06	9.4	-	0.41	-	-	0.66	0.3	0.53	0.8	0	0.44	0.04	3.14	13.65	0.01	1.62	0.86	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.84	5.47	0.06	9.4	-	0.41	-	-	0.66	0.3	0.53	0.8	0	0.44	0.04	3.14	13.65	0.01	1.62	0.86	-	1.07	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.84
H3312_044_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1740.68	17.58	1459.83	1010.02	195.5	2.89	0.03	172.26	36.05	316.31	316.13	0.38	261.68	21.03	4243.15	8191.69	3.83	969.53	514.78	0	285.6	842.92						0														0	0	0/day 1-8 75/d 9-15 125/d 16-100																																							0	0	77.39	0	25	0	0	46.1	100	20	30.26	20	20	20	0	20	20	20	20	0	45	30																					0	0	77.39	0	25	0	0	46.1	100	20	30.26	20	20	20	0	20	20	20	20		45	30								0													-	-	9.41	-	0.41	-	-	0.66	0.3	0.53	0.8	0	0.44	0.04	-	13.65	0.01	1.62	0.86	-	1.07	2.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.89	-	-	9.41	-	0.41	-	-	0.66	0.3	0.53	0.8	0	0.44	0.04	-	13.65	0.01	1.62	0.86	-	1.07	2.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.89
H3312_801_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1628.04	16.44	1356.58	1042.14	202.59	2.39	0.02	202.57	37.49	585.77	229.22	0	135.82	31.13	4624.06	8630.65	1.64	750.84	529.04	0	285.6	769.12						0														200/day for 7 days	200/day for 7 days	100/day for 100 days							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.5	104.9	35	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.5	104.9	35	35	35	35	35	35	35	35		67.5	35								0													19.49	0.2	11.3	3.04	2.53	0.72	0.01	0.84	0.47	0.41	2	-	0.4	0.09	13.49	25.17	0	2.19	1.54	-	1.61	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.76	19.49	0.2	11.3	3.04	2.53	0.72	0.01	0.84	0.47	0.41	2	-	0.4	0.09	13.49	25.17	0	2.19	1.54	-	1.61	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.76
H3312_804_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1628.04	16.44	1356.58	1042.14	202.59	2.39	0.02	202.57	37.49	585.77	229.22	0	135.82	31.13	4624.06	8630.65	1.64	750.84	529.04	0	285.6	769.12						0														200/day for 7 days	200/day for 7 days	100/day for 100 days							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.5	104.9	35	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.5	104.9	35	35	35	35	35	35	35	35		67.5	35								0													19.49	0.2	11.3	3.04	2.53	0.72	0.01	0.84	0.47	0.41	2	-	0.4	0.09	13.49	25.17	0	2.19	1.54	-	1.61	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.76	19.49	0.2	11.3	3.04	2.53	0.72	0.01	0.84	0.47	0.41	2	-	0.4	0.09	13.49	25.17	0	2.19	1.54	-	1.61	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.76
H3312_805_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1628.04	16.44	1356.58	1042.14	202.59	2.39	0.02	202.57	37.49	585.77	229.22	0	135.82	31.13	4624.06	8630.65	1.64	750.84	529.04	0	285.6	769.12						0														200/day for 7 days	200/day for 7 days	100/day for 100 days							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.5	104.9	35	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.5	104.9	35	35	35	35	35	35	35	35		67.5	35								0													19.49	0.2	11.3	3.04	2.53	0.72	0.01	0.84	0.47	0.41	2	-	0.4	0.09	13.49	25.17	0	2.19	1.54	-	1.61	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.76	19.49	0.2	11.3	3.04	2.53	0.72	0.01	0.84	0.47	0.41	2	-	0.4	0.09	13.49	25.17	0	2.19	1.54	-	1.61	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.76
H3327_001_0	2006											0																Coin		V						V	V	V	V	V		V		V																																																														-						7.87		239						75.25	3046	4500	357	242.75		1681		538																									0-20 DME		50 ER/25 UC						15 rehab copay	5 OV copay	15 OV copay	15 OV copay	15 OV copay		15 OV copay other prof		15 vision exam copay																									0.07		48.76						15	5	15	15	15		15		15																										0.07		48.76						15	5	15	15	15		15		15																				0	-	-	-	-	-	0.52	-	0.97	-	-	-	-	-	0.09	1.27	5.63	0.45	0.3	-	2.1	-	0.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12	-	-	-	-	-	0.52	-	0.97	-	-	-	-	-	0.09	1.27	5.63	0.45	0.3	-	2.1	-	0.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12
H3327_002_0	2006											0																Coin		V						V			V	V		V		V																																																														-						7.87		239						75.25			357	242.75		1681		538																									0-20 DME		50 ER/25 UC						15 rehab copay			15 OV copay	15 OV copay		15 OV copay other prof		15 OV vision copay																									0.07		48.76						15			15	15		15		15																										0.07		48.76						15			15	15		15		15																				0	-	-	-	-	-	0.52	-	0.97	-	-	-	-	-	0.09	-	-	0.45	0.3	-	2.1	-	0.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.11	-	-	-	-	-	0.52	-	0.97	-	-	-	-	-	0.09	-	-	0.45	0.3	-	2.1	-	0.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.11
H3327_003_0	2006											0																Coin		V						V	V	V	V	V		V		V																				5000																																										-						6.69		239						63.96	2589.1	3689.85	293.25	197.84		1376.15		442																									0-20 DME		50 ER/25 UC						20 rehab copay	5 OV copay	20 OV copay	20 OV copay	20 OV copay		20 OV copay other prof		20 OV vision copay																									0.07		48.76						20	5	20	20	20		20		20																				0						0.07		48.76						20	5	20	20	20		20		20																				0	-	-	-	-	-	0.44	-	0.97	-	-	-	-	-	0.11	1.08	6.15	0.49	0.33	-	2.29	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.6	-	-	-	-	-	0.44	-	0.97	-	-	-	-	-	0.11	1.08	6.15	0.49	0.33	-	2.29	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.6
H3327_013_0	2006											0																Coin		V						V	V	V	V	V		V		V																																																														-						7.87		239						75.25	3046	4341	345	232.75		1619		520																									0-20 DME		50 ER/25 UC						20 rehab copay	5 OV copay	20 OV copay	20 OV copay	20 OV copay		20 OV copay other prof		20 OV vision copay																									0.07		48.76						20	5	20	20	20		20		20																										0.07		48.76						20	5	20	20	20		20		20																				0	-	-	-	-	-	0.52	-	0.97	-	-	-	-	-	0.13	1.27	7.24	0.58	0.39	-	2.7	-	0.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.65	-	-	-	-	-	0.52	-	0.97	-	-	-	-	-	0.13	1.27	7.24	0.58	0.39	-	2.7	-	0.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.65
H3327_014_0	2006											0																Coin		V						V			V	V		V		V																																																														-						7.87		239						75.25			357	252.75		1736		555																									0-20 DME		50 ER/25 UC						10 rehab copay			15 OV copay	10 OV copay		10 OV copay other prof		10 OV vision copay																									0.07		48.76						10			15	10		10		10																										0.07		48.76						10			15	10		10		10																				0	-	-	-	-	-	0.52	-	0.97	-	-	-	-	-	0.06	-	-	0.45	0.21	-	1.45	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.12	-	-	-	-	-	0.52	-	0.97	-	-	-	-	-	0.06	-	-	0.45	0.21	-	1.45	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.12
H3327_015_0	2006											0											D	D				Coin		V	V					V	V	V	V	V		V		V																																																														-	960	14				6.14		235	236.8					74	2597	4691	352	326		1714		560																				100/day 1st 5 days	100/day 1st 5 days				0-20 DME		50 ER/25 UC	100 copay					20 copay	10 OV copay	20 OV copay	20 OV copay	20 OV copay		20 OV copay other prof		20 OV vision copay																				100	100				0.06		48.76	100					20	10	20	20	20		20		20																					100	100				0.06		48.76	100					20	10	20	20	20		20		20																				0	8	0.12	-	-	-	0.37	-	0.95	1.97	-	-	-	-	0.12	2.16	7.82	0.59	0.54	-	2.86	-	0.93	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.44	8	0.12	-	-	-	0.37	-	0.95	1.97	-	-	-	-	0.12	2.16	7.82	0.59	0.54	-	2.86	-	0.93	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.44
H3327_016_0	2006											0											D	D				Coin		V						V	V	V	V	V		V		V																																																														-	960	14				6.14		235						74	2626	4741	352	326		1714		560																				100/day 1st 5 days	100/day 1st 5 days				0-20 DME		50 ER/25 UC						20 copay	5 OV copay	20 OV copay	20 OV copay	20 OV copay		20 OV copay other prof		20 OV vision copay																				100	100				0.06		48.76						20	5	20	20	20		20		20																					100	100				0.06		48.76						20	5	20	20	20		20		20																				0	8	0.12	-	-	-	0.37	-	0.95	-	-	-	-	-	0.12	1.09	7.9	0.59	0.54	-	2.86	-	0.93	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.48	8	0.12	-	-	-	0.37	-	0.95	-	-	-	-	-	0.12	1.09	7.9	0.59	0.54	-	2.86	-	0.93	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.48
H3327_017_0	2006											0											D	D				Coin		V						V	V	V	V	V		V		V																				5000																																										-	816	11.9				5.22		235						62.9	2207.45	3987.35	299.2	277.1		1456.9		476																				100/day 1st 5 days	100/day 1st 5 days				0-20 DME		50 ER/25 UC						20 copay	10 OV copay	20 OV copay	20 OV copay	20 OV copay		20 OV copay other prof		20 OV vision copay																				100	100				0.06		48.76						20	10	20	20	20		20		20																				0	100	100				0.06		48.76						20	10	20	20	20		20		20																				0	6.8	0.1	-	-	-	0.31	-	0.95	-	-	-	-	-	0.1	1.84	6.65	0.5	0.46	-	2.43	-	0.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.94	6.8	0.1	-	-	-	0.31	-	0.95	-	-	-	-	-	0.1	1.84	6.65	0.5	0.46	-	2.43	-	0.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.94
H3327_021_0	2006											0											D	D				Coin		V						V	V	V	V	V		V		V																																																														-	858	13				6.23		330						104.25	2274	4877	235	267		1405		582																				50/day 1st 5 days	50/day 1st 5 days				0-20 DME		50 ER/25 UC						20 copay	10 OV copay	20 OV copay	20 OV copay	20 OV copay		20 OV copay other prof		20 OV vision copay																				50	50				0.06		48.75						20	10	20	20	20		20		20																					50	50				0.06		48.75						20	10	20	20	20		20		20																				0	3.58	0.05	-	-	-	0.35	-	1.34	-	-	-	-	-	0.17	1.9	8.13	0.39	0.45	-	2.34	-	0.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.66	3.58	0.05	-	-	-	0.35	-	1.34	-	-	-	-	-	0.17	1.9	8.13	0.39	0.45	-	2.34	-	0.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.66
H3327_022_0	2006											0											D	D				Coin		V						V	V	V	V	V		V		V																																																														-	858	13				6.23		330						104.25	2349	5036	243	276		1458		602																				50/day 1st 5 days	50/day 1st 5 days				0-20 DME		50 ER/25 UC						15 copay	5 OV copay	15 OV copay	15 OV copay	15 OV copay		15 OV copay other prof		15 OV vision copay																				50	50				0.06		48.75						15	5	15	15	15		15		15																					50	50				0.06		48.75						15	5	15	15	15		15		15																				0	3.58	0.05	-	-	-	0.35	-	1.34	-	-	-	-	-	0.13	0.98	6.3	0.3	0.35	-	1.82	-	0.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.94	3.58	0.05	-	-	-	0.35	-	1.34	-	-	-	-	-	0.13	0.98	6.3	0.3	0.35	-	1.82	-	0.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.94
H3327_023_0	2006											0											D	D				Coin		V						V	V	V	V	V		V		V																				5000																																										-	729.3	11.05				5.38		330						88.61	1932.9	4145.45	199.75	226.95		1194.25	0	494.7																				50/day 1st 5 days	50/day 1st 5 days				0-20 DME		50 ER/25 UC						20 copay	10 OV copay	20 OV copay	20 OV copay	20 OV copay		20 OV copay other prof		20 OV vision copay																				50	50				0.06		48.75						20	10	20	20	20		20		20																				0	50	50				0.06		48.75						20	10	20	20	20		20		20																				0	3.04	0.05	-	-	-	0.31	-	1.34	-	-	-	-	-	0.15	1.61	6.91	0.33	0.38	-	1.99	-	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.93	3.04	0.05	-	-	-	0.31	-	1.34	-	-	-	-	-	0.15	1.61	6.91	0.33	0.38	-	1.99	-	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.93
H3327_801_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	240.28	5.28	36.34	20.71	4.83	7.79	7.99	173.78	16.2	6.33	17.21		0.25	16.53	58.52	94.92	3.62	2.06	24.48	39.76	4.65	3.9																				5.45 Medicare equiv. coins	5.45 Medicare equiv. coins	16.23 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.05	0.05	0.16	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.05	0.05	0.16	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	13.1	0.29	5.9	-	1.13	1.82	1.86	0.71	3.77	1.47	4.01	-	0.06	3.85	13.64	22.12	0.84	0.48	5.7	9.26	1.08	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.99	13.1	0.29	5.9	-	1.13	1.82	1.86	0.71	3.77	1.47	4.01	-	0.06	3.85	13.64	22.12	0.84	0.48	5.7	9.26	1.08	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.99
H3327_802_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	240.28	5.28	36.34	20.71	4.83	7.79	7.99	173.78	16.2	6.33	17.21		0.25	16.53	58.52	94.92	3.62	2.06	24.48	39.76	4.65	3.9																				5.45 Medicare equiv. coins	5.45 Medicare equiv. coins	16.23 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.05	0.05	0.16	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.05	0.05	0.16	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	13.1	0.29	5.9	-	1.13	1.82	1.86	0.71	3.77	1.47	4.01	-	0.06	3.85	13.64	22.12	0.84	0.48	5.7	9.26	1.08	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.99	13.1	0.29	5.9	-	1.13	1.82	1.86	0.71	3.77	1.47	4.01	-	0.06	3.85	13.64	22.12	0.84	0.48	5.7	9.26	1.08	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.99
H3327_803_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0																																										-	204.24	4.49	30.89	17.6	4.11	6.62	6.79	173.78	13.77	5.38	14.63		0.21	14.05	49.74	80.68	3.08	1.75	20.8	33.8	3.95	3.32																				5.45 Medicare equiv. coins	5.45 Medicare equiv. coins	16.23 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.05	0.05	0.16	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	0.05	0.05	0.16	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	11.13	0.24	5.01	-	0.96	1.54	1.58	0.71	3.21	1.25	3.41	-	0.05	3.27	11.59	18.8	0.72	0.41	4.85	7.88	0.92	0.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.3	11.13	0.24	5.01	-	0.96	1.54	1.58	0.71	3.21	1.25	3.41	-	0.05	3.27	11.59	18.8	0.72	0.41	4.85	7.88	0.92	0.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.3
H3327_804_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0																																										-	204.24	4.49	30.89	17.6	4.11	6.62	6.79	173.78	13.77	5.38	14.63		0.21	14.05	49.74	80.68	3.08	1.75	20.8	33.8	3.95	3.32																				5.45 Medicare equiv. coins	5.45 Medicare equiv. coins	16.23 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.05	0.05	0.16	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	0.05	0.05	0.16	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	11.13	0.24	5.01	-	0.96	1.54	1.58	0.71	3.21	1.25	3.41	-	0.05	3.27	11.59	18.8	0.72	0.41	4.85	7.88	0.92	0.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.3	11.13	0.24	5.01	-	0.96	1.54	1.58	0.71	3.21	1.25	3.41	-	0.05	3.27	11.59	18.8	0.72	0.41	4.85	7.88	0.92	0.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.3
H3327_805_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	172.24	1.86	26.15	15	6.74	6.41	7.49	201.31	18.76	7.34	19.93		0.26	19.13	23.9	105.23	1.93	1.83	23.58	33.92	5.39	4.36																				8.18 Medicare equiv. coins	8.18 Medicare equiv. coins	20.86 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.08	0.08	0.21	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.21	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	14.1	0.15	5.46	-	1.57	1.49	1.75	0.82	4.37	1.71	4.64	-	0.06	4.46	5.57	24.52	0.45	0.43	5.49	7.9	1.26	1.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.21	14.1	0.15	5.46	-	1.57	1.49	1.75	0.82	4.37	1.71	4.64	-	0.06	4.46	5.57	24.52	0.45	0.43	5.49	7.9	1.26	1.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.21
H3327_806_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	172.24	1.86	26.15	15	6.74	6.41	7.49	201.31	18.76	7.34	19.93		0.26	19.13	23.9	105.23	1.93	1.83	23.58	33.92	5.39	4.36																				8.18 Medicare equiv. coins	8.18 Medicare equiv. coins	20.86 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.08	0.08	0.21	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08	0.21	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	14.1	0.15	5.46	-	1.57	1.49	1.75	0.82	4.37	1.71	4.64	-	0.06	4.46	5.57	24.52	0.45	0.43	5.49	7.9	1.26	1.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.21	14.1	0.15	5.46	-	1.57	1.49	1.75	0.82	4.37	1.71	4.64	-	0.06	4.46	5.57	24.52	0.45	0.43	5.49	7.9	1.26	1.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.21
H3327_807_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0																																										-	146.4	1.58	22.23	12.75	5.73	5.45	6.37	201.31	15.95	6.24	16.94		0.22	16.26	20.32	89.45	1.64	1.56	20.04	28.83	4.58	3.71																				8.18 Medicare equiv. coins	8.18 Medicare equiv. coins	20.86 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.08	0.08	0.21	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	0.08	0.08	0.21	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	11.98	0.13	4.64	-	1.33	1.27	1.48	0.82	3.72	1.45	3.95	-	0.05	3.79	4.73	20.84	0.38	0.36	4.67	6.72	1.07	0.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.25	11.98	0.13	4.64	-	1.33	1.27	1.48	0.82	3.72	1.45	3.95	-	0.05	3.79	4.73	20.84	0.38	0.36	4.67	6.72	1.07	0.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.25
H3327_808_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0																																										-	146.4	1.58	22.23	12.75	5.73	5.45	6.37	201.31	15.95	6.24	16.94		0.22	16.26	20.32	89.45	1.64	1.56	20.04	28.83	4.58	3.71																				8.18 Medicare equiv. coins	8.18 Medicare equiv. coins	20.86 Medicare equiv. coins	0.00 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	50 ER/23.3 UC	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins		23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins	23.30 Medicare equiv. coins																				0.08	0.08	0.21	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	0.08	0.08	0.21	0	0.23	0.23	0.23	48.75	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	11.98	0.13	4.64	-	1.33	1.27	1.48	0.82	3.72	1.45	3.95	-	0.05	3.79	4.73	20.84	0.38	0.36	4.67	6.72	1.07	0.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.25	11.98	0.13	4.64	-	1.33	1.27	1.48	0.82	3.72	1.45	3.95	-	0.05	3.79	4.73	20.84	0.38	0.36	4.67	6.72	1.07	0.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.25
H3328_001_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	0	0	0	0	138.13	0	0	247.85	0	0	0	0	0	158.24	4024.62	5872.06	274.99	952.48	0	2584.21	0	0	0	0	0	0	0	0	0	0	0															50 copay			50 copay						15 Copay Rehab/20 Copay MHSA	10 copay	20 copay	25 copay	20 copay																								0	0	0	0	20	0	0	49.96	0	0	0	0	0	17.19	10	20	25	20	0	20	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	20	0	0	49.96	0	0	0	0	0	17.19	10	20	25	20	0	20	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	0.23	-	-	1.03	-	-	-	-	-	0.23	3.35	9.79	0.57	1.59	-	4.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.1	-	-	-	-	0.23	-	-	1.03	-	-	-	-	-	0.23	3.35	9.79	0.57	1.59	-	4.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.1
H3328_002_0	2006																						A	A	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	2097.53	964.92	0	118.91	275.2	0	0	732.45	224.55	0	0	0	0	528.57	3798.96	4352.72	2551.17	475.89	0	2162.19	0	0	0	0	0	0	0	0	0	0	0											300 per admit	300 per admit		10 per visit				50 per visit							10 per visit	20 per visit	20 per visit	20 per visit		20 per visit																						51.03	27.54	0	10	50	0	0	50	35	0	0	0	0	20	10	20	20	20	0	20	0	0	0	0	0	0	0	0	0	0	0												51.03	27.54	0	10	50	0	0	50	35	0	0	0	0	20	10	20	20	20	0	20	0	0	0	0	0	0	0	0	0	0	0												8.92	2.21	-	0.1	1.15	-	-	3.05	0.65	-	-	-	-	0.88	3.17	7.25	4.25	0.79	-	3.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.04	8.92	2.21	-	0.1	1.15	-	-	3.05	0.65	-	-	-	-	0.88	3.17	7.25	4.25	0.79	-	3.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.04
H3328_003_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	0	0	0	0	138.13	0	0	247.85	0	0	0	0	0	158.24	4024.62	5872.06	274.99	952.48	0	2584.21	0	0	0	0	0	0	0	0	0	0	0															50 copay			50 copay						15 Copay Rehab/20 Copay MHSA	10 copay	20 copay	25 copay	20 copay																								0	0	0	0	20	0	0	49.96	0	0	0	0	0	17.19	10	20	25	20	0	20	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	20	0	0	49.96	0	0	0	0	0	17.19	10	20	25	20	0	20	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	0.23	-	-	1.03	-	-	-	-	-	0.23	3.35	9.79	0.57	1.59	-	4.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.1	-	-	-	-	0.23	-	-	1.03	-	-	-	-	-	0.23	3.35	9.79	0.57	1.59	-	4.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.1
H3330_021_1	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2263.24		1477.37	143.7	591.24	6.04	6.04	231.29	81.05					333.33	6639.16	8168.29	154.85	116.14	387.12	1935.61	2480.87			40.3	1398.52		338.76															100		25 (days 21-100)																																							14.93	0	5	0	100	0.2	0.2	50	75	0	0	0	0	75	5	15	25	15	15	15	0	15	20	10	25	0	20	0														none	14.93		5		100	0.2	0.2	50	75	0	0	0	0	75	5	15	25	15	15	15	0	15	20	10	25	0	20	0														0	2.81	-	0.62	-	4.93	1.21	1.21	0.96	0.51	-	-	-	-	2.08	2.77	10.21	0.32	0.15	0.48	2.42	-	-	-	0.03	2.91	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.19	2.81	-	0.62	-	4.93	1.21	1.21	0.96	0.51	-	-	-	-	2.08	2.77	10.21	0.32	0.15	0.48	2.42	-	-	-	0.03	2.91	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.19
H3330_021_2	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	Coin	V	V	O	O	O										n/a																																										-	2295.9		1343.91	154.66	382.03	6.22	6.22	188.38	143.75					333.33	6262.28	7704.62	146.06	109.54	365.15	1825.74				35.82	1370.17		1.99															250 (day 1) /50 day (days 2-10)		25 (days 21-100)																																							79.85	0	5	0	100	0.2	0.2	50	75	0	0	0	0	75	10	20	30	20	20	20	0	10	20	10	25	0	1	0														none	79.85		5		100	0.2	0.2	50	75	0	0	0	0	75	10	20	30	20	20	20	0	10	20	10	25	0	1	0														0	15.28	-	0.56	-	3.18	1.24	1.24	0.78	0.9	-	-	-	-	2.08	5.22	12.84	0.37	0.18	0.61	3.04	-	-	-	0.03	2.85	-	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.41	15.28	-	0.56	-	3.18	1.24	1.24	0.78	0.9	-	-	-	-	2.08	5.22	12.84	0.37	0.18	0.61	3.04	-	-	-	0.03	2.85	-	1.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.41
H3330_021_3	2006											none											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V				V	V		Coin															none																																										-	2247.41		1189.19		186.07	4.07	4.07	284.32	155.38					333.33	6008.08	7391.86	140.13	105.1	350.33	1751.63				33.58	1166.06		0.9															250/50 day		25 (21-100)																																							79.85		5		100	0.2	0.2	50	75					75	10	20	30	20	20	20				10	25		1															none	79.85		5		100	0.2	0.2	50	75					75	10	20	30	20	20	20				10	25		1																14.95	-	0.5	-	1.55	0.81	0.81	1.18	0.97	-	-	-	-	2.08	5.01	12.32	0.35	0.18	0.58	2.92	-	-	-	0.03	2.43	-	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.58	14.95	-	0.5	-	1.55	0.81	0.81	1.18	0.97	-	-	-	-	2.08	5.01	12.32	0.35	0.18	0.58	2.92	-	-	-	0.03	2.43	-	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.58
H3330_023_1	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	Coin	V	V	O	O	O										n/a																																										-	2286.94		1477.37	143.7	591.24	6.07	6.07	231.29	81.05					333.33	6591.02	8962.66	161.82	121.36	404.54	2022.72	2480.87			40.3	1398.52		1.27															250 (day 1) /50 day (days 2-10)		25 (days 21-100) Copay																																							37.31	0	5	0	100	0.2	0.2	50	75	0	0	0	0	75	5	25	25	25	25	25	0	15	20	10	15	0	1	0														none	37.31		5		100	0.2	0.2	50	75	0	0	0	0	75	5	25	25	25	25	25	0	15	20	10	15	0	1	0														0	7.11	-	0.62	-	4.93	1.21	1.21	0.96	0.51	-	-	-	-	2.08	2.75	18.67	0.34	0.25	0.84	4.21	-	-	-	0.03	1.75	-	1.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.75	7.11	-	0.62	-	4.93	1.21	1.21	0.96	0.51	-	-	-	-	2.08	2.75	18.67	0.34	0.25	0.84	4.21	-	-	-	0.03	1.75	-	1.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.75
H3330_023_2	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	Coin	V	V	O	O	O										n/a																																										-	2319.93		1343.91	154.66	382.03	6.29	6.29	188.38	143.75					333.33	6216.88	8453.89	152.63	114.47	381.58	1907.9				35.82	1370.17		2.01															300 (day 1) /50 day (days 2-10)		25 (days 21-100)																																							87.31	0	5	0	100	0.2	0.2	50	75	0	0	0	0	75	10	30	30	30	30	30	0	10	20	10	25	0	1	0														none	87.31		5		100	0.2	0.2	50	75	0	0	0	0	75	10	30	30	30	30	30	0	10	20	10	25	0	1	0														0	16.88	-	0.56	-	3.18	1.26	1.26	0.78	0.9	-	-	-	-	2.08	5.18	21.13	0.38	0.29	0.95	4.77	-	-	-	0.03	2.85	-	2.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.5	16.88	-	0.56	-	3.18	1.26	1.26	0.78	0.9	-	-	-	-	2.08	5.18	21.13	0.38	0.29	0.95	4.77	-	-	-	0.03	2.85	-	2.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.5
H3330_023_3	2006											none											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V				V	V		Coin															none																																										-	2270.95		1189.19		186.07	4.08	4.08	284.32	155.38					333.33	6627.24	9011.91	162.71	122.03	406.77	2033.83				33.58	1166.06		0.9															300/50 day		25 (21-100)																																							87.31		5		100	0.2	0.2	50	75					75	10	30	30	30	30	30		10	20	10	25		1															none	87.31		5		100	0.2	0.2	50	75					75	10	30	30	30	30	30		10	20	10	25		1																16.52	-	0.5	-	1.55	0.82	0.82	1.18	0.97	-	-	-	-	2.08	5.52	22.53	0.41	0.31	1.02	5.08	-	-	-	0.03	2.43	-	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.67	16.52	-	0.5	-	1.55	0.82	0.82	1.18	0.97	-	-	-	-	2.08	5.52	22.53	0.41	0.31	1.02	5.08	-	-	-	0.03	2.43	-	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.67
H3330_025_1	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2263.24		1477.37	143.7	591.24	6.04	6.04	231.29	81.05						6639.16	8168.29	154.85	116.14	387.12	1935.61	2480.87			40.3	1398.52		338.76																																																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														none	0		0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03
H3330_025_2	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2295.9		1343.91	154.66	382.03	6.22	6.22	188.38	143.75						6262.28	7704.62	146.06	109.54	365.15	1825.74	2051.25			35.82	1370.17		536.07																																																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														none	0		0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03
H3330_025_3	2006											none																																		V																		none																																										-																								33.58																																																																																		10																		none																								10																			-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03
H3330_026_0	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2267.88		1430.44	150.81	521.37	5.9	5.9	227.74	98.26				98.21	964.93	5916.6	7279.31	138	103.5	344.99	1724.96	2503.44			38.96	1374.99		366.68															250 (day 1) /50 day (days 2-10)		25 (days 21-100)																																							79.85	0	5	0	50	0.2	0.2	50	75	0	0	0	0	0	10	20	30	20	20	20	0	10	20	10	15	0	20	0														none	79.85		5		50	0.2	0.2	50	75	0	0	0	0	0	10	20	30	20	20	20	0	10	20	10	15	0	20	0														0	15.09	-	0.6	-	2.17	1.18	1.18	0.95	0.61	-	-	-	-	-	4.93	12.13	0.34	0.17	0.57	2.87	-	-	-	0.03	1.72	-	0.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.18	15.09	-	0.6	-	2.17	1.18	1.18	0.95	0.61	-	-	-	-	-	4.93	12.13	0.34	0.17	0.57	2.87	-	-	-	0.03	1.72	-	0.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.18
H3330_802_1	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2263.24		1477.37	143.7	591.24	6.04	6.04	231.29	81.05						6639.16	8168.29	154.85	116.14	387.12	1935.61	2480.87			40.3	1398.52		338.76															100		25 (days 21-100)																																							14.93	0	5	0	50	0.2	0.2	50	75	0	0	0	0	0	5	15	25	15	15	15	0	15	20	10	15	0	20	0														none	14.93		5		50	0.2	0.2	50	75	0	0	0	0	0	5	15	25	15	15	15	0	15	20	10	15	0	20	0														0	2.81	-	0.62	-	2.46	1.21	1.21	0.96	0.51	-	-	-	-	-	2.77	10.21	0.32	0.15	0.48	2.42	-	-	-	0.03	1.75	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.47	2.81	-	0.62	-	2.46	1.21	1.21	0.96	0.51	-	-	-	-	-	2.77	10.21	0.32	0.15	0.48	2.42	-	-	-	0.03	1.75	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.47
H3330_802_2	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2295.9		1343.91	154.66	382.03	6.22	6.22	188.38	143.75						6262.28	7704.62	146.06	109.54	365.15	1825.74				35.82	1370.17		536.07															250 (day 1) /50 day (days 2-10)		25 (days 21-100)																																							79.85	0	5	0	50	0.2	0.2	50	75	0	0	0	0	0	10	20	30	20	20	20	0	10	20	10	15	0	20	0														none	79.85		5		50	0.2	0.2	50	75	0	0	0	0	0	10	20	30	20	20	20	0	10	20	10	15	0	20	0														0	15.28	-	0.56	-	1.59	1.24	1.24	0.78	0.9	-	-	-	-	-	5.22	12.84	0.37	0.18	0.61	3.04	-	-	-	0.03	1.71	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.5	15.28	-	0.56	-	1.59	1.24	1.24	0.78	0.9	-	-	-	-	-	5.22	12.84	0.37	0.18	0.61	3.04	-	-	-	0.03	1.71	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.5
H3330_802_3	2006											none											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V				V	V		V															none																																										-	2247.41		1189.19		186.07	4.07	4.07	284.32	155.38						6008.08	7391.86	140.13	105.1	350.33	1751.63				33.58	1166.06		241.53															250/50 day		25 (21-100)																																							79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20				10	15		20															none	79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20				10	15		20																14.95	-	0.5	-	0.78	0.81	0.81	1.18	0.97	-	-	-	-	-	5.01	12.32	0.35	0.18	0.58	2.92	-	-	-	0.03	1.46	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.25	14.95	-	0.5	-	0.78	0.81	0.81	1.18	0.97	-	-	-	-	-	5.01	12.32	0.35	0.18	0.58	2.92	-	-	-	0.03	1.46	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.25
H3330_803_1	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2263.24		1477.37	143.7	591.24	6.04	6.04	231.29	81.05						6639.16	8168.29	154.85	116.14	387.12	1935.61	2480.87			40.3	1398.52		338.76															100		25 (days 21-100)																																							14.93	0	5	0	50	0.2	0.2	50	75	0	0	0	0	0	5	15	25	15	15	15	0	15	20	10	15	0	20	0														none	14.93		5		50	0.2	0.2	50	75	0	0	0	0	0	5	15	25	15	15	15	0	15	20	10	15	0	20	0														0	2.81	-	0.62	-	2.46	1.21	1.21	0.96	0.51	-	-	-	-	-	2.77	10.21	0.32	0.15	0.48	2.42	-	-	-	0.03	1.75	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.47	2.81	-	0.62	-	2.46	1.21	1.21	0.96	0.51	-	-	-	-	-	2.77	10.21	0.32	0.15	0.48	2.42	-	-	-	0.03	1.75	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.47
H3330_803_2	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2295.9		1343.91	154.66	382.03	6.22	6.22	188.38	143.75						6262.28	7704.62	146.06	109.54	365.15	1825.74				35.82	1370.17		536.07															250 (day 1) /50 day (days 2-10)		25 (days 21-100)																																							79.85	0	5	0	50	0.2	0.2	50	75	0	0	0	0	0	10	20	30	20	20	20	0	10	20	10	15	0	20	0														none	79.85		5		50	0.2	0.2	50	75	0	0	0	0	0	10	20	30	20	20	20	0	10	20	10	15	0	20	0														0	15.28	-	0.56	-	1.59	1.24	1.24	0.78	0.9	-	-	-	-	-	5.22	12.84	0.37	0.18	0.61	3.04	-	-	-	0.03	1.71	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.5	15.28	-	0.56	-	1.59	1.24	1.24	0.78	0.9	-	-	-	-	-	5.22	12.84	0.37	0.18	0.61	3.04	-	-	-	0.03	1.71	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.5
H3330_803_3	2006											none											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V				V	V		V															none																																										-	2247.41		1189.19		186.07	4.07	4.07	284.32	155.38						6008.08	7391.86	140.13	105.1	350.33	1751.63				33.58	1166.06		241.53															250/50 day		25 (21-100)																																							79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20				10	15		20															none	79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20				10	15		20																14.95	-	0.5	-	0.78	0.81	0.81	1.18	0.97	-	-	-	-	-	5.01	12.32	0.35	0.18	0.58	2.92	-	-	-	0.03	1.46	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.25	14.95	-	0.5	-	0.78	0.81	0.81	1.18	0.97	-	-	-	-	-	5.01	12.32	0.35	0.18	0.58	2.92	-	-	-	0.03	1.46	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.25
H3330_804_1	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2286.94		1477.37	143.7	591.24	6.07	6.07	231.29	81.05						6591.02	8962.66	161.82	121.36	404.54	2022.72	2480.87			40.3	1398.52		338.76															250 (day 1) /50 day (days 2-10)		25 (days 21-100) Copay																																							37.31	0	5	0	50	0.2	0.2	50	75	0	0	0	0	0	5	25	25	25	25	25	0	15	20	10	15	0	20	0														none	37.31		5		50	0.2	0.2	50	75	0	0	0	0	0	5	25	25	25	25	25	0	15	20	10	15	0	20	0														0	7.11	-	0.62	-	2.46	1.21	1.21	0.96	0.51	-	-	-	-	-	2.75	18.67	0.34	0.25	0.84	4.21	-	-	-	0.03	1.75	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.5	7.11	-	0.62	-	2.46	1.21	1.21	0.96	0.51	-	-	-	-	-	2.75	18.67	0.34	0.25	0.84	4.21	-	-	-	0.03	1.75	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.5
H3330_804_2	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2319.93		1343.91	154.66	382.03	6.29	6.29	188.38	143.75						6216.88	8453.89	152.63	114.47	381.58	1907.9				35.82	1370.17		536.07															300 (day 1) /50 day (days 2-10)		25 (days 21-100)																																							87.31	0	5	0	50	0.2	0.2	50	75	0	0	0	0	0	10	30	30	30	30	30	0	10	20	10	15	0	20	0														none	87.31		5		50	0.2	0.2	50	75	0	0	0	0	0	10	30	30	30	30	30	0	10	20	10	15	0	20	0														0	16.88	-	0.56	-	1.59	1.26	1.26	0.78	0.9	-	-	-	-	-	5.18	21.13	0.38	0.29	0.95	4.77	-	-	-	0.03	1.71	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.57	16.88	-	0.56	-	1.59	1.26	1.26	0.78	0.9	-	-	-	-	-	5.18	21.13	0.38	0.29	0.95	4.77	-	-	-	0.03	1.71	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.57
H3330_804_3	2006											none											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V				V	V		V															none																																										-	2270.95		1189.19		186.07	4.08	4.08	284.32	155.38						6627.24	9011.91	162.71	122.03	406.77	2033.83				33.58	1166.06		241.53															300/50 day		25 (21-100)																																							87.31		5		50	0.2	0.2	50	75						10	30	30	30	30	30		10	20	10	15		20															none	87.31		5		50	0.2	0.2	50	75						10	30	30	30	30	30		10	20	10	15		20																16.52	-	0.5	-	0.78	0.82	0.82	1.18	0.97	-	-	-	-	-	5.52	22.53	0.41	0.31	1.02	5.08	-	-	-	0.03	1.46	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.34	16.52	-	0.5	-	0.78	0.82	0.82	1.18	0.97	-	-	-	-	-	5.52	22.53	0.41	0.31	1.02	5.08	-	-	-	0.03	1.46	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.34
H3330_805_1	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2286.94		1477.37	143.7	591.24	6.07	6.07	231.29	81.05						6591.02	8962.66	161.82	121.36	404.54	2022.72	2480.87			40.3	1398.52		338.76															250 (day 1) /50 day (days 2-10)		25 (days 21-100) Copay																																							37.31	0	5	0	50	0.2	0.2	50	75	0	0	0	0	0	5	25	25	25	25	25	0	15	20	10	15	0	20	0														none	37.31		5		50	0.2	0.2	50	75	0	0	0	0	0	5	25	25	25	25	25	0	15	20	10	15	0	20	0														0	7.11	-	0.62	-	2.46	1.21	1.21	0.96	0.51	-	-	-	-	-	2.75	18.67	0.34	0.25	0.84	4.21	-	-	-	0.03	1.75	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.5	7.11	-	0.62	-	2.46	1.21	1.21	0.96	0.51	-	-	-	-	-	2.75	18.67	0.34	0.25	0.84	4.21	-	-	-	0.03	1.75	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.5
H3330_805_2	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2319.93		1343.91	154.66	382.03	6.29	6.29	188.38	143.75						6216.88	8453.89	152.63	114.47	381.58	1907.9				35.82	1370.17		536.07															300 (day 1) /50 day (days 2-10)		25 (days 21-100)																																							87.31	0	5	0	50	0.2	0.2	50	75	0	0	0	0	0	10	30	30	30	30	30	0	10	20	10	15	0	20	0														none	87.31		5		50	0.2	0.2	50	75	0	0	0	0	0	10	30	30	30	30	30	0	10	20	10	15	0	20	0														0	16.88	-	0.56	-	1.59	1.26	1.26	0.78	0.9	-	-	-	-	-	5.18	21.13	0.38	0.29	0.95	4.77	-	-	-	0.03	1.71	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.57	16.88	-	0.56	-	1.59	1.26	1.26	0.78	0.9	-	-	-	-	-	5.18	21.13	0.38	0.29	0.95	4.77	-	-	-	0.03	1.71	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.57
H3330_805_3	2006											none											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V				V	V		V															none																																										-	2270.95		1189.19		186.07	4.08	4.08	284.32	155.38						6627.24	9011.91	162.71	122.03	406.77	2033.83				33.58	1166.06		241.53															300/50 day		25 (21-100)																																							87.31		5		50	0.2	0.2	50	75						10	30	30	30	30	30		10	20	10	15		20															none	87.31		5		50	0.2	0.2	50	75						10	30	30	30	30	30		10	20	10	15		20																16.52	-	0.5	-	0.78	0.82	0.82	1.18	0.97	-	-	-	-	-	5.52	22.53	0.41	0.31	1.02	5.08	-	-	-	0.03	1.46	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.34	16.52	-	0.5	-	0.78	0.82	0.82	1.18	0.97	-	-	-	-	-	5.52	22.53	0.41	0.31	1.02	5.08	-	-	-	0.03	1.46	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.34
H3330_806_1	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2263.24		1477.37	143.7	591.24	6.04	6.04	231.29	81.05						6639.16	8168.29	154.85	116.14	387.12	1935.61	2480.87			40.3	1398.52		338.76																																																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														none	0		0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03
H3330_806_2	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2295.9		1343.91	154.66	382.03	6.22	6.22	188.38	143.75						6262.28	7704.62	146.06	109.54	365.15	1825.74	2051.25			35.82	1370.17		536.07																																																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														none	0		0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03
H3330_806_3	2006											none																																		V																		none																																										-																								33.58																																																																																		10																		none																								10																			-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03
H3330_807_1	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2263.24		1477.37	143.7	591.24	6.04	6.04	231.29	81.05						6639.16	8168.29	154.85	116.14	387.12	1935.61	2480.87			40.3	1398.52		338.76																																																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														none	0		0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03
H3330_807_2	2006											none											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	O	O	O										n/a																																										-	2295.9		1343.91	154.66	382.03	6.22	6.22	188.38	143.75						6262.28	7704.62	146.06	109.54	365.15	1825.74	2051.25			35.82	1370.17		536.07																																																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														none	0		0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0														0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03
H3330_807_3	2006											none																																		V																		none																																										-																								33.58																																																																																		10																		none																								10																			-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03
H3333_020_0	2006											2960											A	D	D	Coin	P	Coin	Coin	V	V	V	Coin	V	V	V	P	P	Coin	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	300.12	101.44	897.63	21.66	156.83	8.08	11.97	321.59	292.63	0	22.33	0	1.32	182.32	3591.6	4288.31	2.63	947.06	20.17	358.84	16.15	0	0	0	124	0	222	0	0	0	0											300	150 days 1-5	0 days 1-20 100 days 21-100	0	100	0	0	50	50 - ASC 75 OP Facility	0	0.1		50		10	25 - Spec. 30 - Chiro Podiatrist	1	25	10		0.2				25 - 1 Routine Exam		25 - 1 Routine Exam															300	107.55	27.6	0.15	100	0.2	0.2	50	68.76	0	0.09	0	50	43.4	10	25.24	0.5	26.71	0.09	24.99	0.2	0	0	0	25	0	25	0	0	0	0												300	107.55	27.6	0.15	100	0.2	0.2	50	68.76	0	0.09	0	50	43.4	10	25.24	0.5	26.71	0.09	24.99	0.2	0	0	0	25	0	25	0	0	0	0												7.5	0.91	2.06	3.25	1.31	1.62	2.39	1.34	1.68	-	2.01	-	0.01	0.66	2.99	9.02	1.3	2.11	1.81	0.75	3.23	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.67	7.5	0.91	2.06	3.25	1.31	1.62	2.39	1.34	1.68	-	2.01	-	0.01	0.66	2.99	9.02	1.3	2.11	1.81	0.75	3.23	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.67
H3333_022_0	2006											2960											A	D	D	Coin	P	Coin	Coin	V	V	V	Coin	V	V	V	P	P	Coin	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	300.12	101.44	897.63	21.66	156.83	8.08	11.97	321.59	292.63	0	22.33	0	1.32	182.32	3591.6	4288.31	2.63	947.06	20.17	358.84	16.15	0	0	0	124	0	222	0	0	0	0											150	75 days 1-5	0 days 1-20 100 days 21-100	0	50	0	0	35	25 - ASC 50 OP Facility	0	0.1		50		5	15 - Spec. 20 - Chiro Podiatrist	1	15	10		0.2				15 - 1 Routine Exam		15 - 1 Routine Exam															150	53.78	27.6	0.15	50	0.2	0.2	35	43.76	0	0.09	0	50	34.97	5	15.24	0.5	16.83	0.09	15	0.2	0	0	0	15	0	15	0	0	0	0												150	53.78	27.6	0.15	50	0.2	0.2	35	43.76	0	0.09	0	50	34.97	5	15.24	0.5	16.83	0.09	15	0.2	0	0	0	15	0	15	0	0	0	0												3.75	0.45	2.06	3.25	0.65	1.62	2.39	0.94	1.07	-	2.01	-	0.01	0.53	1.5	5.44	1.3	1.33	1.81	0.45	3.23	-	-	-	0.16	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.23	3.75	0.45	2.06	3.25	0.65	1.62	2.39	0.94	1.07	-	2.01	-	0.01	0.53	1.5	5.44	1.3	1.33	1.81	0.45	3.23	-	-	-	0.16	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.23
H3333_801_0	2006											2960											A	D	D	Coin	P	Coin	Coin	V	V	V	Coin	V	V	V	P	P	Coin	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	321.32	83.27	750.93	0	129.35	10.67	11.99	293.6	350.05	9783.08	21.33	43.63	1.19	973.6	3826.75	5228.96	2.39	850.14	24.69	13518.08	21.05	64.65	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				761.1	54.07	67.96	0	108.17	0.23	0.23	100.5	282.36	5.91	0.23	156.25	569.13	53.8	14.81	17.26	0.23	19.78	0.23	19.44	0.23	13.75	0	0	0	0	0	0	0	0	0												761.1	54.07	67.96	0	108.17	0.23	0.23	100.5	282.36	5.91	0.23	156.25	569.13	53.8	14.81	17.26	0.23	19.78	0.23	19.44	0.23	13.75	0	0	0	0	0	0	0	0	0												20.38	0.38	4.25	-	1.17	2.49	2.79	2.46	8.24	4.82	4.97	0.57	0.06	4.37	4.72	7.52	0.56	1.4	5.75	21.89	4.9	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.76	20.38	0.38	4.25	-	1.17	2.49	2.79	2.46	8.24	4.82	4.97	0.57	0.06	4.37	4.72	7.52	0.56	1.4	5.75	21.89	4.9	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.76
H3335_002_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	230.41	3.32	1345.61	0	222.68	17.58	1.23	395.77	356.65	0	755.69	0	204.95	222.57	4658.36	5525.25	232.97	291.3	782.74	1889.67	926.03	14.74	0	0	353.69	0	151.58	0	0	0	0											200 for 1st 2 admits	200 for 1st 2 admits						20 - 50																																		200	200	25	0	50	0.2	0.2	47.18	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0												200	200	25	0	50	0.2	0.2	47.18	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											0	3.84	0.06	2.8	-	0.93	3.52	0.25	1.56	2.97	-	1.26	-	0.34	0.37	5.82	9.21	0.39	0.49	1.3	3.15	1.54	0.02	-	-	0.59	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.66	3.84	0.06	2.8	-	0.93	3.52	0.25	1.56	2.97	-	1.26	-	0.34	0.37	5.82	9.21	0.39	0.49	1.3	3.15	1.54	0.02	-	-	0.59	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.66
H3335_003_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	230.87	3.33	1345.61	0	222.68	17.58	1.23	397.01	361.38	0	765.73	0	205.46	223.13	5008.99	5701.99	240.73	301.01	793.15	1909.77	935.88	14.74	0	0	365.48	0	156.63	0	0	0	0											100 for 1st 2 admits	100 for 1st 2 admits						15 - 50																																		100	100	25	0	50	0.2	0.2	46.61	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0												100	100	25	0	50	0.2	0.2	46.61	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											0	1.92	0.03	2.8	-	0.93	3.52	0.25	1.54	1.05	-	0.96	-	0.26	0.28	2.09	7.13	0.3	0.38	0.99	2.39	1.17	0.02	-	-	0.46	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.65	1.92	0.03	2.8	-	0.93	3.52	0.25	1.54	1.05	-	0.96	-	0.26	0.28	2.09	7.13	0.3	0.38	0.99	2.39	1.17	0.02	-	-	0.46	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.65
H3335_004_0	2006											1500											Coin	Coin	Coin		T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	O			V		Coin															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	200.26	2.14	42.96	0	236.4	16.86	1.18	322.75	17.82	6.97	18.93	0	5.28	18.75	21.49	6797.32	1.66	1.75	26.75	105.79	14.37	573.11	0	0	374.24	0	0.79	0	0	0	0																		50 or 10								15 25 or 10						25 or 10																				0.1	0.1	0.1	0	100	0.1	0.1	44.13	0.1	0.1	0.1	0	0.1	0.1	0.1	6.62	0.1	0.1	0.1	0.1	0.1	4	0	0	15	0	0.1	0	0	0	0											4000	0.07	0.07	0.1	0	100	0.07	0.07	43.91	0.07	0.07	0.07	0	0.07	0.07	0.06	4.94	0.07	0.07	0.07	0.07	0.07	2.84	0	0	15	0	0.07	0	0	0	0											0	13.07	0.14	4.3	-	1.97	1.1	0.08	1.18	1.16	0.45	1.24	-	0.34	1.22	1.37	2.8	0.11	0.11	1.75	6.91	0.94	0.14	-	-	0.47	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.9	13.07	0.14	4.3	-	1.97	1.1	0.08	1.18	1.16	0.45	1.24	-	0.34	1.22	1.37	2.8	0.11	0.11	1.75	6.91	0.94	0.14	-	-	0.47	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.9
H3335_005_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	255.05	3.68	1743.53	0	238.81	16.86	1.18	318.94	279.33	0	591.85	0	160.51	174.32	4770.05	5664.88	239.93	300.01	746.66	1946.14	953.7	15.09	0	0	362.17	0	155.21	0	0	0	0											250 for 1st 2 admits	250 for 1st 2 admits						20 - 50																																		250	250	25	0	50	0.2	0.2	46.41	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											3000	250	250	25	0	50	0.2	0.2	46.41	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											0	5.31	0.08	3.63	-	1	3.37	0.24	1.23	2.33	-	0.99	-	0.27	0.29	5.96	9.44	0.4	0.5	1.24	3.24	1.59	0.03	-	-	0.6	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42	5.31	0.08	3.63	-	1	3.37	0.24	1.23	2.33	-	0.99	-	0.27	0.29	5.96	9.44	0.4	0.5	1.24	3.24	1.59	0.03	-	-	0.6	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42
H3335_006_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	255.3	3.68	1743.53	0	238.81	16.86	1.18	320.21	283.04	0	599.72	0	160.92	174.76	5129.09	5846.14	247.93	310.01	756.58	1966.84	963.85	15.09	0	0	374.24	0	160.39	0	0	0	0											200 for 1st 2 admits	200 for 1st 2 admits						15 - 50																																		200	200	25	0	50	0.2	0.2	45.69	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											2500	200	200	25	0	50	0.2	0.2	45.69	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											0	4.26	0.06	3.63	-	1	3.37	0.24	1.22	0.83	-	0.75	-	0.2	0.22	2.14	7.31	0.31	0.39	0.95	2.46	1.2	0.02	-	-	0.47	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.2	4.26	0.06	3.63	-	1	3.37	0.24	1.22	0.83	-	0.75	-	0.2	0.22	2.14	7.31	0.31	0.39	0.95	2.46	1.2	0.02	-	-	0.47	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.2
H3335_007_0	2006											1500											Coin	Coin	Coin		T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	O			V		Coin															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	188.09	2.01	26.83	0	203.86	15.19	1.06	519.93	22.81	8.92	24.24	0	6.76	24	20.08	6186.45	1.39	1.47	18.86	90.43	12.06	482.33	0	0	349.76	0	0.74	0	0	0	0																		50 or 10								15 25 or 10						25 or 10																				0.1	0.1	0.1	0	100	0.1	0.1	46.6	0.1	0.1	0.1	0	0.1	0.1	0.1	6.7	0.1	0.1	0.1	0.1	0.1	4.06	0	0	15	0	0.1	0	0	0	0											4000	0.07	0.07	0.1	0	100	0.07	0.07	46.47	0.07	0.07	0.07	0	0.07	0.07	0.07	5.07	0.07	0.07	0.07	0.07	0.07	2.96	0	0	15	0	0.07	0	0	0	0											0	12.55	0.13	2.68	-	1.7	1.01	0.07	2.01	1.52	0.6	1.62	-	0.45	1.6	1.31	2.61	0.09	0.1	1.26	6.04	0.8	0.12	-	-	0.44	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.77	12.55	0.13	2.68	-	1.7	1.01	0.07	2.01	1.52	0.6	1.62	-	0.45	1.6	1.31	2.61	0.09	0.1	1.26	6.04	0.8	0.12	-	-	0.44	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.77
H3335_008_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	228.3	3.29	1085.31	0	205.94	15.19	1.06	516.36	478.21	0	1013.25	0	274.8	298.43	4458.05	5175.33	201.32	251.73	682.86	1632.99	800.24	14.1	0	0	338.48	0	145.06	0	0	0	0											250 for 1st 2 admits	250 for 1st 2 admits						20 - 50																																		250	250	25	0	50	0.2	0.2	47.93	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											3000	250	250	25	0	50	0.2	0.2	47.93	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											0	4.76	0.07	2.26	-	0.86	3.04	0.21	2.06	3.99	-	1.69	-	0.46	0.5	5.57	8.63	0.34	0.42	1.14	2.72	1.33	0.02	-	-	0.56	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.86	4.76	0.07	2.26	-	0.86	3.04	0.21	2.06	3.99	-	1.69	-	0.46	0.5	5.57	8.63	0.34	0.42	1.14	2.72	1.33	0.02	-	-	0.56	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.86
H3335_009_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	228.53	3.29	1085.31	0	205.94	15.19	1.06	517.55	484.56	0	1026.72	0	275.49	299.18	4793.6	5340.02	208.03	260.12	691.94	1650.37	808.76	14.1	0	0	349.76	0	149.9	0	0	0	0											200 for 1st 2 admits	200 for 1st 2 admits						15 - 50																																		200	200	25	0	50	0.2	0.2	47.51	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0												2500	200	200	25	0	50	0.2	0.2	47.51	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0												0	3.81	0.05	2.26	-	0.86	3.04	0.21	2.05	1.41	-	1.28	-	0.34	0.37	2	6.68	0.26	0.33	0.86	2.06	1.01	0.02	-	-	0.44	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.54	3.81	0.05	2.26	-	0.86	3.04	0.21	2.05	1.41	-	1.28	-	0.34	0.37	2	6.68	0.26	0.33	0.86	2.06	1.01	0.02	-	-	0.44	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.54
H3335_013_0	2006											1500											Coin	Coin	Coin		T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	O			V		Coin															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	193.51	2.07	37.31	0	239.21	18.27	1.27	319.34	15.54	6.07	16.51	0	4.6	16.35	22.42	7036.69	1.69	1.78	26.63	103.07	14.6	581.82	0	0	390.09	0	0.83	0	0	0	0																		50 or 10								15 25 or 10						25 or 10																				0.1	0.1	0.1	0	100	0.1	0.1	43.82	0.1	0.1	0.1	0	0.1	0.1	0.1	6.65	0.1	0.1	0.1	0.1	0.1	4.02	0	0	15	0	0.1	0	0	0	0											4000	0.07	0.07	0.1	0	100	0.07	0.07	43.59	0.07	0.07	0.07	0	0.07	0.07	0.06	5	0.07	0.07	0.07	0.07	0.07	2.89	0	0	15	0	0.07	0	0	0	0											0	12.79	0.14	3.73	-	1.99	1.21	0.08	1.16	1.03	0.4	1.09	-	0.3	1.08	1.45	2.93	0.11	0.12	1.76	6.81	0.97	0.14	-	-	0.49	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.84	12.79	0.14	3.73	-	1.99	1.21	0.08	1.16	1.03	0.4	1.09	-	0.3	1.08	1.45	2.93	0.11	0.12	1.76	6.81	0.97	0.14	-	-	0.49	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.84
H3335_014_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	228.35	3.29	1408.17	0	241.65	18.27	1.27	315.37	274.17	0	580.93	0	157.55	171.1	4972.1	5870.07	243.4	304.35	787.62	1974.31	967.5	15.73	0	0	377.51	0	161.79	0	0	0	0											250 for 1st 2 admits	250 for 1st 2 admits						20 - 50																																		250	250	25	0	50	0.2	0.2	46.22	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											3000	250	250	25	0	50	0.2	0.2	46.22	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											0	4.76	0.07	2.93	-	1.01	3.65	0.25	1.21	2.28	-	0.97	-	0.26	0.29	6.22	9.78	0.41	0.51	1.31	3.29	1.61	0.03	-	-	0.63	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.74	4.76	0.07	2.93	-	1.01	3.65	0.25	1.21	2.28	-	0.97	-	0.26	0.29	6.22	9.78	0.41	0.51	1.31	3.29	1.61	0.03	-	-	0.63	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.74
H3335_015_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	228.58	3.3	1408.17	0	241.65	18.27	1.27	316.69	277.81	0	588.65	0	157.95	171.53	5346.34	6057.63	251.51	314.49	798.1	1995.31	977.8	15.73	0	0	390.09	0	167.18	0	0	0	0											200 for 1st 2 admits	200 for 1st 2 admits						15 - 50																																		200	200	25	0	50	0.2	0.2	45.46	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											2500	200	200	25	0	50	0.2	0.2	45.46	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											0	3.81	0.05	2.93	-	1.01	3.65	0.25	1.2	0.81	-	0.74	-	0.2	0.21	2.23	7.57	0.31	0.39	1	2.49	1.22	0.02	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.81	3.81	0.05	2.93	-	1.01	3.65	0.25	1.2	0.81	-	0.74	-	0.2	0.21	2.23	7.57	0.31	0.39	1	2.49	1.22	0.02	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.81
H3335_016_0	2006											1500											Coin	Coin	Coin		T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	O			V		Coin															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	209.97	2.24	24.97	0	227.59	16.62	1.16	578.65	25.2	9.85	26.77	0	7.47	26.52	21.18	6112.77	1.42	1.5	19.1	91.37	12.3	465.01	0	0	348.29	0	0.78	0	0	0	0																		50 or 10								15 25 or 10						25 or 10																				0.1	0.1	0.1	0	100	0.1	0.1	46.97	0.1	0.1	0.1	0	0.1	0.1	0.1	7.03	0.1	0.1	0.1	0.1	0.1	4.28	0	0	15	0	0.1	0	0	0	0											4000	0.06	0.06	0.1	0	100	0.06	0.06	46.85	0.06	0.06	0.06	0	0.06	0.06	0.06	5.19	0.06	0.06	0.06	0.06	0.06	3.04	0	0	15	0	0.06	0	0	0	0											0	13.58	0.14	2.5	-	1.9	1.07	0.07	2.26	1.63	0.64	1.73	-	0.48	1.71	1.34	2.64	0.09	0.1	1.23	5.91	0.8	0.12	-	-	0.44	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.42	13.58	0.14	2.5	-	1.9	1.07	0.07	2.26	1.63	0.64	1.73	-	0.48	1.71	1.34	2.64	0.09	0.1	1.23	5.91	0.8	0.12	-	-	0.44	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.42
H3335_017_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	259.34	3.74	986.58	0	229.91	16.62	1.16	575.1	536.79	0	1137.37	0	308.46	334.98	4439.34	5119.46	193.9	242.45	665.91	1572.8	770.74	14.04	0	0	337.06	0	144.45	0	0	0	0											250 for 1st 2 admits	250 for 1st 2 admits						20 - 50																																		250	250	25	0	50	0.2	0.2	48.15	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											3000	250	250	25	0	50	0.2	0.2	48.15	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											0	5.4	0.08	2.06	-	0.96	3.32	0.23	2.31	4.47	-	1.9	-	0.51	0.56	5.55	8.53	0.32	0.4	1.11	2.62	1.28	0.02	-	-	0.56	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.45	5.4	0.08	2.06	-	0.96	3.32	0.23	2.31	4.47	-	1.9	-	0.51	0.56	5.55	8.53	0.32	0.4	1.11	2.62	1.28	0.02	-	-	0.56	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.45
H3335_018_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	259.6	3.74	986.58	0	229.91	16.62	1.16	576.28	543.91	0	1152.49	0	309.24	335.83	4773.49	5282.1	200.36	250.54	674.76	1589.53	778.94	14.04	0	0	348.29	0	149.27	0	0	0	0											200 for 1st 2 admits	200 for 1st 2 admits						15 - 50																																		200	200	25	0	50	0.2	0.2	47.77	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											2500	200	200	25	0	50	0.2	0.2	47.77	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											0	4.33	0.06	2.06	-	0.96	3.32	0.23	2.29	1.59	-	1.44	-	0.39	0.42	1.99	6.6	0.25	0.31	0.84	1.99	0.97	0.02	-	-	0.44	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.68	4.33	0.06	2.06	-	0.96	3.32	0.23	2.29	1.59	-	1.44	-	0.39	0.42	1.99	6.6	0.25	0.31	0.84	1.99	0.97	0.02	-	-	0.44	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.68
H3335_019_0	2006											1500											Coin	Coin	Coin		T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	O			V		Coin															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	196.78	2.1	25.53	0	227.13	16.59	1.16	656.83	28.85	11.28	30.65	0	8.55	30.36	21.13	6100.57	1.42	1.49	19.06	91.19	12.28	464.08	0	0	347.6	0	0.78	0	0	0	0																		50 or 10								15 25 or 10						25 or 10																				0.1	0.1	0.1	0	100	0.1	0.1	47.34	0.1	0.1	0.1	0	0.1	0.1	0.1	7.03	0.1	0.1	0.1	0.1	0.1	4.28	0	0	15	0	0.1	0	0	0	0											4000	0.06	0.06	0.1	0	100	0.06	0.06	47.23	0.06	0.06	0.06	0	0.06	0.06	0.06	5.19	0.06	0.06	0.06	0.06	0.06	3.03	0	0	15	0	0.06	0	0	0	0											0	12.72	0.14	2.55	-	1.89	1.07	0.07	2.59	1.87	0.73	1.98	-	0.55	1.96	1.33	2.64	0.09	0.1	1.23	5.9	0.79	0.12	-	-	0.43	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.81	12.72	0.14	2.55	-	1.89	1.07	0.07	2.59	1.87	0.73	1.98	-	0.55	1.96	1.33	2.64	0.09	0.1	1.23	5.9	0.79	0.12	-	-	0.43	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.81
H3335_020_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	238.62	3.44	1008.7	0	229.45	16.59	1.16	653.28	614.64	0	1302.31	0	353.2	383.57	4430.48	5109.24	193.51	241.97	664.58	1569.66	769.21	14.02	0	0	336.39	0	144.17	0	0	0	0											250 for 1st 2 admits	250 for 1st 2 admits						20 - 50																																		250	250	25	0	50	0.2	0.2	48.37	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											3000	250	250	25	0	50	0.2	0.2	48.37	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											0	4.97	0.07	2.1	-	0.96	3.32	0.23	2.63	5.12	-	2.17	-	0.59	0.64	5.54	8.52	0.32	0.4	1.11	2.62	1.28	0.02	-	-	0.56	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.41	4.97	0.07	2.1	-	0.96	3.32	0.23	2.63	5.12	-	2.17	-	0.59	0.64	5.54	8.52	0.32	0.4	1.11	2.62	1.28	0.02	-	-	0.56	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.41
H3335_021_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	238.86	3.44	1008.7	0	229.45	16.59	1.16	654.46	622.79	0	1319.63	0	354.09	384.53	4763.96	5271.56	199.97	250.04	673.41	1586.36	777.39	14.02	0	0	347.6	0	148.97	0	0	0	0											200 for 1st 2 admits	200 for 1st 2 admits						15 - 50																																		200	200	25	0	50	0.2	0.2	48.04	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											2500	200	200	25	0	50	0.2	0.2	48.04	35	0	15	0	15	15	5	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											0	3.98	0.06	2.1	-	0.96	3.32	0.23	2.62	1.82	-	1.65	-	0.44	0.48	1.98	6.59	0.25	0.31	0.84	1.98	0.97	0.02	-	-	0.43	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.23	3.98	0.06	2.1	-	0.96	3.32	0.23	2.62	1.82	-	1.65	-	0.44	0.48	1.98	6.59	0.25	0.31	0.84	1.98	0.97	0.02	-	-	0.43	-	0.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.23
H3335_031_0	2006																								D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	1683.97	0	254.92	18.65	1.3	570.83	532.11	0	1127.5	0	302.53	328.55	5363.54	6159.44	230.13	287.76	792.49	1825.69	894.68	16.44	0	0	407.65	0	174.71	0	0	0	0																		15 - 50																																		0	0	25	0	50	0.2	0.2	47.37	35	0	15	0	15	15	10	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0												0	0	25	0	50	0.2	0.2	47.37	35	0	15	0	15	15	10	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	0											0	-	-	3.51	-	1.06	3.73	0.26	2.25	1.55	-	1.41	-	0.38	0.41	4.47	7.7	0.29	0.36	0.99	2.28	1.12	0.02	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.52	-	-	3.51	-	1.06	3.73	0.26	2.25	1.55	-	1.41	-	0.38	0.41	4.47	7.7	0.29	0.36	0.99	2.28	1.12	0.02	-	-	0.51	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.52
H3335_032_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V															3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	261.62	3.77	1683.97	0	254.92	18.65	1.3	569.45	525.15	0	1112.7	0	301.77	327.72	5195.93	5969.95	222.71	278.48	782.09	1806.47	885.26	16.44	0	0	394.5	0	169.07	0	0	0	0											100 for 1st 2 admits	100 for 1st 2 admits						20 - 50																																		100	100	25	0	50	0.2	0.2	47.81	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0												100	100	25	0	50	0.2	0.2	47.81	100	0	20	0	20	20	15	20	20	20	20	20	20	20	0	0	20	0	20	0	0	0	0											0	2.18	0.03	3.51	-	1.06	3.73	0.26	2.27	4.38	-	1.85	-	0.5	0.55	6.49	9.95	0.37	0.46	1.3	3.01	1.48	0.03	-	-	0.66	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.36	2.18	0.03	3.51	-	1.06	3.73	0.26	2.27	4.38	-	1.85	-	0.5	0.55	6.49	9.95	0.37	0.46	1.3	3.01	1.48	0.03	-	-	0.66	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.36
H3335_801_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	272.37	3.95	1400.31	0	1137.91	42616.85	221.7	424.33	343.35	2245.34	1137.7	0	585.94	1835.03	5657.57	6817.27	261.91	982.46	5521.36	24667.2	996.76	568.66	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				754.73	559.1	63.24	0	16.23	1.17	15.65	26.09	147.01	8.79	47.14	0	25.53	28.95	11.43	14.83	19.43	5.45	14.7	12.11	44.14	9.74	0	0	0	0	0	0	0	0	0												754.73	559.1	63.24	0	16.23	1.17	15.65	26.09	147.01	8.79	47.14	0	25.53	28.95	11.43	14.83	19.43	5.45	14.7	12.11	44.14	9.74	0	0	0	0	0	0	0	0	0											123	17.13	0.18	7.38	-	1.54	4.15	0.29	0.92	4.21	1.64	4.47	-	1.25	4.43	5.39	8.42	0.42	0.45	6.77	24.89	3.67	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.05	17.13	0.18	7.38	-	1.54	4.15	0.29	0.92	4.21	1.64	4.47	-	1.25	4.43	5.39	8.42	0.42	0.45	6.77	24.89	3.67	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.05
H3335_802_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	299.94	4.35	1792.57	0	1229.96	46064.29	239.63	334.33	261.35	1709.07	865.97	0	445.99	1396.75	5838.79	7045.92	271.85	1019.78	5308.26	29398.81	1034.62	590.18	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				685.06	507.49	68.86	0	14.51	1.04	13.99	30.31	176.57	10.56	56.62	0	30.66	34.77	10.36	13.43	17.62	4.94	14.53	10.46	40.01	8.83	0	0	0	0	0	0	0	0	0												685.06	507.49	68.86	0	14.51	1.04	13.99	30.31	176.57	10.56	56.62	0	30.66	34.77	10.36	13.43	17.62	4.94	14.53	10.46	40.01	8.83	0	0	0	0	0	0	0	0	0											123	17.12	0.18	10.29	-	1.49	4.01	0.28	0.84	3.85	1.5	4.09	-	1.14	4.05	5.04	7.89	0.4	0.42	6.43	25.63	3.45	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.52	17.12	0.18	10.29	-	1.49	4.01	0.28	0.84	3.85	1.5	4.09	-	1.14	4.05	5.04	7.89	0.4	0.42	6.43	25.63	3.45	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.52
H3335_803_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.1	3.87	1101.55	0	1047.49	39230.6	204.08	544.99	453.46	2965.39	1502.54	0	773.84	2423.5	5389.16	6334.19	225.28	845.07	4794.45	21572.78	857.37	490.52	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				657.66	487.19	61.4	0	15.17	1.09	14.62	23.78	132.02	7.89	42.33	0	22.92	26	10.35	13.55	17.61	4.94	11.21	12.05	40	8.92	0	0	0	0	0	0	0	0	0												657.66	487.19	61.4	0	15.17	1.09	14.62	23.78	132.02	7.89	42.33	0	22.92	26	10.35	13.55	17.61	4.94	11.21	12.05	40	8.92	0	0	0	0	0	0	0	0	0											123	14.64	0.16	5.64	-	1.32	3.57	0.25	1.08	4.99	1.95	5.3	-	1.48	5.25	4.65	7.15	0.33	0.35	4.48	21.66	2.86	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.45	14.64	0.16	5.64	-	1.32	3.57	0.25	1.08	4.99	1.95	5.3	-	1.48	5.25	4.65	7.15	0.33	0.35	4.48	21.66	2.86	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.45
H3335_805_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.51	3.88	1425.79	0	1241.19	46484.83	241.82	334.68	260.13	1701.12	861.95	0	443.92	1390.26	6069.52	7274.48	275.04	1031.72	5584.24	28990.62	1046.73	597.51	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				704.31	521.75	61.27	0	15.54	1.12	14.99	27	156.85	9.38	50.3	0	27.23	30.88	10.37	13.48	17.64	4.94	13.72	10.31	40.06	8.86	0	0	0	0	0	0	0	0	0												704.31	521.75	61.27	0	15.54	1.12	14.99	27	156.85	9.38	50.3	0	27.23	30.88	10.37	13.48	17.64	4.94	13.72	10.31	40.06	8.86	0	0	0	0	0	0	0	0	0											123	15.7	0.17	7.28	-	1.61	4.33	0.3	0.75	3.4	1.33	3.61	-	1.01	3.58	5.25	8.17	0.4	0.43	6.38	24.9	3.49	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.53	15.7	0.17	7.28	-	1.61	4.33	0.3	0.75	3.4	1.33	3.61	-	1.01	3.58	5.25	8.17	0.4	0.43	6.38	24.9	3.49	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.53
H3335_806_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	304.73	4.42	1026.71	0	1170.56	43839.72	228.06	620.76	521.61	3411.01	1728.33	0	890.12	2787.69	5371.88	6265.28	217.19	814.72	4680.07	21612.27	826.58	473.37	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				657.68	487.2	64.35	0	14.86	1.07	14.33	23.58	129.92	7.77	41.66	0	22.56	25.58	10.97	14.39	18.65	5.23	11.64	12.17	42.37	9.48	0	0	0	0	0	0	0	0	0												657.68	487.2	64.35	0	14.86	1.07	14.33	23.58	129.92	7.77	41.66	0	22.56	25.58	10.97	14.39	18.65	5.23	11.64	12.17	42.37	9.48	0	0	0	0	0	0	0	0	0											123	16.7	0.18	5.51	-	1.45	3.9	0.27	1.22	5.65	2.21	6	-	1.67	5.94	4.91	7.51	0.34	0.36	4.54	21.91	2.92	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.56	16.7	0.18	5.51	-	1.45	3.9	0.27	1.22	5.65	2.21	6	-	1.67	5.94	4.91	7.51	0.34	0.36	4.54	21.91	2.92	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.56
H3335_807_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	278.88	4.04	1050.08	0	1161.28	43492.31	226.25	681.66	576.56	3770.41	1910.43	0	983.91	3081.41	5329.31	6215.63	215.47	808.27	4642.98	21441	820.03	469.62	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				658.26	487.63	62.88	0	14.86	1.07	14.33	23.66	129.92	7.77	41.66	0	22.56	25.58	10.97	14.39	18.65	5.23	11.64	12.17	42.37	9.48	0	0	0	0	0	0	0	0	0												658.26	487.63	62.88	0	14.86	1.07	14.33	23.66	129.92	7.77	41.66	0	22.56	25.58	10.97	14.39	18.65	5.23	11.64	12.17	42.37	9.48	0	0	0	0	0	0	0	0	0											123	15.3	0.16	5.5	-	1.44	3.87	0.27	1.34	6.24	2.44	6.63	-	1.85	6.57	4.87	7.45	0.33	0.35	4.5	21.74	2.9	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.14	15.3	0.16	5.5	-	1.44	3.87	0.27	1.34	6.24	2.44	6.63	-	1.85	6.57	4.87	7.45	0.33	0.35	4.5	21.74	2.9	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.14
H3335_811_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	307.13	4.45	1695.41	0	1294.1	48466.5	252.13	644.86	537.28	3513.49	1780.26	0	916.87	2871.44	6269.01	7280.4	248.73	933.03	5480.55	24430.37	946.61	542.42	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				765.56	567.12	61.25	0	15.04	1.08	14.5	23.03	127.43	7.62	40.86	0	22.13	25.09	10.79	14.18	18.36	5.15	13.83	12.35	41.69	9.34	0	0	0	0	0	0	0	0	0												765.56	567.12	61.25	0	15.04	1.08	14.5	23.03	127.43	7.62	40.86	0	22.13	25.09	10.79	14.18	18.36	5.15	13.83	12.35	41.69	9.34	0	0	0	0	0	0	0	0	0											123	19.59	0.21	8.65	-	1.62	4.37	0.3	1.24	5.71	2.23	6.06	-	1.69	6	5.64	8.6	0.38	0.4	6.32	25.15	3.29	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.88	19.59	0.21	8.65	-	1.62	4.37	0.3	1.24	5.71	2.23	6.06	-	1.69	6	5.64	8.6	0.38	0.4	6.32	25.15	3.29	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.88
H3335_813_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	272.37	3.95	1400.31	0	1137.91	42616.85	221.7	424.33	343.35	2245.34	1137.7	0	585.94	1835.03	5657.57	6817.27	261.91	982.46	5521.36	24667.2	996.76	568.66	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				754.73	559.1	63.24	0	16.23	1.17	15.65	26.09	147.01	8.79	47.14	0	25.53	28.95	11.43	14.83	19.43	5.45	14.7	12.11	44.14	9.74	0	0	0	0	0	0	0	0	0												754.73	559.1	63.24	0	16.23	1.17	15.65	26.09	147.01	8.79	47.14	0	25.53	28.95	11.43	14.83	19.43	5.45	14.7	12.11	44.14	9.74	0	0	0	0	0	0	0	0	0											123	17.13	0.18	7.38	-	1.54	4.15	0.29	0.92	4.21	1.64	4.47	-	1.25	4.43	5.39	8.42	0.42	0.45	6.77	24.89	3.67	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.05	17.13	0.18	7.38	-	1.54	4.15	0.29	0.92	4.21	1.64	4.47	-	1.25	4.43	5.39	8.42	0.42	0.45	6.77	24.89	3.67	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.05
H3335_814_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	299.94	4.35	1792.57	0	1229.96	46064.29	239.63	334.33	261.35	1709.07	865.97	0	445.99	1396.75	5838.79	7045.92	271.85	1019.78	5308.26	29398.81	1034.62	590.18	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				685.06	507.49	68.86	0	14.51	1.04	13.99	30.31	176.57	10.56	56.62	0	30.66	34.77	10.36	13.43	17.62	4.94	14.53	10.46	40.01	8.83	0	0	0	0	0	0	0	0	0												685.06	507.49	68.86	0	14.51	1.04	13.99	30.31	176.57	10.56	56.62	0	30.66	34.77	10.36	13.43	17.62	4.94	14.53	10.46	40.01	8.83	0	0	0	0	0	0	0	0	0											123	17.12	0.18	10.29	-	1.49	4.01	0.28	0.84	3.85	1.5	4.09	-	1.14	4.05	5.04	7.89	0.4	0.42	6.43	25.63	3.45	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.52	17.12	0.18	10.29	-	1.49	4.01	0.28	0.84	3.85	1.5	4.09	-	1.14	4.05	5.04	7.89	0.4	0.42	6.43	25.63	3.45	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.52
H3335_815_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.1	3.87	1101.55	0	1047.49	39230.6	204.08	544.99	453.46	2965.39	1502.54	0	773.84	2423.5	5389.16	6334.19	225.28	845.07	4794.45	21572.78	857.37	490.52	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				657.66	487.19	61.4	0	15.17	1.09	14.62	23.78	132.02	7.89	42.33	0	22.92	26	10.35	13.55	17.61	4.94	11.21	12.05	40	8.92	0	0	0	0	0	0	0	0	0												657.66	487.19	61.4	0	15.17	1.09	14.62	23.78	132.02	7.89	42.33	0	22.92	26	10.35	13.55	17.61	4.94	11.21	12.05	40	8.92	0	0	0	0	0	0	0	0	0											123	14.64	0.16	5.64	-	1.32	3.57	0.25	1.08	4.99	1.95	5.3	-	1.48	5.25	4.65	7.15	0.33	0.35	4.48	21.66	2.86	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.45	14.64	0.16	5.64	-	1.32	3.57	0.25	1.08	4.99	1.95	5.3	-	1.48	5.25	4.65	7.15	0.33	0.35	4.48	21.66	2.86	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.45
H3335_816_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.51	3.88	1425.79	0	1241.19	46484.83	241.82	334.68	260.13	1701.12	861.95	0	443.92	1390.26	6069.52	7274.48	275.04	1031.72	5584.24	28990.62	1046.73	597.51	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				704.31	521.75	61.27	0	15.54	1.12	14.99	27	156.85	9.38	50.3	0	27.23	30.88	10.37	13.48	17.64	4.94	13.72	10.31	40.06	8.86	0	0	0	0	0	0	0	0	0												704.31	521.75	61.27	0	15.54	1.12	14.99	27	156.85	9.38	50.3	0	27.23	30.88	10.37	13.48	17.64	4.94	13.72	10.31	40.06	8.86	0	0	0	0	0	0	0	0	0											123	15.7	0.17	7.28	-	1.61	4.33	0.3	0.75	3.4	1.33	3.61	-	1.01	3.58	5.25	8.17	0.4	0.43	6.38	24.9	3.49	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.53	15.7	0.17	7.28	-	1.61	4.33	0.3	0.75	3.4	1.33	3.61	-	1.01	3.58	5.25	8.17	0.4	0.43	6.38	24.9	3.49	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.53
H3335_817_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	304.73	4.42	1026.71	0	1170.56	43839.72	228.06	620.76	521.61	3411.01	1728.33	0	890.12	2787.69	5371.88	6265.28	217.19	814.72	4680.07	21612.27	826.58	473.37	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				657.68	487.2	64.35	0	14.86	1.07	14.33	23.58	129.92	7.77	41.66	0	22.56	25.58	10.97	14.39	18.65	5.23	11.64	12.17	42.37	9.48	0	0	0	0	0	0	0	0	0												657.68	487.2	64.35	0	14.86	1.07	14.33	23.58	129.92	7.77	41.66	0	22.56	25.58	10.97	14.39	18.65	5.23	11.64	12.17	42.37	9.48	0	0	0	0	0	0	0	0	0											123	16.7	0.18	5.51	-	1.45	3.9	0.27	1.22	5.65	2.21	6	-	1.67	5.94	4.91	7.51	0.34	0.36	4.54	21.91	2.92	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.56	16.7	0.18	5.51	-	1.45	3.9	0.27	1.22	5.65	2.21	6	-	1.67	5.94	4.91	7.51	0.34	0.36	4.54	21.91	2.92	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.56
H3335_818_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	278.88	4.04	1050.08	0	1161.28	43492.31	226.25	681.66	576.56	3770.41	1910.43	0	983.91	3081.41	5329.31	6215.63	215.47	808.27	4642.98	21441	820.03	469.62	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				658.26	487.63	62.88	0	14.86	1.07	14.33	23.66	129.92	7.77	41.66	0	22.56	25.58	10.97	14.39	18.65	5.23	11.64	12.17	42.37	9.48	0	0	0	0	0	0	0	0	0												658.26	487.63	62.88	0	14.86	1.07	14.33	23.66	129.92	7.77	41.66	0	22.56	25.58	10.97	14.39	18.65	5.23	11.64	12.17	42.37	9.48	0	0	0	0	0	0	0	0	0											123	15.3	0.16	5.5	-	1.44	3.87	0.27	1.34	6.24	2.44	6.63	-	1.85	6.57	4.87	7.45	0.33	0.35	4.5	21.74	2.9	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.14	15.3	0.16	5.5	-	1.44	3.87	0.27	1.34	6.24	2.44	6.63	-	1.85	6.57	4.87	7.45	0.33	0.35	4.5	21.74	2.9	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.14
H3335_819_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	307.13	4.45	1695.41	0	1294.1	48466.5	252.13	644.86	537.28	3513.49	1780.26	0	916.87	2871.44	6269.01	7280.4	248.73	933.03	5480.55	24430.37	946.61	542.42	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				765.56	567.12	61.25	0	15.04	1.08	14.5	23.03	127.43	7.62	40.86	0	22.13	25.09	10.79	14.18	18.36	5.15	13.83	12.35	41.69	9.34	0	0	0	0	0	0	0	0	0												765.56	567.12	61.25	0	15.04	1.08	14.5	23.03	127.43	7.62	40.86	0	22.13	25.09	10.79	14.18	18.36	5.15	13.83	12.35	41.69	9.34	0	0	0	0	0	0	0	0	0											123	19.59	0.21	8.65	-	1.62	4.37	0.3	1.24	5.71	2.23	6.06	-	1.69	6	5.64	8.6	0.38	0.4	6.32	25.15	3.29	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.88	19.59	0.21	8.65	-	1.62	4.37	0.3	1.24	5.71	2.23	6.06	-	1.69	6	5.64	8.6	0.38	0.4	6.32	25.15	3.29	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.88
H3336_001_0	2006											UNLIMITED											D	D	D		T	COIN		V								V	V	V		V		V					P																																																									-	1920	80	1200		700	0.06		330								3600	335	695		640		400					50															8 day maximum	8 day maximum	30 day maximum			10 coinsurance																																				50	50	50		40	16.06		47.73								15	43.8	15		15		75					15																47.67	47.67	49.17		40	16.06		47.73								15	43.8	15		15		75					15																7.63	0.32	4.92	-	2.33	0.99	-	1.31	-	-	-	-	-	-	-	4.5	1.22	0.87	-	0.8	-	2.5	-	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.45	7.63	0.32	4.92	-	2.33	0.99	-	1.31	-	-	-	-	-	-	-	4.5	1.22	0.87	-	0.8	-	2.5	-	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.45
H3336_003_0	2006																													V								V	V	V		V		V																																																														-								786								5937	2581	2766		1390		126																																																																				50								10	20	10		10		10																												50								10	20	10		10		10																					-	-	-	-	-	-	-	3.28	-	-	-	-	-	-	-	4.95	4.3	2.31	-	1.16	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.09	-	-	-	-	-	-	-	3.28	-	-	-	-	-	-	-	4.95	4.3	2.31	-	1.16	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.09
H3336_004_0	2006											UN:IMITED											D	D	D			COIN		V								V	V	V		V		V					P																																																									-	1920	80	1200			0.06		330								3600	335	695		640		400					50															8 day maximum	8 day maximum	30 day maximum			10 coinsurance																																				50	50	50			16.06		47.73								15	43.8	15		15		75					15																47.67	47.67	49.17			16.06		47.73								15	43.8	15		15		75					15																7.63	0.32	4.92	-	-	0.99	-	1.31	-	-	-	-	-	-	-	4.5	1.22	0.87	-	0.8	-	2.5	-	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.12	7.63	0.32	4.92	-	-	0.99	-	1.31	-	-	-	-	-	-	-	4.5	1.22	0.87	-	0.8	-	2.5	-	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.12
H3337_001_0	2006											none													D		T	coin	coin	V					Coin	V			V	V		V							V															none																																										-			90		160	9.21	1.43	190					1.4	210			630	180		35							100																	0 0-20 days. 25 after		50 co-pay/trip	20 co-insurance	20 co-insurance	50 co-pay/visit					20 co-insurance	20 co-pay/visit			20 co-pay/visit	20 co-pay/visit		50 co-pay/visit							20 co-pay/visit																	25		50	0.2	0.2	50					0.2	20			20	20		50							20															none			25		50	0.2	0.2	50					0.2	20			20	20		50							20																-	-	0.19	-	0.67	1.84	0.29	0.79	-	-	-	-	0.28	0.35	-	-	1.05	0.3	-	0.15	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.07	-	-	0.19	-	0.67	1.84	0.29	0.79	-	-	-	-	0.28	0.35	-	-	1.05	0.3	-	0.15	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.07
H3337_002_0	2006											none																		V						V		V	V	V		V																						none																																										-								280						210		4000	630	192		2040																													50 co-pay /visit						20 co-pay /visit		10 co-pay /visit	20 co-pay /visit	10 co-pay /visit		10 co-pay /visit																													50						20		10	20	10		10																						none								50						20		10	20	10		10																							-	-	-	-	-	-	-	1.17	-	-	-	-	-	0.35	-	3.33	1.05	0.16	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.76	-	-	-	-	-	-	-	1.17	-	-	-	-	-	0.35	-	3.33	1.05	0.16	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.76
H3337_003_0	2006											none																		V						V		V	V	V		V																						none																																										-								240						210		4000	630	120		2040																													50 co-pay/visit						20 co-pay/visit		10 co-pay/visit	20 co-pay/visit	10 co-pay/visit		10 co-pay/visit																													50						20		10	20	10		10																						none								50						20		10	20	10		10																							-	-	-	-	-	-	-	1	-	-	-	-	-	0.35	-	3.33	1.05	0.1	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.53	-	-	-	-	-	-	-	1	-	-	-	-	-	0.35	-	3.33	1.05	0.1	-	1.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.53
H3340_001_0	2006											Unlimited											A	A	D	V	T	O	O	P	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	V	V	V	Coin	V	V											Unlimited	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	442.8	0	0	0	0	0	252.9	0	6210	2796.3	577.8	0	2298.6	0	0	0	0	0	0	0	0	0	0	0																		ER @ 50 copay and Urgent Care @ 10 copay																																																																											Unlimited	0	0	0	0	0	0	0	49.84	0	0	0	0	0	10	0	10	20	10	0	10	0	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	1.84	-	-	-	-	-	0.21	-	5.18	4.66	0.48	-	1.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.28	-	-	-	-	-	-	-	1.84	-	-	-	-	-	0.21	-	5.18	4.66	0.48	-	1.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.28
H3340_002_0	2006											Unlimited											A	A	D	V	T	O	O	P	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	V	V	V	Coin	V	V											Unlimited	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	429.3	0	0	0	0	0	245.7	0	5987.7	2687.4	554.4	0	2205.9	0	0	0	0	0	0	0	0	0	0	0																		ER @ 50 copay and Urgent Care @ 10 copay																																																																											Unlimited	0	0	0	0	0	0	0	49.83	0	0	0	0	0	10	0	10	20	10	0	10	0	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	1.78	-	-	-	-	-	0.2	-	4.99	4.48	0.46	-	1.84	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.76	-	-	-	-	-	-	-	1.78	-	-	-	-	-	0.2	-	4.99	4.48	0.46	-	1.84	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.76
H3341_007_0	2006											-											D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	S	V	T	V	V	V	V	V	Coin	V	V											-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	29.38	15.75	504	0	0	0	0	0	0	0	6996	2859	573	0	2146	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	50/10	0	0	0	0	0	0	0	10	20	10	0	10	0	0	0	0/50	0	0	0	0	0	0	0											0	0	0	0	0	0	0	47.85	0	0	0	0	0	0	0	10	20	10	0	10	0	0	0	18.5	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	47.85	0	0	0	0	0	0	0	10	20	10	0	10	0	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	2.01	-	-	-	-	-	-	-	5.83	4.77	0.48	-	1.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.87	-	-	-	-	-	-	-	2.01	-	-	-	-	-	-	-	5.83	4.77	0.48	-	1.79	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.87
H3341_008_0	2006											-											D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	S	V	T	V	V	V	V	V	Coin	V	V											-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1328.93	28.07	437.12	0	0	11.42	7.4	217	0	0	0	0	0	182.5	0	4483	320	397	0	2065	0	1080	0	4144	0	0	0	0	0	0	0											50	5000	25	0	0	10	0	50/25	0	0	0	0	0	0	0	25	50/25	25	0	25	0	25	0	0/50	0	0	0	0	0	0	0											50	50	25	0	0	0.1	0	48.65	0	0	0	0	0	0	0	25	41.89	25	0	25	0	25	0	18.5	0	0	0	0	0	0	0											-	50	50	25	0	0	0.1	0	48.64	0	0	0	0	0	25	0	25	25	25	0	25	0	25	0	18.21	0	0	0	0	0	0	0											0	5.54	0.12	0.91	-	-	1.14	-	0.88	-	-	-	-	-	0.38	-	9.34	0.67	0.83	-	4.3	-	2.25	-	6.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.64	5.54	0.12	0.91	-	-	1.14	-	0.88	-	-	-	-	-	0.38	-	9.34	0.67	0.83	-	4.3	-	2.25	-	6.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.64
H3342_001_0	2006																						D		D					V	V						V	V	V	V			S				V	P																5000																																										-	1626.6		1074.93					169.4	223.25						4674.93	5732.15	228.19	487.63			489.08				119.07	134.45																50  Days 1-8		25 Days 1-100					50	100						10	25	25	25			0-177				10	15-85																34.8		25					50	100						10	22.27	25	25			18.85				10	29																	34.8		25					50	100						10	22.26	25	25			18.85				10	29																	4.72	-	2.24	-	-	-	-	0.71	1.86	-	-	-	-	-	3.9	10.63	0.48	1.02	-	-	0.77	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.73	4.72	-	2.24	-	-	-	-	0.71	1.86	-	-	-	-	-	3.9	10.63	0.48	1.02	-	-	0.77	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.73
H3342_002_0	2006																						D		D					V	V						V	V	V	V			S				V	P																5000																																										-	1564.36		767.46					206.56	236.4						4483.3	6619.92	239.84	646.5			371.5				119.16	134.45																100 Days 1-8		25 Days 1-100					50	200						10	25	25	25			0-177				10	15-85																77.05		25					50	200						10	22.76	25	25			18.85				10	29																	77.05		25					50	200						10	22.76	25	25			18.85				10	29																	10.04	-	1.6	-	-	-	-	0.86	3.94	-	-	-	-	-	3.74	12.56	0.5	1.35	-	-	0.58	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.59	10.04	-	1.6	-	-	-	-	0.86	3.94	-	-	-	-	-	3.74	12.56	0.5	1.35	-	-	0.58	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.59
H3342_003_0	2006																						D		D					V	V						V	V	V	V			S				V	P																5000																																										-	2002.7		991.72					159.5	217.17						4374.77	6497.3	226.43	703.56			393.75				119.07	134.45																100  Days 1-8		25 Days 1-100					50	200						10	25	25	25			0-177				10	15-85																64.7		25					50	200						10	22.54	25	25			18.85				10	29																	64.7		25					50	200						10	22.49	25	25			18.85				10	29																	10.8	-	2.07	-	-	-	-	0.66	3.62	-	-	-	-	-	3.65	12.18	0.47	1.47	-	-	0.62	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.95	10.8	-	2.07	-	-	-	-	0.66	3.62	-	-	-	-	-	3.65	12.18	0.47	1.47	-	-	0.62	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.95
H3342_004_0	2006																						D		D					V	V						V	V	V	V			S				V	P																5000																																										-	2135.41		994.03					204.16	262.73						5199.66	6895.07	175.06	663.77			338.09				119.32	134.45																100 Days 1-8		25 Days 1-100					50	200						10	25	25	25			0-177				10	15-85																70.85		25					50	200						10	22.43	25	25			18.85				10	29																	70.85		25					50	200						10	22.43	25	25			18.85				10	29																	12.61	-	2.07	-	-	-	-	0.85	4.38	-	-	-	-	-	4.33	12.89	0.36	1.38	-	-	0.53	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.83	12.61	-	2.07	-	-	-	-	0.85	4.38	-	-	-	-	-	4.33	12.89	0.36	1.38	-	-	0.53	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.83
H3342_006_0	2006																						D		D					V	V						V	V	V	V			S				V	P																5000																																										-	1564.36		767.46					206.56	236.4						4483.3	6619.92	239.84	646.5			371.5				119.16	134.45																100 Days 1-8		25 Days 1-100					50	200						10	25	25	25			0-177				10	15-85																77.05		25					50	200						10	22.76	25	25			18.85				10	29																	77.05		25					50	200						10	22.76	25	25			18.85				10	29																	10.04	-	1.6	-	-	-	-	0.86	3.94	-	-	-	-	-	3.74	12.56	0.5	1.35	-	-	0.58	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.59	10.04	-	1.6	-	-	-	-	0.86	3.94	-	-	-	-	-	3.74	12.56	0.5	1.35	-	-	0.58	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.59
H3342_007_0	2006																						D		D					V	V						V	V	V	V			S				V	P																5000																																										-	2002.7		991.72					159.5	217.17						4374.77	6497.3	226.43	703.56			393.75				119.07	134.45																100  Days 1-8		25 Days 1-100					50	200						10	25	25	25			0-177				10	15-85																64.7		25					50	200						10	22.54	25	25			18.85				10	29																	64.7		25					50	200						10	22.49	25	25			18.85				10	29																	10.8	-	2.07	-	-	-	-	0.66	3.62	-	-	-	-	-	3.65	12.18	0.47	1.47	-	-	0.62	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.95	10.8	-	2.07	-	-	-	-	0.66	3.62	-	-	-	-	-	3.65	12.18	0.47	1.47	-	-	0.62	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.95
H3342_008_0	2006																						D		D					V	V						V	V	V	V			S				V	P																5000																																										-	2135.41		994.03					204.16	262.73						5199.66	6895.07	175.06	663.77			338.09				119.32	134.45																100 Days 1-8		25 Days 1-100					50	200						10	25	25	25			0-177				10	15-85																70.85		25					50	200						10	22.43	25	25			18.85				10	29																	70.85		25					50	200						10	22.43	25	25			18.85				10	29																	12.61	-	2.07	-	-	-	-	0.85	4.38	-	-	-	-	-	4.33	12.89	0.36	1.38	-	-	0.53	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.83	12.61	-	2.07	-	-	-	-	0.85	4.38	-	-	-	-	-	4.33	12.89	0.36	1.38	-	-	0.53	-	-	-	0.1	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.83
H3342_801_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																															-	264.6	3.83	27.08		6.48	4.97	9.24	186.55	37.74	12.31	27.04	2.02	0.37	5.5	36.98	147.91	2.6	11.66	31.54	13.55	33.06																					FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin		20 Coin	20 Coin	20 Coin	50	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin																					0.06	0.06	0.16		0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																						0.06	0.06	0.16		0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																						15.18	0.22	4.37	-	1.3	0.99	1.85	0.78	7.55	2.46	5.41	0.4	0.07	1.1	7.4	29.58	0.52	2.33	6.31	2.71	6.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.15	15.18	0.22	4.37	-	1.3	0.99	1.85	0.78	7.55	2.46	5.41	0.4	0.07	1.1	7.4	29.58	0.52	2.33	6.31	2.71	6.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.15
H3342_802_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																															-	264.6	3.83	27.08		6.48	4.97	9.24	186.55	37.74	12.31	27.04	2.02	0.37	5.5	36.98	147.91	2.6	11.66	31.54	13.55	33.06																					FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin		20 Coin	20 Coin	20 Coin	50	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin																					0.06	0.06	0.16		0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																						0.06	0.06	0.16		0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																						15.19	0.22	4.37	-	1.3	0.99	1.85	0.78	7.55	2.46	5.41	0.4	0.07	1.1	7.4	29.58	0.52	2.33	6.31	2.71	6.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.15	15.19	0.22	4.37	-	1.3	0.99	1.85	0.78	7.55	2.46	5.41	0.4	0.07	1.1	7.4	29.58	0.52	2.33	6.31	2.71	6.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.15
H3342_803_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																															-	264.6	3.83	27.08		6.48	4.97	9.24	186.55	37.74	12.31	27.04	2.02	0.37	5.5	36.98	147.91	2.6	11.66	31.54	13.55	33.06																					FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin		20 Coin	20 Coin	20 Coin	50	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin																					0.06	0.06	0.16		0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																						0.06	0.06	0.16		0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																						15.18	0.22	4.37	-	1.3	0.99	1.85	0.78	7.55	2.46	5.41	0.4	0.07	1.1	7.4	29.58	0.52	2.33	6.31	2.71	6.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.15	15.18	0.22	4.37	-	1.3	0.99	1.85	0.78	7.55	2.46	5.41	0.4	0.07	1.1	7.4	29.58	0.52	2.33	6.31	2.71	6.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.15
H3342_804_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																															-	264.6	3.83	27.08		6.48	4.97	9.24	186.55	37.74	12.31	27.04	2.02	0.37	5.5	36.98	147.91	2.6	11.66	31.54	13.55	33.06																					FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin		20 Coin	20 Coin	20 Coin	50	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin	20 Coin																					0.06	0.06	0.16		0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																						0.06	0.06	0.16		0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																						15.19	0.22	4.37	-	1.3	0.99	1.85	0.78	7.55	2.46	5.41	0.4	0.07	1.1	7.4	29.58	0.52	2.33	6.31	2.71	6.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.15	15.19	0.22	4.37	-	1.3	0.99	1.85	0.78	7.55	2.46	5.41	0.4	0.07	1.1	7.4	29.58	0.52	2.33	6.31	2.71	6.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.15
H3344_001_0	2006											0											A	A	Coin	V	T	Coin	Coin	V	P		P			P	V	V	V	V	V	V	Coin	P			V		V															2500																																										-	202.03	4.31	2.33	1141.56	84	6.35	1.55	232.62	445.85		586.93			746.68	4136.33	2013.66	176.62	452.31	850.83	2686.92	7.23	96.92			490	490	16.15															250 copay per admission 1000 maximum per year	250 copay per admission 1000 maximum per year	20	10 copayment	50 copayment	20	0	50 copayment	50 copayment		20 copayment			15 copayment	5 copayment	20 copayment	25 copayment	15 copayment	20 copayment	20 copayment	20	20 copayment			5 copayment	Mixture of Copay and Coinsurance	20 copayment																																																									250	250	0.2	10	50	0.2	0.2	50	50		20			15	5	20	25	15	20	20	0.2	20			5	36.33	20																4.21	0.09	0.47	0.95	0.35	1.27	0.31	0.97	1.86	-	0.98	-	-	0.93	1.72	3.36	0.37	0.57	1.42	4.48	1.45	0.16	-	-	0.2	1.48	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.62	4.21	0.09	0.47	0.95	0.35	1.27	0.31	0.97	1.86	-	0.98	-	-	0.93	1.72	3.36	0.37	0.57	1.42	4.48	1.45	0.16	-	-	0.2	1.48	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.62
H3344_003_0	2006																									V	T	Coin		V	P		P			P		V	V	V	V	V	Coin	P			V	P	V	Coin														2500																																										-				1141.75	84.02	7.9		232.66	448.08		635.5			775.53		2186.55	176.65	452.39	922.62	2577.09	7.23	96.94			490	490	16.16	6.22																	10 copayment	50 copayment	20		50 copayment	25 copayment		10 copayment			15 copayment		10 copayment	25 copayment	15 copayment	10 Copayment	10 copayment	20	20 copayment			5 copayment	Mixture of copays and coinsurance	10 copayment	50																																																											10	50	0.2		50	25		10			15		10	25	15	10	10	0.2	20			5	36.33	10	0.5														0	-	-	-	0.95	0.35	1.58	-	0.97	0.93	-	0.53	-	-	0.97	-	1.82	0.37	0.57	0.77	2.15	1.45	0.16	-	-	0.2	1.48	0.01	3.11	-	-	-	-	-	-	-	-	-	-	-	-	-	18.37	-	-	-	0.95	0.35	1.58	-	0.97	0.93	-	0.53	-	-	0.97	-	1.82	0.37	0.57	0.77	2.15	1.45	0.16	-	-	0.2	1.48	0.01	3.11	-	-	-	-	-	-	-	-	-	-	-	-	-	18.37
H3344_801_0	2006																						A	A	Coin	V	T	Coin	Coin	V	P		P			P	V	V	Coin	V	V	V	Coin	P			V	P	V	Coin	Coin																																																							-	172.48	2.3	18	854.52	58.16	5.92	1.66	183.11	466.75	0	480.09	0	0	750.91	3563.85	2039.85	0.88	653.45	864.77	3747.61	6.92	118.48	0	0	490	490	16.16															750 per admission	750 per admission	20 Coinsurance	15 copayment	50 copayment	20 Coinsurance	20 Coinsurance	50 copayment	75 copayment		35 copayment			35 copayment	25 copayment	35 copayment	50 Coinsurance	15 copayment	35 copayment	35 copayment	20 Coinsurance	20 copayment			5 copayment	Mixture of copays and coinsurance	20 copayment															750	750	0.2	15	50	0.2	0.2	50	75		35			35	25	35	0.5	15	35	35	0.2	20			5	36.33	35																750	750	0.2	15	50	0.2	0.2	50	75		35			35	25	35	0.5	15	35	35	0.2	20			5	36.33	35																10.78	0.14	3.6	1.07	0.24	1.18	0.33	0.76	2.92	-	1.4	-	-	2.19	7.42	5.95	0.44	0.82	2.52	10.93	1.38	0.2	-	-	0.2	1.48	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.02	10.78	0.14	3.6	1.07	0.24	1.18	0.33	0.76	2.92	-	1.4	-	-	2.19	7.42	5.95	0.44	0.82	2.52	10.93	1.38	0.2	-	-	0.2	1.48	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.02
H3344_802_0	2006																						A	A	Coin	V	T	Coin	Coin	V	P		P			P	V	V	Coin	V	V	V	Coin	P			V	P	V	Coin	Coin																																																							-	172.48	2.3	18	854.52	58.16	5.92	1.66	183.11	466.75	0	490.09	0	0	770.14	3706.19	2121.03	0.88	653.45	877.85	4604.69	6.92	118.48	0	0	490	490	16.16															750 per admission	750 per admission	20 Coinsurance	15 copayment	50 copayment	20 Coinsurance	20 Coinsurance	50 copayment	75 copayment		20 copayment			20 copayment	20 copayment	20 copayment	50 Coinsurance	15 copayment	20 copayment	20 copayment	20 Coinsurance	20 copayment			5 copayment	Mixture of copays and coinsurance	20 copayment															750	750	0.2	15	50	0.2	0.2	50	75		20			20	20	20	0.5	15	20	20	0.2	20			5	36.33	20																750	750	0.2	15	50	0.2	0.2	50	75		20			20	20	20	0.5	15	20	20	0.2	20			5	36.33	20																10.78	0.14	3.6	1.07	0.24	1.18	0.33	0.76	2.92	-	0.82	-	-	1.28	6.18	3.54	0.44	0.82	1.46	7.67	1.38	0.2	-	-	0.2	1.48	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.53	10.78	0.14	3.6	1.07	0.24	1.18	0.33	0.76	2.92	-	0.82	-	-	1.28	6.18	3.54	0.44	0.82	1.46	7.67	1.38	0.2	-	-	0.2	1.48	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.53
H3345_001_1	2006											0											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V	S				V		V															2500																																										-	2150.08		1403.5		561.68	5.74	5.74	242.85	77						6307.2	7759.88	147.11	110.33	367.77	1838.83					1328.6		321.82															100/Admit		25 (Days 21-100)																																							14.93		5		50	0.2	0.2	50	75						5	15	25	15	15	15					15		20															0	14.93		5		50	0.2	0.2	50	75						5	15	25	15	15	15					15		20															0	2.67	-	0.58	-	2.34	1.15	1.15	1.01	0.48	-	-	-	-	-	2.63	9.7	0.31	0.14	0.46	2.3	-	-	-	-	1.66	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.11	2.67	-	0.58	-	2.34	1.15	1.15	1.01	0.48	-	-	-	-	-	2.63	9.7	0.31	0.14	0.46	2.3	-	-	-	-	1.66	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.11
H3345_001_2	2006											0											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V	S				V		V															2500																																										-	2181.11		1276.72		362.93	5.91	5.91	197.8	136.56						5949.17	7319.39	138.76	104.07	346.89	1734.45	0	0	0	0	1301.66	0	509.27															250 (Day 1)/50 (Days 2-10)		25 (21-100)																																							79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	14.51	-	0.53	-	1.51	1.18	1.18	0.82	0.85	-	-	-	-	-	4.96	12.2	0.35	0.17	0.58	2.89	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.22	14.51	-	0.53	-	1.51	1.18	1.18	0.82	0.85	-	-	-	-	-	4.96	12.2	0.35	0.17	0.58	2.89	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.22
H3345_001_3	2006											0											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V					V		V															2500																																										-	2135.04		1129.73		176.76	3.87	3.87	298.53	147.61						5707.67	7022.27	133.12	99.84	332.81	1664.04					1301.66	0	509.27															250 (Day 1)/50 (Days 2-10)		25 (21-100)																																							79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	14.21	-	0.47	-	0.74	0.77	0.77	1.24	0.92	-	-	-	-	-	4.76	11.7	0.33	0.17	0.55	2.77	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.89	14.21	-	0.47	-	0.74	0.77	0.77	1.24	0.92	-	-	-	-	-	4.76	11.7	0.33	0.17	0.55	2.77	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.89
H3345_801_5	2006											0											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V	S				V		V															2500																																										-	2150.08		1403.5		561.68	5.74	5.74	242.85	77						6307.2	7759.88	147.11	110.33	367.77	1838.83					1328.6		321.82															100/Admit		25 (Days 21-100)																																							14.93		5		50	0.2	0.2	50	75						5	15	25	15	15	15					15		20															0	14.93		5		50	0.2	0.2	50	75						5	15	25	15	15	15					15		20															0	2.67	-	0.58	-	2.34	1.15	1.15	1.01	0.48	-	-	-	-	-	2.63	9.7	0.31	0.14	0.46	2.3	-	-	-	-	1.66	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.11	2.67	-	0.58	-	2.34	1.15	1.15	1.01	0.48	-	-	-	-	-	2.63	9.7	0.31	0.14	0.46	2.3	-	-	-	-	1.66	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.11
H3345_801_6	2006											0											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V	S				V		V															2500																																										-	2181.11		1276.72		362.93	5.91	5.91	197.8	136.56						5949.17	7319.39	138.76	104.07	346.89	1734.45	0	0	0	0	1301.66	0	509.27															250 (Day 1)/50 (Days 2-10)		25 (21-100)																																							79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	14.51	-	0.53	-	1.51	1.18	1.18	0.82	0.85	-	-	-	-	-	4.96	12.2	0.35	0.17	0.58	2.89	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.22	14.51	-	0.53	-	1.51	1.18	1.18	0.82	0.85	-	-	-	-	-	4.96	12.2	0.35	0.17	0.58	2.89	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.22
H3345_801_7	2006											0											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V					V		V															2500																																										-	2135.04		1129.73		176.76	3.87	3.87	298.53	147.61						5707.67	7022.27	133.12	99.84	332.81	1664.04					1301.66	0	509.27															250 (Day 1)/50 (Days 2-10)		25 (21-100)																																							79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	14.21	-	0.47	-	0.74	0.77	0.77	1.24	0.92	-	-	-	-	-	4.76	11.7	0.33	0.17	0.55	2.77	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.89	14.21	-	0.47	-	0.74	0.77	0.77	1.24	0.92	-	-	-	-	-	4.76	11.7	0.33	0.17	0.55	2.77	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.89
H3345_802_1	2006											0											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V	S				V		V															2500																																										-	2150.08		1403.5		561.68	5.74	5.74	242.85	77						6307.2	7759.88	147.11	110.33	367.77	1838.83					1328.6		321.82															100/Admit		25 (Days 21-100)																																							14.93		5		50	0.2	0.2	50	75						5	15	25	15	15	15					15		20															0	14.93		5		50	0.2	0.2	50	75						5	15	25	15	15	15					15		20															0	2.67	-	0.58	-	2.34	1.15	1.15	1.01	0.48	-	-	-	-	-	2.63	9.7	0.31	0.14	0.46	2.3	-	-	-	-	1.66	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.11	2.67	-	0.58	-	2.34	1.15	1.15	1.01	0.48	-	-	-	-	-	2.63	9.7	0.31	0.14	0.46	2.3	-	-	-	-	1.66	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.11
H3345_802_2	2006											0											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V	S				V		V															2500																																										-	2181.11		1276.72		362.93	5.91	5.91	197.8	136.56						5949.17	7319.39	138.76	104.07	346.89	1734.45	0	0	0	0	1301.66	0	509.27															250 (Day 1)/50 (Days 2-10)		25 (21-100)																																							79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	14.51	-	0.53	-	1.51	1.18	1.18	0.82	0.85	-	-	-	-	-	4.96	12.2	0.35	0.17	0.58	2.89	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.22	14.51	-	0.53	-	1.51	1.18	1.18	0.82	0.85	-	-	-	-	-	4.96	12.2	0.35	0.17	0.58	2.89	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.22
H3345_802_3	2006											0											D		D		T	Coin	Coin	V	V						V	V	V	V	V	V					V		V															2500																																										-	2135.04		1129.73		176.76	3.87	3.87	298.53	147.61						5707.67	7022.27	133.12	99.84	332.81	1664.04					1301.66	0	509.27															250 (Day 1)/50 (Days 2-10)		25 (21-100)																																							79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	79.85		5		50	0.2	0.2	50	75						10	20	30	20	20	20					15		20															0	14.21	-	0.47	-	0.74	0.77	0.77	1.24	0.92	-	-	-	-	-	4.76	11.7	0.33	0.17	0.55	2.77	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.89	14.21	-	0.47	-	0.74	0.77	0.77	1.24	0.92	-	-	-	-	-	4.76	11.7	0.33	0.17	0.55	2.77	-	-	-	-	1.63	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.89
H3346_001_0	2006	OP Facility - Other	Professional									0	Mental Health Ther. Radiology	Physicals									A	A	Coin	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	Coin	P	P	P	Coin	Coin	T	P	P	P	P	P	O	O	O	Coin	V									2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									-	299.79	4.03	36.83	1390.94	429.32	1.01	0.96	300.36	318.89	5905.67	562.24	66.02	19.24	786.06	7540.35	12969.27	0.89	901.63	3861.6	428.39	2.8	0.01	3.47	0	451.97	191.41	65.36	11.05	0	0	0	19.95	323.9									No Copay Unlimited Days	No Copay Medicare Limits Apply	0 for days 0-10 25 for days 11-100	No Copay for visits 1-20 15 per Visit for Visits 21+	35 per trip	20 Coinsurance	20 Coinsurance	50 per ER Visit 10 per Urgent Care Visit	No Cost Sharing	No Cost Sharing	15 per Visit for X-rays only	No Cost Sharing	No Cost Sharing	15 OP Rehab and 15 OP Substance Abuse	10 per Visit	15 per Specialist Visit 15 for Pelvic Exam	15 for 1st OP MH visit 50 thereafter	15 per Visit	No Cost Sharing	15 Per BMM CS Ophtalmology (1)	20 Coinsurance	No Cost Sharing	No Cost Sharing	Not Covered	10 per Visit	80 Maximum Annual Benefit	15 per Visit	600 Maximum 3-Year Benefit	Not Applicable	No Cost Sharing	Not Applicable	15 for 1st OP MH visit 50 thereafter 0 for Ther. Rad.	10 per Visit									0	0	0.13	3.5	35	0.2	0.2	48.26	0	0	15	0	0	5.71	5.44	6.16	0.43	15	0	15	0.2	0	0	0	10	0	15	0	0	0	0	0.01	10									2000	0	0	0.13	3.5	35	0.2	0.2	48.26	0	0	15	0	0	5.71	5.44	6.16	0.43	15	0	15	0.2	0	0	0	10	0	15	0	0	0	0	0.01	10									0	-	-	4.76	0.41	1.25	0.2	0.19	1.21	-	-	0.7	-	-	0.37	3.42	6.65	0.38	1.13	-	0.54	0.56	-	-	-	0.38	-	0.08	-	-	-	-	0.25	0.27	-	-	-	-	-	-	-	-	22.75	-	-	4.76	0.41	1.25	0.2	0.19	1.21	-	-	0.7	-	-	0.37	3.42	6.65	0.38	1.13	-	0.54	0.56	-	-	-	0.38	-	0.08	-	-	-	-	0.25	0.27	-	-	-	-	-	-	-	-	22.75
H3346_002_0	2006	OP Facility - Other	Professional									0	Mental Health Ther. Radiology	Physicals									A	A	Coin	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	Coin	P	P	P	Coin	Coin	T	P	P	P	P	P	O	O	O	Coin	V									2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									-	299.79	4.03	36.83	1390.94	429.32	1.01	0.96	300.36	318.89	5905.67	562.24	66.02	19.24	786.06	7540.35	12969.27	0.89	901.63	3861.6	428.39	2.8	0.01	3.47	0	451.97	191.41	65.36	11.05	0	0	0	19.95	323.9									No Copay Unlimited Days	No Copay Medicare Limits Apply	0 for days 0-10 25 for days 11-100	No Copay for visits 1-20 15 per Visit for Visits 21+	35 per trip	20 Coinsurance	20 Coinsurance	50 per ER Visit 10 per Urgent Care Visit	No Cost Sharing	No Cost Sharing	15 per Visit for X-rays only	No Cost Sharing	No Cost Sharing	15 OP Rehab and 15 OP Substance Abuse	10 per Visit	15 per Specialist Visit 15 for Pelvic Exam	15 for 1st OP MH visit 50 thereafter	15 per Visit	No Cost Sharing	15 Per BMM CS Ophtalmology (1)	20 Coinsurance	No Cost Sharing	No Cost Sharing	Not Covered	10 per Visit	80 Maximum Annual Benefit	15 per Visit	600 Maximum 3-Year Benefit	Not Applicable	No Cost Sharing	Not Applicable	15 for 1st OP MH visit 50 thereafter 0 for Ther. Rad.	10 per Visit									0	0	0.13	3.5	35	0.2	0.2	48.26	0	0	15	0	0	5.71	5.44	6.16	0.43	15	0	15	0.2	0	0	0	10	0	15	0	0	0	0	0.01	10									2000	0	0	0.13	3.5	35	0.2	0.2	48.26	0	0	15	0	0	5.71	5.44	6.16	0.43	15	0	15	0.2	0	0	0	10	0	15	0	0	0	0	0.01	10									0	-	-	4.76	0.41	1.25	0.2	0.19	1.21	-	-	0.7	-	-	0.37	3.42	6.65	0.38	1.13	-	0.54	0.56	-	-	-	0.38	-	0.08	-	-	-	-	0.25	0.27	-	-	-	-	-	-	-	-	22.75	-	-	4.76	0.41	1.25	0.2	0.19	1.21	-	-	0.7	-	-	0.37	3.42	6.65	0.38	1.13	-	0.54	0.56	-	-	-	0.38	-	0.08	-	-	-	-	0.25	0.27	-	-	-	-	-	-	-	-	22.75
H3346_801_0	2006	OP Facility - Other										0	Mental Health Ther. Rad.										A	A	Coin	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	Coin	P	P	P	Coin	Coin	T	P	P	P	P	P	O	O	O	Coin										2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	299.79	4.03	36.83	1390.94	429.32	1.01	0.96	300.36	318.89	5905.67	562.24	66.02	19.24	720.04	7864.24	12969.7	0.89	901.63	3861.6	428.39	2.8	0	3.47	0	451.97	191.41	65.36	11.05	0	0	0	21.86										100 per admit 300 OOP Max Unlimited Days	100 per admit 300 OOP Max Medicare Limits Apply	0 for days 0-10 25 for days 11-100	No Copay for visits 1-20 15 per Visit for Visits 21+	35 per trip	20 Coinsurance	20 Coinsurance	50 per ER Visit 10 per Urgent Care Visit	No Cost Sharing Includes ASC	No Cost Sharing	15 per Visit for X-rays only	No Cost Sharing	No Cost Sharing	15 OP Rehab and 15 OP Substance Abuse	10 per Visit	15 per Specialist Visit 10 per Pelvic Exam	15 for 1st OP MH visit 50 thereafter	15 per Visit	No Cost Sharing	15 Per BMM CS Ophtalmology (1)	20 Coinsurance	No Cost Sharing	No Cost Sharing	Not Covered	10 per Visit	80 Maximum Annual Benefit	15 per Visit	600 Maximum 3-Year Benefit	Not Applicable	No Cost Sharing	Not Applicable	15 for 1st OP MH visit 50 thereafter										85.72	85.72	0.13	3.5	35	0.2	0.2	48.26	0	0	15	0	0	6.25	5.63	6.19	0.43	15	0	15	0.2	0	0	0	10	0	15	0	0	0	0	0.01										2000	85.72	85.72	0.13	3.5	35	0.2	0.2	48.26	0	0	15	0	0	6.25	5.63	6.19	0.43	15	0	15	0.2	0	0	0	10	0	15	0	0	0	0	0.01										0	2.14	0.03	4.76	0.41	1.25	0.2	0.19	1.21	-	-	0.7	-	-	0.37	3.69	6.69	0.38	1.13	-	0.54	0.56	-	-	-	0.38	-	0.08	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	24.96	2.14	0.03	4.76	0.41	1.25	0.2	0.19	1.21	-	-	0.7	-	-	0.37	3.69	6.69	0.38	1.13	-	0.54	0.56	-	-	-	0.38	-	0.08	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	24.96
H3346_802_0	2006	OP Facility - Other										0	Mental Health										A	A	Coin	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	Coin	P	P	P	Coin	Coin	T	P	P	P	P	P	O	O	O	Coin										2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										-	299.79	4.03	36.83	1390.94	429.32	1.01	0.96	300.36	318.89	5905.67	562.24	66.02	19.24	720.04	7864.24	12969.7	0.89	901.63	3861.6	428.39	2.8	0	3.47	0	451.97	191.41	65.36	11.05	0	0	0	21.86										100 per admit 300 OOP Max Unlimited Days	100 per admit 300 OOP Max Medicare Limits Apply	0 for days 0-10 25 for days 11-100	No Copay for visits 1-20 15 per Visit for Visits 21+	35 per trip	20 Coinsurance	20 Coinsurance	50 per ER Visit 10 per Urgent Care Visit	No Cost Sharing Includes ASC	No Cost Sharing	15 per Visit for X-rays only	No Cost Sharing	No Cost Sharing	15 OP Rehab and 15 OP Substance Abuse	10 per Visit	15 per Specialist Visit 10 per Pelvic Exam	15 for 1st OP MH visit 50 thereafter	15 per Visit	No Cost Sharing	15 Per BMM CS Ophtalmology (1)	20 Coinsurance	No Cost Sharing	No Cost Sharing	Not Covered	10 per Visit	80 Maximum Annual Benefit	15 per Visit	600 Maximum 3-Year Benefit	Not Applicable	No Cost Sharing	Not Applicable	15 for 1st OP MH visit 50 thereafter										85.72	85.72	0.13	3.5	35	0.2	0.2	48.26	0	0	15	0	0	6.25	5.63	6.19	0.43	15	0	15	0.2	0	0	0	10	0	15	0	0	0	0	0.01										2000	85.72	85.72	0.13	3.5	35	0.2	0.2	48.26	0	0	15	0	0	6.25	5.63	6.19	0.43	15	0	15	0.2	0	0	0	10	0	15	0	0	0	0	0.01										0	2.14	0.03	4.76	0.41	1.25	0.2	0.19	1.21	-	-	0.7	-	-	0.37	3.69	6.69	0.38	1.13	-	0.54	0.56	-	-	-	0.38	-	0.08	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	24.96	2.14	0.03	4.76	0.41	1.25	0.2	0.19	1.21	-	-	0.7	-	-	0.37	3.69	6.69	0.38	1.13	-	0.54	0.56	-	-	-	0.38	-	0.08	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	24.96
H3347_001_0	2006											2960											D		D		T	P		V	P							V						O																																																														-	3254.11		1823.68		650.66	508.68		201.14	153.89							38138.86						15311.2																				300 per Admit		50 for 21st to 100 days		50 per trip	20 to 500 cap		50 per visit	100 per proc							20 / visit						various																				24.06		35		12.56	17.36		36.54	63.82							2.22						9.82																					24.06		35		12.56	17.36		36.54	63.82							2.22						9.82																					6.52	-	5.32	-	0.68	0.74	-	0.61	0.82	-	-	-	-	-	-	7.06	-	-	-	-	-	12.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.28	6.52	-	5.32	-	0.68	0.74	-	0.61	0.82	-	-	-	-	-	-	7.06	-	-	-	-	-	12.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.28
H3351_001_0	2006																						A	A	D		T	Coin		V	V		V		V	V	P	P	P	P			S	O			V		V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	286.99	7.36	2069.18	0	251.66	15.8	0	255.06	874.02	0	1308.51	0	8.21	25.52	4073.35	7425.45	176.76	389.52	0	0	1367.56	29.83	0	0	1308.33	0	55.62	0	0	0	100																			Oct-50																						100 20 coins 5000 max											350	350	25	0	50	0.1	0	50	27.08	0	10	0	10	10	5	10	10	10	0	0	10	10	0	0	10	0	10	0	0	0	33.09												350	350	25	0	50	0.1	0	50	27.08	0	10	0	10	10	5	10	10	10	0	0	10	10	0	0	10	0	10	0	0	0	33.09												8.37	0.21	4.31	-	1.05	1.6	-	1.06	1.97	-	1.09	-	0.01	0.02	1.7	6.19	0.15	0.32	-	-	1.14	0.02	-	-	1.09	-	0.05	-	-	-	0.28	-	-	-	-	-	-	-	-	-	-	30.63	8.37	0.21	4.31	-	1.05	1.6	-	1.06	1.97	-	1.09	-	0.01	0.02	1.7	6.19	0.15	0.32	-	-	1.14	0.02	-	-	1.09	-	0.05	-	-	-	0.28	-	-	-	-	-	-	-	-	-	-	30.63
H3351_002_0	2006																						A	A	D		T	Coin		V	V		V		V	V	P	P	P	P			S	O			V		V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	287.28	7.37	2069.18	0	251.66	15.8	0	255.06	874.14	0	1292.24	0	8.21	25.52	3910.41	7192.95	171.23	377.35	0	0	1339.36	29.83	0	0	1267.45	0	53.88	0	0	0	100																			15-35																						100 20 coins 5000 max											300	300	25	0	50	0.1	0	50	23.56	0	15	0	15	15	10	15	15	15	0	0	15	15	0	0	15	0	15	0	0	0	33.09												300	300	25	0	50	0.1	0	50	23.56	0	15	0	15	15	10	15	15	15	0	0	15	15	0	0	15	0	15	0	0	0	33.09												7.18	0.18	4.31	-	1.05	1.6	-	1.06	1.72	-	1.62	-	0.01	0.03	3.26	8.99	0.21	0.47	-	-	1.67	0.04	-	-	1.58	-	0.07	-	-	-	0.28	-	-	-	-	-	-	-	-	-	-	35.33	7.18	0.18	4.31	-	1.05	1.6	-	1.06	1.72	-	1.62	-	0.01	0.03	3.26	8.99	0.21	0.47	-	-	1.67	0.04	-	-	1.58	-	0.07	-	-	-	0.28	-	-	-	-	-	-	-	-	-	-	35.33
H3351_004_0	2006																						A	A	D		T	Coin		V	V		V		V	V	P	P	P	P			S	O			V		V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	287.28	7.37	2069.18	0	251.66	15.8	0	255.06	874.14	0	1292.24	0	8.21	25.52	3910.41	7192.95	171.23	377.35	0	0	1339.36	29.83	0	0	1267.45	0	53.88	0	0	0	100																			15-35																						100 20 coins 5000 max											300	300	25	0	50	0.1	0	50	23.56	0	15	0	15	15	10	15	15	15	0	0	15	15	0	0	15	0	15	0	0	0	33.09												300	300	25	0	50	0.1	0	50	23.56	0	15	0	15	15	10	15	15	15	0	0	15	15	0	0	15	0	15	0	0	0	33.09												7.18	0.18	4.31	-	1.05	1.6	-	1.06	1.72	-	1.62	-	0.01	0.03	3.26	8.99	0.21	0.47	-	-	1.67	0.04	-	-	1.58	-	0.07	-	-	-	0.28	-	-	-	-	-	-	-	-	-	-	35.33	7.18	0.18	4.31	-	1.05	1.6	-	1.06	1.72	-	1.62	-	0.01	0.03	3.26	8.99	0.21	0.47	-	-	1.67	0.04	-	-	1.58	-	0.07	-	-	-	0.28	-	-	-	-	-	-	-	-	-	-	35.33
H3351_006_0	2006																								D		T	Coin	Coin	V			V		V	V	P	P	P	P	P	P	S	O		V	V		V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	1717.9	0	250.43	18.28	1.27	539.23	0	0	1061.67	0	284.87	309.37	5490.45	6046.35	225.76	282.29	778.18	1790.97	877.66	16.14	0	857.01	444.7	0	190.59	0	0	0	100																		15-50																100/50/50 with 500 max							100 20 coins 5000 max											0	0	25	0	35	0.2	0.2	47.26	0	0	15	0	15	15	5	15	15	15	15	15	15	15	0	96.26	15	0	15	0	0	0	31.93												0	0	25	0	35	0.2	0.2	47.26	0	0	15	0	15	15	5	15	15	15	15	15	15	15	0	96.26	15	0	15	0	0	0	31.93											0	-	-	3.58	-	0.73	3.66	0.25	2.12	-	-	1.33	-	0.36	0.39	2.29	7.56	0.28	0.35	0.97	2.24	1.1	0.02	-	6.87	0.56	-	0.24	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	35.16	-	-	3.58	-	0.73	3.66	0.25	2.12	-	-	1.33	-	0.36	0.39	2.29	7.56	0.28	0.35	0.97	2.24	1.1	0.02	-	6.87	0.56	-	0.24	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	35.16
H3351_007_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	187.82	2.71	1717.9	0	249.67	18.28	1.27	540.59	499.54	0	1075.61	0	285.59	310.15	5490.45	6225.91	233.04	291.39	788.4	1828.68	896.14	16.14	0	0	459.05	0	196.74	0	0	0	100											Max of 1 per year	Max of 1 per year						Oct-50																							100 20 coins 5000 max											100	100	25	0	50	0.2	0.2	46.78	50	0	10	0	10	10	5	10	10	10	10	10	10	10	0	0	10	0	10	0	0	0	31.95												100	100	25	0	50	0.2	0.2	46.78	50	0	10	0	10	10	5	10	10	10	10	10	10	10	0	0	10	0	10	0	0	0	31.95											0	1.57	0.02	3.58	-	1.04	3.66	0.25	2.11	2.08	-	0.9	-	0.24	0.26	2.29	5.19	0.19	0.24	0.66	1.52	0.75	0.01	-	-	0.38	-	0.16	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	27.37	1.57	0.02	3.58	-	1.04	3.66	0.25	2.11	2.08	-	0.9	-	0.24	0.26	2.29	5.19	0.19	0.24	0.66	1.52	0.75	0.01	-	-	0.38	-	0.16	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	27.37
H3351_008_0	2006																						A	A	D		T	Coin	Coin	V	V		V		V	V	P	P	P	P	P	P	S	O			V		V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	304.9	4.4	1717.9	0	249.67	18.28	1.27	539.23	498.21	0	1061.67	0	284.87	309.37	5270.84	6046.35	225.76	282.29	778.18	1790.97	877.66	16.14	0	0	444.7	0	190.59	0	0	0	87.86																		15-50																							100 20 coins 4000 max											100	100	25	0	50	0.2	0.2	47.26	65	0	15	0	15	15	10	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	32.46												100	100	25	0	50	0.2	0.2	47.26	65	0	15	0	15	15	10	15	15	15	15	15	15	15	0	0	15	0	15	0	0	0	32.46											0	2.54	0.04	3.58	-	1.04	3.66	0.25	2.12	2.7	-	1.33	-	0.36	0.39	4.39	7.56	0.28	0.35	0.97	2.24	1.1	0.02	-	-	0.56	-	0.24	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	35.95	2.54	0.04	3.58	-	1.04	3.66	0.25	2.12	2.7	-	1.33	-	0.36	0.39	4.39	7.56	0.28	0.35	0.97	2.24	1.1	0.02	-	-	0.56	-	0.24	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	35.95
H3351_009_0	2006											2000											Coin	Coin	Coin		Coin	Coin		V	Coin	Coin	Coin		Coin	Coin	Coin	P	Coin	Coin			Coin	O			V		Coin				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	205.97	3.12	39.83	0	9.84	15.8	0	255.06	42.02	14.61	50.98	0	0.39	3.85	36.91	9555.59	1.49	2.74	0	0	37.28	29.83	0	0	1267.45	0	0.49	17.35	0	0	100																										Chiro - 25 All other - 10															100 20 coins 4000 max											0.1	0.1	0.1	0	0.1	0.1	0	50	0.1	0.1	0.1	0	0.1	0.1	0.1	17.84	0.1	0.1	0	0	0.1	25	0	0	15	0	0.1	0	0	0	29.46											2000	0.07	0.07	0.07	0	0.07	0.07	0	50	0.07	0.07	0.07	0	0.07	0.07	0.07	12.86	0.07	0.07	0	0	0.07	25	0	0	15	0	0.07	0	0	0	29.46												14.27	0.22	2.76	-	0.68	1.09	-	1.06	2.91	1.01	3.53	-	0.03	0.27	2.51	10.24	0.1	0.19	-	-	2.58	0.06	-	-	1.58	-	0.03	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	45.4	14.27	0.22	2.76	-	0.68	1.09	-	1.06	2.91	1.01	3.53	-	0.03	0.27	2.51	10.24	0.1	0.19	-	-	2.58	0.06	-	-	1.58	-	0.03	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	45.4
H3351_801_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1610.79	31.84	1742.95	436.64	210.12	1122.39	0	647.53	1278.21	7231.02	4524.56	0	10.33	59.06	5430.45	11028.98	208.1	528.36	0	0	1667.71	39.45	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				132.01	45.45	40.03	0	107.15	36.35	0	55.58	116.33	6.43	37.99	0	75.76	145.66	17.17	34.46	20.21	20.62	0	0	91.81	17.18	0	0	0	0	0	0	0	0	0												132.01	45.45	40.03	0	107.15	36.35	0	55.58	116.33	6.43	37.99	0	75.76	145.66	17.17	34.46	20.21	20.62	0	0	91.81	17.18	0	0	0	0	0	0	0	0	0											123	17.72	0.12	5.81	-	1.88	3.4	-	3	12.39	3.87	14.33	-	0.07	0.72	7.77	31.67	0.35	0.91	-	-	12.76	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.82	17.72	0.12	5.81	-	1.88	3.4	-	3	12.39	3.87	14.33	-	0.07	0.72	7.77	31.67	0.35	0.91	-	-	12.76	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.82
H3351_802_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	301.42	4.37	1728.85	0	1268.12	47493.44	247.07	612.76	509.2	3329.88	1687.22	0	868.95	2721.38	6158.07	7150.23	244.13	915.76	5384.38	23964.17	929.09	532.39	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				783.76	580.6	61.22	0	15.05	1.08	14.51	24.09	133.69	7.99	42.87	0	23.21	26.32	10.78	14.17	18.34	5.14	13.92	12.36	41.66	9.34	0	0	0	0	0	0	0	0	0												783.76	580.6	61.22	0	15.05	1.08	14.51	24.09	133.69	7.99	42.87	0	23.21	26.32	10.78	14.17	18.34	5.14	13.92	12.36	41.66	9.34	0	0	0	0	0	0	0	0	0											123	19.69	0.21	8.82	-	1.59	4.28	0.3	1.23	5.67	2.22	6.03	-	1.68	5.97	5.53	8.44	0.37	0.39	6.25	24.68	3.23	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107	19.69	0.21	8.82	-	1.59	4.28	0.3	1.23	5.67	2.22	6.03	-	1.68	5.97	5.53	8.44	0.37	0.39	6.25	24.68	3.23	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107
H3351_803_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1610.79	31.84	1742.95	436.64	210.12	1122.39	0	647.53	1278.21	7231.02	4524.56	0	10.33	59.06	5430.45	11028.98	208.1	528.36	0	0	1667.71	39.45	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				132.01	45.45	40.03	0	107.15	36.35	0	55.58	116.33	6.43	37.99	0	75.76	145.66	17.17	34.46	20.21	20.62	0	0	91.81	17.18	0	0	0	0	0	0	0	0	0												132.01	45.45	40.03	0	107.15	36.35	0	55.58	116.33	6.43	37.99	0	75.76	145.66	17.17	34.46	20.21	20.62	0	0	91.81	17.18	0	0	0	0	0	0	0	0	0											123	17.72	0.12	5.81	-	1.88	3.4	-	3	12.39	3.87	14.33	-	0.07	0.72	7.77	31.67	0.35	0.91	-	-	12.76	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.82	17.72	0.12	5.81	-	1.88	3.4	-	3	12.39	3.87	14.33	-	0.07	0.72	7.77	31.67	0.35	0.91	-	-	12.76	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.82
H3351_804_0	2006																																																																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	301.42	4.37	1728.85	0	1268.12	47493.44	247.07	612.76	509.2	3329.88	1687.22	0	868.95	2721.38	6158.07	7150.23	244.13	915.76	5384.38	23964.17	929.09	532.39	0	0	0	0	0	0	0	0	0											FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				783.76	580.6	61.22	0	15.05	1.08	14.51	24.09	133.69	7.99	42.87	0	23.21	26.32	10.78	14.17	18.34	5.14	13.92	12.36	41.66	9.34	0	0	0	0	0	0	0	0	0												783.76	580.6	61.22	0	15.05	1.08	14.51	24.09	133.69	7.99	42.87	0	23.21	26.32	10.78	14.17	18.34	5.14	13.92	12.36	41.66	9.34	0	0	0	0	0	0	0	0	0											123	19.69	0.21	8.82	-	1.59	4.28	0.3	1.23	5.67	2.22	6.03	-	1.68	5.97	5.53	8.44	0.37	0.39	6.25	24.68	3.23	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107	19.69	0.21	8.82	-	1.59	4.28	0.3	1.23	5.67	2.22	6.03	-	1.68	5.97	5.53	8.44	0.37	0.39	6.25	24.68	3.23	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107
H3359_001_0	2006																						D	D	D			Coin	Coin	P								V	Coin	V			S																																																															-	1388.65	52.01	801.12	0	0	4.77	1.97	126.16	0	0	0	0	0	0	0	3847.38	1.47	387.83	0	0	395.57	0	0	0	0	0	0	0	0	0	0											50 for days 1-8	50 for days 1-8	50 for days 1-30																																							50	50	50	0	0	0.1	0.1	50	0	0	0	0	0	0	0	10	0.5	10	0	0	25	0	0	0	0	0	0	0	0	0	0												50	50	50	0	0	0.1	0.1	50	0	0	0	0	0	0	0	10	0.5	10	0	0	25	0	0	0	0	0	0	0	0	0	0												5.79	0.22	3.34	-	-	0.48	0.2	0.53	-	-	-	-	-	-	-	3.21	0.73	0.32	-	-	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.63	5.79	0.22	3.34	-	-	0.48	0.2	0.53	-	-	-	-	-	-	-	3.21	0.73	0.32	-	-	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.63
H3359_019_0	2006																						D	D	D			Coin	Coin	P								V	Coin	V			S			Coin																																																												-	2449.59	178.06	1105.43	0	0	6.34	3	267.15	0	0	0	0	0	0	0	4816.49	2.04	398.94	0	0	113.49	0	0	22.37	0	0	0	0	0	0	0											50 for days 1-8	50 for days 1-8	50 for days 1-30																					0 or 50																		50	50	50	0	0	0.1	0.1	50	0	0	0	0	0	0	0	10	0.5	10	0	0	25	0	0	0.13	0	0	0	0	0	0	0												50	50	50	0	0	0.1	0.1	50	0	0	0	0	0	0	0	10	0.5	10	0	0	25	0	0	0.13	0	0	0	0	0	0	0												10.21	0.74	4.61	-	-	0.63	0.3	1.11	-	-	-	-	-	-	-	4.01	1.02	0.33	-	-	0.24	-	-	2.8	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26	10.21	0.74	4.61	-	-	0.63	0.3	1.11	-	-	-	-	-	-	-	4.01	1.02	0.33	-	-	0.24	-	-	2.8	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26
H3359_021_0	2006																						Coin	Coin	Coin		Coin			Coin	Coin	Coin	Coin		Coin	Coin																													0	0	0	0	0.23	0.1	0.1	0.68	0.23	0.48	1.13	0	0.03	0.07	0.75	4.07	0.12	0.11	0.05	0	0.55	0	0	0	0	0	0	0	0	0	0											8.71	516.73	34.62	37.33	0	8.02	0	0	23.86	8.11	16.82	39.95	0	1.08	2.51	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											Medicare FFS	Medicare FFS	Medicare FFS		0 or 20			0 or 20	0 or 20	0 or 20	0 or 20		0 or 20	0 or 20																												0.07	0.08	0.13	0	0	0	0	0.01	0.01	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0.07	0.08	0.13	0	0	0	0	0.01	0.01	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											110	38.24	2.6	5.03	-	0.03	-	-	0.13	0.05	0.07	0.18	-	0	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.34	38.24	2.6	5.03	-	0.26	0.1	0.1	0.81	0.28	0.55	1.31	-	0.04	0.08	0.75	4.07	0.12	0.11	0.05	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.05
H3359_026_0	2006																													V						V		P	P	P																																																																		-	0	0	0	0	0	0	0	936.84	0	0	0	0	0	497.88	0	7744.15	2299.17	1988.68	0	0	0	0	0	0	0	0	0	0	0	0	0																		10 or 50																																		0	0	0	0	0	0	0	46.92	0	0	0	0	0	10	0	10	20	10	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	46.92	0	0	0	0	0	10	0	10	20	10	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	3.66	-	-	-	-	-	0.41	-	6.45	3.83	1.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.02	-	-	-	-	-	-	-	3.66	-	-	-	-	-	0.41	-	6.45	3.83	1.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.02
H3359_027_0	2006																						D	D	D			Coin	Coin	P								V	Coin	V			S			Coin																																																												-	1326.27	62.8	895.98	0	0	3.49	2	122.93	0	0	0	0	0	0	0	2889.94	1.45	398.36	0	0	72.71	0	0	21.73	0	0	0	0	0	0	0											50 for days 1-8	50 for days 1-8	50 for days 1-30																					0 or 50																		50	50	50	0	0	0.1	0.1	50	0	0	0	0	0	0	0	10	0.5	10	0	0	25	0	0	0.13	0	0	0	0	0	0	0												50	50	50	0	0	0.1	0.1	50	0	0	0	0	0	0	0	10	0.5	10	0	0	25	0	0	0.13	0	0	0	0	0	0	0												5.53	0.26	3.73	-	-	0.35	0.2	0.51	-	-	-	-	-	-	-	2.41	0.72	0.33	-	-	0.15	-	-	2.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.92	5.53	0.26	3.73	-	-	0.35	0.2	0.51	-	-	-	-	-	-	-	2.41	0.72	0.33	-	-	0.15	-	-	2.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.92
H3359_804_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	296.45	3.18	51.75	27.01	6.31	16.99	1.19	3.52	15.77	6.16	16.75	0	4.67	16.59	27.81	45.77	2.88	3.03	34.01	136.11	24.9	3.05	0	0	0	0	0	0	0	0	0																																																				0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	16.42	0.18	8.39	-	1.47	3.96	0.28	0.82	3.67	1.44	3.9	-	1.09	3.87	6.48	10.66	0.67	0.71	7.93	31.71	5.8	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	110.15	16.42	0.18	8.39	-	1.47	3.96	0.28	0.82	3.67	1.44	3.9	-	1.09	3.87	6.48	10.66	0.67	0.71	7.93	31.71	5.8	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	110.15
H3359_805_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	296.45	3.18	51.75	27.01	6.31	16.99	1.19	3.52	15.77	6.16	16.75	0	4.67	16.59	27.81	45.77	2.88	3.03	34.01	136.11	24.9	3.05	0	0	0	0	0	0	0	0	0																																																				0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	16.42	0.18	8.39	-	1.47	3.96	0.28	0.82	3.67	1.44	3.9	-	1.09	3.87	6.48	10.66	0.67	0.71	7.93	31.71	5.8	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	110.15	16.42	0.18	8.39	-	1.47	3.96	0.28	0.82	3.67	1.44	3.9	-	1.09	3.87	6.48	10.66	0.67	0.71	7.93	31.71	5.8	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	110.15
H3359_806_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	296.45	3.18	51.75	27.01	6.31	16.99	1.19	3.52	15.77	6.16	16.75	0	4.67	16.59	27.81	45.77	2.88	3.03	34.01	136.11	24.9	3.05	0	0	0	0	0	0	0	0	0																																																				0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	16.42	0.18	8.39	-	1.47	3.96	0.28	0.82	3.67	1.44	3.9	-	1.09	3.87	6.48	10.66	0.67	0.71	7.93	31.71	5.8	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	110.15	16.42	0.18	8.39	-	1.47	3.96	0.28	0.82	3.67	1.44	3.9	-	1.09	3.87	6.48	10.66	0.67	0.71	7.93	31.71	5.8	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	110.15
H3359_807_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	296.45	3.18	51.75	27.01	6.31	16.99	1.19	3.52	15.77	6.16	16.75	0	4.67	16.59	27.81	45.77	2.88	3.03	34.01	136.11	24.9	3.05	0	0	0	0	0	0	0	0	0																																																				0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.06	0.06	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	16.42	0.18	8.39	-	1.47	3.96	0.28	0.82	3.67	1.44	3.9	-	1.09	3.87	6.48	10.66	0.67	0.71	7.93	31.71	5.8	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	110.15	16.42	0.18	8.39	-	1.47	3.96	0.28	0.82	3.67	1.44	3.9	-	1.09	3.87	6.48	10.66	0.67	0.71	7.93	31.71	5.8	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	110.15
H3361_019_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1723.66	35.75	1474.33	1473.4	415.76	23262.67	24021.7	341.76	312.21	2677.85	1067.26	0	59.7	681.65	7697.67	10831.44	220.74	277.22	4224.29	12996.57	472.91	957.13	0	381	423.87	268.45	149.82	16.9	0	0	135.93											200 days 1 to 5	200 days 1 to 5	100 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 150	Eff. copay 0 to 25	Eff. copay 0 to 75	0	0	Eff. copay 0 to 100	10	Eff. copay 0 to 30	Eff. copay 15 to 25	30	0	Eff. copay 20 coins. 0 to 30 copay	Eff. copay 20 coins.	0	0	0	0	0	35	0	0	0	Eff. copay 0 to 50											129.98	129.5	75.87	10	100	1.03	1.29	50	116.67	5.02	17.58	0	0	5.09	6.71	16.85	24	30	0	4.48	19.79	0	0	0	0	0	35	0	0	0	20.34											N/A	129.98	129.5	75.87	10	100	1.03	1.29	50	116.67	5.02	17.58	0	0	5.09	6.71	16.85	24	30	0	4.48	19.79	0	0	0	0	0	35	0	0	0	20.34												18.67	0.39	9.32	1.23	3.46	1.99	2.59	1.42	3.04	1.12	1.56	-	-	0.29	4.31	15.21	0.44	0.69	-	4.85	0.78	-	-	-	-	-	0.44	-	-	-	0.23	-	-	-	-	-	-	-	-	-	-	72.03	18.67	0.39	9.32	1.23	3.46	1.99	2.59	1.42	3.04	1.12	1.56	-	-	0.29	4.31	15.21	0.44	0.69	-	4.85	0.78	-	-	-	-	-	0.44	-	-	-	0.23	-	-	-	-	-	-	-	-	-	-	72.03
H3361_020_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1533.42	28.92	1354.11	1994.03	324.78	17747.08	18244.22	234.14	171.88	1464.9	607.2	0	35.23	394.62	6982.47	10074.3	252.13	322	3504.06	13716.46	279.06	785.44	200	381	387.1	255.03	146.9	16.63	0	100	258.22											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100	0	0	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	0	0	0	0	0	0	0	0	0 to 15 copay	0	5	0	Eff. copay 10 to 20 coins.  0 to 15 copay	Eff. copay 20 coins.	0	0	0	0	0	20	0	0	0	0											0	0	0	0	0	1.03	1.18	0	0	0	0	0	0	0	0	8.92	0	5	0	3.5	36.46	0	0	0	0	0	20	0	0	0	0											N/A	0	0	0	0	0	1.03	1.18	0	0	0	0	0	0	0	0	8.92	0	5	0	3.5	36.46	0	0	0	0	0	20	0	0	0	0												-	-	-	-	-	1.53	1.79	-	-	-	-	-	-	-	-	7.49	-	0.13	-	4	0.85	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.03	-	-	-	-	-	1.53	1.79	-	-	-	-	-	-	-	-	7.49	-	0.13	-	4	0.85	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.03
H3361_021_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1608.25	31.91	1374.34	1202.67	320.85	17715.27	18249.8	225.83	202.13	1707	686.37	0	39.96	452.11	6790.3	9667.42	206.43	262.09	3762.01	11807.8	316.61	792.47	0	381	376.84	247.82	137.54	15.91	0	0	116.91											150 days 1 to 5	150 days 1 to 5	100 days 8 to 100	0	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 150	Eff. copay 0 to 25	Eff. copay 0 to 100	0	0	Eff. copay 0 to 100	10	0 to 30 copay	Eff. copay 15 to 25	30	0	Eff. copay 20 coins.  0 to 30 copay	Eff. copay 20 coins.	0	0	0	0	0	25	0	0	0	Eff. copay 0 to 50											100.7	100.36	75.87	0	100	0.88	1.17	50	116.67	5.27	23.69	0	0	4.97	6.89	17.82	24	30	0	4.62	28.23	0	0	0	0	0	25	0	0	0	19.89											N/A	100.7	100.36	75.87	0	100	0.88	1.17	50	116.67	5.27	23.69	0	0	4.97	6.89	17.82	24	30	0	4.62	28.23	0	0	0	0	0	25	0	0	0	19.89												13.5	0.27	8.69	-	2.67	1.3	1.79	0.94	1.97	0.75	1.35	-	-	0.19	3.9	14.36	0.41	0.66	-	4.54	0.74	-	-	-	-	-	0.29	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	58.5	13.5	0.27	8.69	-	2.67	1.3	1.79	0.94	1.97	0.75	1.35	-	-	0.19	3.9	14.36	0.41	0.66	-	4.54	0.74	-	-	-	-	-	0.29	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	58.5
H3361_022_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2007.67	42.38	1462.1	1560.26	429.19	24110.92	25127.55	509.44	467.75	3857.07	1534.83	0	88.69	1015.15	7445.99	10583.2	195.83	244.86	4507.4	9819.56	702.62	1090.53	0	381	433.9	318.55	151.52	18.91	0	0	127.7											175 days 1 to 6	175 days 1 to 6	100 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 15 to 35	Eff. copay 15 to 75			Eff. copay 0 to 100	Eff. Copay 0 to	Eff. copay 0 to 35	Eff. copay 25 to 35	40		Eff. copay 20 coins. 0 to 40	Eff. copay 20 coins.						35				Eff. copay 0 to 50											119.21	118.64	75.87	10	100	0.95	1.24	50	116.67	19.14	29.56	0	0	5.12	6.96	18.68	34	40	0	9.21	17.95	0	0	0	0	0	35	0	0	0	27.92											N/A	119.21	118.64	75.87	10	100	0.95	1.24	50	116.67	19.14	29.56	0	0	5.12	6.96	18.68	34	40	0	9.21	17.95	0	0	0	0	0	35	0	0	0	27.92												19.94	0.42	9.24	1.3	3.58	1.9	2.59	2.12	4.55	6.15	3.78	-	-	0.43	4.32	16.48	0.55	0.82	-	7.54	1.05	-	-	-	-	-	0.44	-	-	-	0.3	-	-	-	-	-	-	-	-	-	-	87.51	19.94	0.42	9.24	1.3	3.58	1.9	2.59	2.12	4.55	6.15	3.78	-	-	0.43	4.32	16.48	0.55	0.82	-	7.54	1.05	-	-	-	-	-	0.44	-	-	-	0.3	-	-	-	-	-	-	-	-	-	-	87.51
H3361_023_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1621.2	30.57	1439.77	2122.53	341.53	18662.34	19184.8	245.95	180.55	1538.79	637.83	0	37	414.53	7342.58	10593.86	265.13	338.61	3684.77	14423.85	293.13	825.79	200	381	407.07	268.18	154.47	17.48	0	100	265.35											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100	0	0	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	0	0	0	0	0	0	0	0	0 to 15 copay	0	5	0	Eff. copay 10 to 20 coins.  0 to 15 copay	Eff. copay 20 coins.	0	0	0	0	0	20	0	0	0	0											0	0	0	0	0	1.05	1.19	0	0	0	0	0	0	0	0	8.96	0	5	0	3.34	35.27	0	0	0	0	0	20	0	0	0	0											N/A	0	0	0	0	0	1.05	1.19	0	0	0	0	0	0	0	0	8.96	0	5	0	3.34	35.27	0	0	0	0	0	20	0	0	0	0												-	-	-	-	-	1.64	1.9	-	-	-	-	-	-	-	-	7.91	-	0.14	-	4.01	0.86	-	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.72	-	-	-	-	-	1.64	1.9	-	-	-	-	-	-	-	-	7.91	-	0.14	-	4.01	0.86	-	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.72
H3361_024_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1555.09	29.33	1337.68	1980.44	332.68	18178.81	18687.81	239.65	175.92	1499.33	621.48	0	36.05	403.9	7152.33	10319.38	258.26	329.84	3589.3	14050.14	285.62	804.43	200	381	396.52	261.23	150.47	17.03	0	100	261.58											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100	0	0	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	0	0	0	0	0	0	0	0	0 to 15 copay	0	5	0	Eff. copay 10 to 20 coins.  0 to 15 copay	Eff. copay 20 coins.	0	0	0	0	0	20	0	0	0	0											0	0	0	0	0	1.03	1.16	0	0	0	0	0	0	0	0	8.74	0	5	0	3.19	34.54	0	0	0	0	0	20	0	0	0	0											N/A	0	0	0	0	0	1.03	1.16	0	0	0	0	0	0	0	0	8.74	0	5	0	3.19	34.54	0	0	0	0	0	20	0	0	0	0												-	-	-	-	-	1.56	1.81	-	-	-	-	-	-	-	-	7.51	-	0.14	-	3.73	0.82	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.83	-	-	-	-	-	1.56	1.81	-	-	-	-	-	-	-	-	7.51	-	0.14	-	3.73	0.82	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.83
H3361_025_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1636.53	31.24	1420.51	2059.35	343.82	18834.2	19353.1	244.68	178.92	1530.72	634.01	0	36.47	409.18	7377.46	10647.97	269.73	343.78	3705.29	14694.4	288.93	822.88	200	381	405.76	264.73	153.26	17.21	0	100	269.81											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100	0	0	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	0	0	0	0	0	0	0	0	0 to 15 copay	0	5	0	Eff. copay 10 to 20 coins.  0 to 15 copay	Eff. copay 20 coins.	0	0	0	0	0	20	0	0	0	0											0	0	0	0	0	1.03	1.17	0	0	0	0	0	0	0	0	8.81	0	5	0	3.42	36.42	0	0	0	0	0	20	0	0	0	0											N/A	0	0	0	0	0	1.03	1.17	0	0	0	0	0	0	0	0	8.81	0	5	0	3.42	36.42	0	0	0	0	0	20	0	0	0	0												-	-	-	-	-	1.62	1.89	-	-	-	-	-	-	-	-	7.81	-	0.14	-	4.19	0.88	-	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.78	-	-	-	-	-	1.62	1.89	-	-	-	-	-	-	-	-	7.81	-	0.14	-	4.19	0.88	-	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.78
H3361_026_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1943.93	41.03	1603.27	1522.11	465.7	26162.28	27008.01	381.54	350.33	3016.05	1199.49	0	66.43	760.3	8530.98	11984.03	246.05	307.66	4712.75	14549.2	526.23	1055.59	0	381	464.17	304.27	162.09	18.06	0	0	155.25											200 days 1 to 5	200 days 1 to 5	100 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 25	Eff. copay 0 to 75	0		Eff. copay 0 to 100	Eff. Copay 0 to 25	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30 copay	Eff. copay 20 coins.						35				Eff. copay 0 to 50											129.98	129.5	75.87	10	100	1.06	1.33	50	116.67	4.96	17.54	0	0	5.12	6.63	17.11	24	30	0	4.7	20.23	0	0	0	0	0	35	0	0	0	20.63											N/A	129.98	129.5	75.87	10	100	1.06	1.33	50	116.67	4.96	17.54	0	0	5.12	6.63	17.11	24	30	0	4.7	20.23	0	0	0	0	0	35	0	0	0	20.63												21.06	0.44	10.14	1.27	3.88	2.32	2.99	1.59	3.41	1.25	1.75	-	-	0.32	4.71	17.09	0.49	0.77	-	5.7	0.89	-	-	-	-	-	0.47	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	80.8	21.06	0.44	10.14	1.27	3.88	2.32	2.99	1.59	3.41	1.25	1.75	-	-	0.32	4.71	17.09	0.49	0.77	-	5.7	0.89	-	-	-	-	-	0.47	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	80.8
H3361_027_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1540.04	29.49	1169.3	1751.58	336.84	18464.36	18971.14	198.73	174.73	1454.99	589.77	0	35.56	399.14	6962.89	10081.9	224.67	286.82	3491.07	13836.22	281.72	804.03	0	381	396.42	257.92	147.24	16.75	0	0	121.41											75 days 1 to 10	75 days 1 to 10	50 days 15 to 100	0	50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 150	Eff. copay 0 to 25	Eff. copay 0 to 75	0	0	Eff. copay 0 to 100	5	0 to 30 copay	Eff. copay 15 to 25	30	0	Eff. copay 20 coins.  0 to 30 copay	Eff. copay 20 coins.	0	0	0	0	0	25	0	0	0	Eff. copay 0 to 50											60.06	59.96	29.36	0	50	1.01	1.35	50	116.67	5.5	17.93	0	0	4.86	4.02	18.19	24	30	0	4.5	36	0	0	0	0	0	25	0	0	0	19.65											N/A	60.06	59.96	29.36	0	50	1.01	1.35	50	116.67	5.5	17.93	0	0	4.86	4.02	18.19	24	30	0	4.5	36	0	0	0	0	0	25	0	0	0	19.65												7.71	0.15	2.86	-	1.4	1.56	2.13	0.83	1.7	0.67	0.88	-	-	0.16	2.33	15.28	0.45	0.72	-	5.19	0.85	-	-	-	-	-	0.31	-	-	-	0.2	-	-	-	-	-	-	-	-	-	-	45.36	7.71	0.15	2.86	-	1.4	1.56	2.13	0.83	1.7	0.67	0.88	-	-	0.16	2.33	15.28	0.45	0.72	-	5.19	0.85	-	-	-	-	-	0.31	-	-	-	0.2	-	-	-	-	-	-	-	-	-	-	45.36
H3361_028_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2027.04	42.55	1446.84	1572.38	439.51	24653.95	25690.98	518.4	475.37	3900.63	1553.32	0	90.33	1033.27	7572.2	10826.08	201.56	252.5	4570.44	9980.95	715.6	1119.75	0	381	447.89	329.33	157.11	19.62	0	0	130.04											200 days 1 to 5	200 days 1 to 5	100 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 15 to 35	Eff. copay 15 to 75			Eff. copay 0 to 100	Eff. Copay 0 to 35	Eff. copay 0 to 35	Eff. copay 25 to 35	35		Eff. copay 20 coins. 0 to 35 coins.	Eff. copay 20 coins.						35		0	0	Eff. copay 0 to 50											133.19	132.73	75.87	10	100	1	1.31	50	116.67	19.17	29.62	0	0	5.11	10.46	18.22	34	35	0	8.61	19.1	0	0	0	0	0	35	0	0	0	27.76											N/A	133.19	132.73	75.87	10	100	1	1.31	50	116.67	19.17	29.62	0	0	5.11	10.46	18.22	34	35	0	8.61	19.1	0	0	0	0	0	35	0	0	0	27.76												22.5	0.47	9.15	1.31	3.66	2.06	2.8	2.16	4.62	6.23	3.83	-	-	0.44	6.6	16.44	0.57	0.74	-	7.16	1.14	-	-	-	-	-	0.46	-	-	-	0.3	-	-	-	-	-	-	-	-	-	-	92.64	22.5	0.47	9.15	1.31	3.66	2.06	2.8	2.16	4.62	6.23	3.83	-	-	0.44	6.6	16.44	0.57	0.74	-	7.16	1.14	-	-	-	-	-	0.46	-	-	-	0.3	-	-	-	-	-	-	-	-	-	-	92.64
H3361_029_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1991.67	40.63	1555.74	2099.29	389.33	21662.28	22194.17	199.05	179.23	1465.35	588.01	0	35.09	398.07	7777.41	11354.06	269.34	339.48	3939.65	16750.94	278.01	868.8	0	381	430.52	273.81	154.37	16.67	0	0	156.53											100 days 1 to 5	100 days 1 to 5	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 15 to 25	Eff. copay 15 to 75			Eff. copay 0 to 100	Eff. Copay 0 to 25	Eff. copay 0 to 25	Eff. copay 25 to 35	25		Eff. copay 20 coins. 0 to 35 coins.	Eff. copay 20 coins.						35		0	0	Eff. copay 0 to 50											71.42	71.22	37.93	0	50	1.02	1.31	50	116.67	17.16	29.62	0	0	5	9.8	14.67	34	25	0	6.92	36.02	0	0	0	0	0	35	0	0	0	20.77											N/A	71.42	71.22	37.93	0	50	1.02	1.31	50	116.67	17.16	29.62	0	0	5	9.8	14.67	34	25	0	6.92	36.02	0	0	0	0	0	35	0	0	0	20.77												11.85	0.24	4.92	-	1.62	1.83	2.43	0.83	1.74	2.09	1.45	-	-	0.17	6.35	13.88	0.76	0.71	-	9.66	0.83	-	-	-	-	-	0.45	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	62.11	11.85	0.24	4.92	-	1.62	1.83	2.43	0.83	1.74	2.09	1.45	-	-	0.17	6.35	13.88	0.76	0.71	-	9.66	0.83	-	-	-	-	-	0.45	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	62.11
H3361_030_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1519.58	29.74	1098.65	1237.08	353.44	19502.92	20008.74	193.35	171.59	1439.42	581	0	34.4	387.69	6403.91	9065	185.03	235.89	3522.65	11217.42	272.53	758.94	0	381	370.77	258.11	136.25	16.62	0	0	103.85											150 days 1 to 5	150 days 1 to 5	100 days 8 to 100	0	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 150	Eff. copay 0 to 25	Eff. copay 0 to 100	0	0	Eff. copay 0 to 100	10	Eff. copay 0 to 30	Eff. copay 15 to 25	30	0	Eff. copay 20 coins. 0 to 30	Eff. copay 20 coins.  0 to 30 copay	0	0	0	0	0	25	0	0	0	Eff. copay 0 to 50											100.7	100.36	75.87	0	100	1.03	1.31	50	116.67	5.38	23.79	0	0	4.92	7.1	18.69	24	30	0	4.47	28.8	0	0	0	0	0	25	0	0	0	19.28											N/A	100.7	100.36	75.87	0	100	1.03	1.31	50	116.67	5.38	23.79	0	0	4.92	7.1	18.69	24	30	0	4.47	28.8	0	0	0	0	0	25	0	0	0	19.28												12.75	0.25	6.95	-	2.95	1.67	2.18	0.81	1.67	0.65	1.15	-	-	0.16	3.79	14.12	0.37	0.59	-	4.18	0.65	-	-	-	-	-	0.28	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	55.33	12.75	0.25	6.95	-	2.95	1.67	2.18	0.81	1.67	0.65	1.15	-	-	0.16	3.79	14.12	0.37	0.59	-	4.18	0.65	-	-	-	-	-	0.28	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	55.33
H3361_031_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2402.43	46.54	1836.14	2751.45	1599.41	29303.34	30094.12	312.96	272.13	2421.44	930.24	0	55.04	618.84	11813.5	16984.26	364.62	539.18	6005.91	24018.68	436.07	1258.67	400	381	0	0	0	0	0	100	359.68											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.11	175.1	54.11	0	14.29	0	0	45.96	241.25	0	76.67	0	4.05	46.52	0	0	18.57	0	0	1.77	36.9	0	0	0	0	0	0	0	0	0	0.17											N/A	180.11	175.1	54.11	0	14.29	0	0	45.96	241.25	0	76.67	0	4.05	46.52	0	0	18.57	0	0	1.77	36.9	0	0	0	0	0	0	0	0	0	0.17												36.06	0.68	8.28	-	1.9	-	-	1.2	5.47	-	5.94	-	0.02	2.4	-	-	0.56	-	-	3.54	1.34	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	67.4	36.06	0.68	8.28	-	1.9	-	-	1.2	5.47	-	5.94	-	0.02	2.4	-	-	0.56	-	-	3.54	1.34	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	67.4
H3361_032_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2715.26	53.57	2138.69	3086.79	1730.78	31840.34	32672.76	325.51	284.37	2553.54	974.84	0	56.94	641.96	12762.93	18351.89	398.88	591.53	6501.88	26529.91	451.12	1336.75	400	381	0	0	0	0	0	100	389.1											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.12	175.1	54.11	0	14.42	0	0	45.83	240.95	0	76.68	0	4.07	46.81	0	0	18.74	0	0	1.75	37.04	0	0	0	0	0	0	0	0	0	0.17											N/A	180.12	175.1	54.11	0	14.42	0	0	45.83	240.95	0	76.68	0	4.07	46.81	0	0	18.74	0	0	1.75	37.04	0	0	0	0	0	0	0	0	0	0.17												40.75	0.78	9.64	-	2.08	-	-	1.24	5.71	-	6.23	-	0.02	2.5	-	-	0.62	-	-	3.87	1.39	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	74.86	40.75	0.78	9.64	-	2.08	-	-	1.24	5.71	-	6.23	-	0.02	2.5	-	-	0.62	-	-	3.87	1.39	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	74.86
H3361_034_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2675.55	52.5	2072.05	3025.22	1726.64	31725.23	32561.77	329.86	286.18	2562.68	980.21	0	57.49	647.51	12739.43	18317.66	396.63	587.7	6485.54	26305.21	455.41	1340.71	400	381	0	0	0	0	0	100	385.54											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.11	175.1	54.11	0	14.66	0	0	44.44	233.09	0	74.15	0	3.93	45.18	0	0	17.72	0	0	1.67	35.78	0	0	0	0	0	0	0	0	0	0.16											N/A	180.11	175.1	54.11	0	14.66	0	0	44.44	233.09	0	74.15	0	3.93	45.18	0	0	17.72	0	0	1.67	35.78	0	0	0	0	0	0	0	0	0	0.16												40.16	0.77	9.34	-	2.11	-	-	1.22	5.56	-	6.06	-	0.02	2.44	-	-	0.59	-	-	3.65	1.36	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	73.27	40.16	0.77	9.34	-	2.11	-	-	1.22	5.56	-	6.06	-	0.02	2.44	-	-	0.59	-	-	3.65	1.36	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	73.27
H3361_035_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2697.51	53.08	2172.87	3141.04	1714.71	31525.41	32353.05	326.69	282.92	2536.98	969.44	0	56.74	639.4	12648.6	18188.79	405.72	584.84	6441.11	26203.89	449.52	1327.84	400	381	0	0	0	0	0	100	385.16											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.11	175.1	54.11	0	14.45	0	0	43.78	229.46	0	73.01	0	3.87	44.52	0	0	17.47	0	0	1.64	35.25	0	0	0	0	0	0	0	0	0	0.16											N/A	180.11	175.1	54.11	0	14.45	0	0	43.78	229.46	0	73.01	0	3.87	44.52	0	0	17.47	0	0	1.64	35.25	0	0	0	0	0	0	0	0	0	0.16												40.49	0.77	9.8	-	2.07	-	-	1.19	5.41	-	5.9	-	0.02	2.37	-	-	0.59	-	-	3.58	1.32	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	73.51	40.49	0.77	9.8	-	2.07	-	-	1.19	5.41	-	5.9	-	0.02	2.37	-	-	0.59	-	-	3.58	1.32	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	73.51
H3361_039_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1592.43	30.11	1356.83	2087.04	339.24	18550.3	19067.3	203.77	178.56	1474.8	598.36	0	36.54	409.52	6942.65	10095.74	224.89	287.73	3497.15	13722.02	289.47	817.86	0	381	403.18	264.88	152.79	17.25	0	100	239.97											200 days 1 to 5	200 days 1 to 5	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 100 to 150	Eff. copay 0 to 30	Eff. copay 0 to 100	0	Eff. copay 20 coins.	Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 30	Eff. copay 20 to 30	30		Eff. copay 10 to 20 coins. 0 to 30 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											131.58	131.12	75.87	0	100	1.05	1.19	50	133.33	6.69	24.01	0	0	4.84	7.3	18.05	29	30	0	3.92	36.9	0	0	0	0	0	20	0	0	0	11.63											N/A	131.58	131.12	75.87	0	100	1.05	1.19	50	133.33	6.69	24.01	0	0	4.84	7.3	18.05	29	30	0	3.92	36.9	0	0	0	0	0	20	0	0	0	11.63												17.46	0.33	8.58	-	2.83	1.62	1.89	0.85	1.98	0.82	1.2	-	-	0.17	4.22	15.19	0.54	0.72	-	4.48	0.89	-	-	-	-	-	0.25	-	-	-	0.23	-	-	-	-	-	-	-	-	-	-	64.26	17.46	0.33	8.58	-	2.83	1.62	1.89	0.85	1.98	0.82	1.2	-	-	0.17	4.22	15.19	0.54	0.72	-	4.48	0.89	-	-	-	-	-	0.25	-	-	-	0.23	-	-	-	-	-	-	-	-	-	-	64.26
H3361_040_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1692.86	32.47	1439.55	2175.18	352.15	19312.95	19839.96	206.01	181.25	1501.42	608.01	0	36.85	413.72	7178.02	10444.76	235.16	300.08	3619.05	14423.77	291.93	838.23	0	381	413.64	268.61	155.88	17.43	0	100	247.4											200 days 1 to 5	200 days 1 to 5	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 100 to 150	Eff. copay 0 to 30	Eff. copay 0 to 100	0		Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 30	Eff. copay 20 to 30	30		Eff. copay 10 to 20 coins. 0 to 30 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											131.58	131.12	75.87	0	100	1.05	1.18	50	133.33	6.63	23.96	0	0	4.87	7.25	17.94	29	30	0	3.72	35.27	0	0	0	0	0	20	0	0	0	12.13											N/A	131.58	131.12	75.87	0	100	1.05	1.18	50	133.33	6.63	23.96	0	0	4.87	7.25	17.94	29	30	0	3.72	35.27	0	0	0	0	0	20	0	0	0	12.13												18.56	0.35	9.1	-	2.93	1.7	1.96	0.86	2.01	0.83	1.21	-	-	0.17	4.33	15.61	0.57	0.75	-	4.47	0.86	-	-	-	-	-	0.26	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	66.79	18.56	0.35	9.1	-	2.93	1.7	1.96	0.86	2.01	0.83	1.21	-	-	0.17	4.33	15.61	0.57	0.75	-	4.47	0.86	-	-	-	-	-	0.26	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	66.79
H3361_041_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1701.9	32.98	1412.81	2106.08	354.1	19462.97	19986.5	203.61	179.7	1492.03	603.32	0	36.35	408.66	7195.98	10476.02	237.75	302.81	3630.65	14639.71	287.96	835.17	0	381	412.24	265.29	154.69	17.17	0	100	250.27											200 days 1 to 5	200 days 1 to 5	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 100 to 150	Eff. copay 0 to 30	Eff. copay 0 to 100	0		Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 30	Eff. copay 20 to 30	30		Eff. copay 10 to 20 coins. 0 to 30 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											131.58	131.12	75.87	0	100	1.03	1.16	50	133.33	6.58	23.92	0	0	4.89	7.21	17.88	29	30	0	3.87	36.42	0	0	0	0	0	20	0	0	0	12.38											N/A	131.58	131.12	75.87	0	100	1.03	1.16	50	133.33	6.58	23.92	0	0	4.89	7.21	17.88	29	30	0	3.87	36.42	0	0	0	0	0	20	0	0	0	12.38												18.66	0.36	8.93	-	2.95	1.67	1.93	0.85	2	0.82	1.2	-	-	0.17	4.32	15.61	0.57	0.76	-	4.72	0.87	-	-	-	-	-	0.26	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	66.91	18.66	0.36	8.93	-	2.95	1.67	1.93	0.85	2	0.82	1.2	-	-	0.17	4.32	15.61	0.57	0.76	-	4.72	0.87	-	-	-	-	-	0.26	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	66.91
H3361_042_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1624.52	30.98	1339.43	2048.58	345.98	18952.63	19474.17	204.54	179.67	1486.53	602.44	0	36.62	410.89	7063.67	10275.71	230.37	294.28	3560.08	14100.88	290.14	827.75	0	381	408.31	266.4	154.22	17.32	0	100	244.04											200 days 1 to 5	200 days 1 to 5	100 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 100 to 150	Eff. copay 0 to 30	Eff. copay 0 to 100	0		Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 30	Eff. copay 20 to 30	30		Eff. copay 10 to 20 coins. 0 to 30 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											131.58	131.12	75.87	0	100	1.03	1.16	50	133.33	6.65	23.98	0	0	4.86	7.26	17.97	29	30	0	3.67	34.75	0	0	0	0	0	20	0	0	0	11.92											N/A	131.58	131.12	75.87	0	100	1.03	1.16	50	133.33	6.65	23.98	0	0	4.86	7.26	17.97	29	30	0	3.67	34.75	0	0	0	0	0	20	0	0	0	11.92												17.81	0.34	8.47	-	2.88	1.63	1.89	0.85	2	0.82	1.2	-	-	0.17	4.28	15.39	0.56	0.74	-	4.31	0.84	-	-	-	-	-	0.26	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	64.67	17.81	0.34	8.47	-	2.88	1.63	1.89	0.85	2	0.82	1.2	-	-	0.17	4.28	15.39	0.56	0.74	-	4.31	0.84	-	-	-	-	-	0.26	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	64.67
H3361_043_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2090.76	39.43	1648.43	2480.18	472.82	25836.64	26563.24	287.81	251.96	2214.88	908.14	0	51.64	578.5	10499.83	15050.74	367.05	468.78	5323.36	20623.76	409.08	1144.85	400	381	563.55	383.49	213.86	24.2	0	100	201.22											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 00 to 00		Eff. copay 0 to 50	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											0	0	0	0	0	1.03	1.18	50	0	0	11.81	0	0	0	0	0	0	0	0	2.1	36.84	0	0	0	0	0	20	0	0	0	0.19											N/A	0	0	0	0	0	1.03	1.18	50	0	0	11.81	0	0	0	0	0	0	0	0	2.1	36.84	0	0	0	0	0	20	0	0	0	0.19												-	-	-	-	-	2.21	2.6	1.2	-	-	0.89	-	-	-	-	-	-	-	-	3.61	1.26	-	-	-	-	-	0.36	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.13	-	-	-	-	-	2.21	2.6	1.2	-	-	0.89	-	-	-	-	-	-	-	-	3.61	1.26	-	-	-	-	-	0.36	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.13
H3361_044_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2277.49	43.55	1820.1	2666.08	498.9	27338.47	28090.44	295.1	259.33	2292.85	938.81	0	52.82	592.75	11066.31	15866.05	391.95	499.42	5618.47	22078.37	418.46	1192.54	400	381	587.95	396.28	221.93	24.89	0	100	218.09																Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50			Eff. copay 0 to 50									Eff. copay 10 to 20 coins. 0 to 20 copay	Eff. copay 20 coins.						20				Eff. copay 0 to 50											0	0	0	0	0	1.04	1.17	50	0	0	11.78	0	0	0	0	0	0	0	0	1.96	35.27	0	0	0	0	0	20	0	0	0	0.19											N/A	0	0	0	0	0	1.04	1.17	50	0	0	11.78	0	0	0	0	0	0	0	0	1.96	35.27	0	0	0	0	0	20	0	0	0	0.19												-	-	-	-	-	2.37	2.74	1.23	-	-	0.92	-	-	-	-	-	-	-	-	3.6	1.23	-	-	-	-	-	0.37	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.46	-	-	-	-	-	2.37	2.74	1.23	-	-	0.92	-	-	-	-	-	-	-	-	3.6	1.23	-	-	-	-	-	0.37	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.46
H3361_045_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2267.96	43.37	1887.8	2749.19	491.19	26916.26	27656.72	290.61	255.39	2257.99	924.54	0	52.02	583.74	10895.4	15621.02	385.9	491.7	5531.7	21737.39	412.1	1174.18	400	381	578.87	390.16	218.5	24.5	0	100	214.72																Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50			Eff. copay 0 to 50									Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20				Eff. copay 0 to 50											0	0	0	0	0	1.02	1.16	50	0	0	11.78	0	0	0	0	0	0	0	0	1.93	34.75	0	0	0	0	0	20	0	0	0	0.19											N/A	0	0	0	0	0	1.02	1.16	50	0	0	11.78	0	0	0	0	0	0	0	0	1.93	34.75	0	0	0	0	0	20	0	0	0	0.19												-	-	-	-	-	2.3	2.66	1.21	-	-	0.91	-	-	-	-	-	-	-	-	3.5	1.19	-	-	-	-	-	0.36	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.14	-	-	-	-	-	2.3	2.66	1.21	-	-	0.91	-	-	-	-	-	-	-	-	3.5	1.19	-	-	-	-	-	0.36	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.14
H3361_046_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2354.8	45.8	1904.36	2709.47	501.48	27581.26	28320.64	287.31	253.82	2261.76	924.36	0	51.26	576.57	11107.3	15929.17	400.09	508.27	5649.66	22608.58	406.11	1179.85	400	381	582.26	387.39	218.2	24.17	0	100	226.79											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100		0	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 00 to 00		Eff. copay 0 to 50	0		Eff. copay 00 coins.	0		Eff. copay 00 to 00			Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											0	0	0	0	0	1.02	1.15	50	0	0	11.74	0	0	0	0	0	0	0	0	2.02	36.42	0	0	0	0	0	20	0	0	0	0.18											N/A	0	0	0	0	0	1.02	1.15	50	0	0	11.74	0	0	0	0	0	0	0	0	2.02	36.42	0	0	0	0	0	20	0	0	0	0.18												-	-	-	-	-	2.34	2.72	1.2	-	-	0.9	-	-	-	-	-	-	-	-	3.8	1.23	-	-	-	-	-	0.36	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.56	-	-	-	-	-	2.34	2.72	1.2	-	-	0.9	-	-	-	-	-	-	-	-	3.8	1.23	-	-	-	-	-	0.36	-	-	-	0	-	-	-	-	-	-	-	-	-	-	12.56
H3361_047_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2804.94	57.44	3261	3151.05	629.56	35123.54	36282.54	676.34	475.43	4420.81	1835.76	0	91.45	1042.46	12837.83	17926.71	405.94	510.89	7103.52	21548.95	724.44	1467.72	0	0	592.86	409.9	279.47	30.54	0	0	40.98											300 per admit	300 per admit		10	50			50	35					Eff. copay 0 to 35	Eff. copay 0 to 10	Eff. copay 0 to 20	20	20		Eff. copay 0 to 20											10											58.79	57.13	0	10	50	0	0	50	35	0	0	0	0	1.77	5.95	7.44	20	20	0	1.25	0	0	0	0	0	0	0	0	0	0	10											N/A	58.79	57.13	0	10	50	0	0	50	35	0	0	0	0	1.77	5.95	7.44	20	20	0	1.25	0	0	0	0	0	0	0	0	0	0	10												13.74	0.27	-	2.63	2.62	-	-	2.82	1.39	-	-	-	-	0.15	6.37	11.12	0.68	0.85	-	2.24	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	44.91	13.74	0.27	-	2.63	2.62	-	-	2.82	1.39	-	-	-	-	0.15	6.37	11.12	0.68	0.85	-	2.24	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	44.91
H3361_050_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2541.3	48.83	2403.84	3398.14	523.49	28715.37	29500.37	630.45	270.59	2397.48	1000.29	0	54.99	617.42	11633.66	16723.82	413.05	1577.57	5896	24581.09	435.61	1246.2	0	0	569.95	393.02	263.31	28.82	0	100	41.47																		50								Eff. copay 0 to 10	20	10		Eff. copay 0 to 10																						0	0	0	0	0	0	0	50	0	0	0	0	0	0	0	9.85	20	10	0	0.96	0	0	0	0	0	0	0	0	0	0	0											N/A	0	0	0	0	0	0	0	50	0	0	0	0	0	0	0	9.85	20	10	0	0.96	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	2.63	-	-	-	-	-	-	-	13.73	0.69	1.31	-	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.32	-	-	-	-	-	-	-	2.63	-	-	-	-	-	-	-	13.73	0.69	1.31	-	1.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.32
H3361_051_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1536.44	28.64	1334.42	2043.92	330.9	18041.24	18554.38	203.79	177.89	1556.98	639.06	0	36.63	409.83	7349.12	10723.94	254.46	325.59	3724.62	14268.69	290.16	807.74	200	381	397.85	264.33	151.59	17.27	0	100	137.83											50 days 1 to 3	50 days 1 to 3	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 50 to 75		Eff. copay 0 to 50	0		Eff. copay 0 to 50	Eff. copay 0 to 20	Eff. copay 0 to 20	Eff. copay 00 to 00			Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											27.42	27.26	37.93	0	50	1.05	1.59	50	66.67	0	11.83	0	0	2.41	0.12	0.25	0	0	0	2.87	36.9	0	0	0	0	0	20	0	0	0	0.32											N/A	27.42	27.26	37.93	0	50	1.05	1.59	50	66.67	0	11.83	0	0	2.41	0.12	0.25	0	0	0	2.87	36.9	0	0	0	0	0	20	0	0	0	0.32												3.51	0.07	4.22	-	1.38	1.57	2.46	0.85	0.99	-	0.63	-	-	0.08	0.07	0.22	-	-	-	3.41	0.89	-	-	-	-	-	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	20.61	3.51	0.07	4.22	-	1.38	1.57	2.46	0.85	0.99	-	0.63	-	-	0.08	0.07	0.22	-	-	-	3.41	0.89	-	-	-	-	-	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	20.61
H3361_052_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1685.44	32.22	1454.1	2154.82	349.45	19149	19674.6	205.93	180.97	1600.05	655.14	0	36.86	413.64	7745.24	11294.78	274.54	349.81	3935.41	15464.6	292.02	834.77	200	381	411.83	268.32	155.45	17.43	0	100	152.76											50 days 1 to 3	50 days 1 to 3	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 50 to 75		Eff. copay 0 to 50	0		Eff. copay 0 to 50	Eff. copay 0 to 20	Eff. copay 0 to 20	Eff. copay 00 to 00			Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											27.42	27.26	37.93	0	50	1.05	1.5	50	66.67	0	11.78	0	0	2.43	0.11	0.24	0	0	0	2.51	35.27	0	0	0	0	0	20	0	0	0	0.3											N/A	27.42	27.26	37.93	0	50	1.05	1.5	50	66.67	0	11.78	0	0	2.43	0.11	0.24	0	0	0	2.51	35.27	0	0	0	0	0	20	0	0	0	0.3												3.85	0.07	4.6	-	1.46	1.68	2.46	0.86	1.01	-	0.64	-	-	0.08	0.07	0.23	-	-	-	3.23	0.86	-	-	-	-	-	0.26	-	-	-	0	-	-	-	-	-	-	-	-	-	-	21.36	3.85	0.07	4.6	-	1.46	1.68	2.46	0.86	1.01	-	0.64	-	-	0.08	0.07	0.23	-	-	-	3.23	0.86	-	-	-	-	-	0.26	-	-	-	0	-	-	-	-	-	-	-	-	-	-	21.36
H3361_053_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1633.79	31.24	1385.17	2054.1	343.27	18810.73	19327.72	202.76	178.18	1575.37	645.04	0	36.29	407.26	7608.43	11098.79	269.69	343.63	3865.89	15191.43	287.52	820.35	200	381	404.55	263.58	152.7	17.13	0	100	150.06											50 days 1 to 3	50 days 1 to 3	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 50 to 75		Eff. copay 0 to 50	0		Eff. copay 0 to 50	Eff. copay 0 to 20	Eff. copay 0 to 20	Eff. copay 00 to 00			Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											27.42	27.26	37.93	0	50	1.03	1.36	50	66.67	0	11.78	0	0	2.43	0.11	0.24	0	0	0	2.42	36.36	0	0	0	0	0	20	0	0	0	0.3											N/A	27.42	27.26	37.93	0	50	1.03	1.36	50	66.67	0	11.78	0	0	2.43	0.11	0.24	0	0	0	2.42	36.36	0	0	0	0	0	20	0	0	0	0.3												3.73	0.07	4.38	-	1.43	1.61	2.2	0.84	0.99	-	0.63	-	-	0.08	0.07	0.22	-	-	-	3.07	0.87	-	-	-	-	-	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	20.46	3.73	0.07	4.38	-	1.43	1.61	2.2	0.84	0.99	-	0.63	-	-	0.08	0.07	0.22	-	-	-	3.07	0.87	-	-	-	-	-	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	20.46
H3361_054_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1496.74	27.68	1271.14	1977.81	328.87	17903.42	18417.71	204.95	178.56	1558.23	640.03	0	36.88	412.29	7308.6	10664.9	251.25	321.9	3701.24	14069.08	292.15	807.81	200	381	397.77	265.77	151.98	17.4	0	100	134.95											50 days 1 to 3	50 days 1 to 3	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	50	Eff. Copay 50 to 75		Eff. copay 0 to 50	0		Eff. copay 0 to 50	Eff. copay 0 to 20	Eff. copay 0 to 20	Eff. copay 00 to 00			Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											27.42	27.26	37.93	0	50	1.03	1.47	50	66.67	0	11.85	0	0	2.41	0.12	0.25	0	0	0	2.51	34.75	0	0	0	0	0	20	0	0	0	0.33											N/A	27.42	27.26	37.93	0	50	1.03	1.47	50	66.67	0	11.85	0	0	2.41	0.12	0.25	0	0	0	2.51	34.75	0	0	0	0	0	20	0	0	0	0.33												3.42	0.06	4.02	-	1.37	1.54	2.26	0.85	0.99	-	0.63	-	-	0.08	0.07	0.22	-	-	-	2.94	0.85	-	-	-	-	-	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	19.56	3.42	0.06	4.02	-	1.37	1.54	2.26	0.85	0.99	-	0.63	-	-	0.08	0.07	0.22	-	-	-	2.94	0.85	-	-	-	-	-	0.25	-	-	-	0	-	-	-	-	-	-	-	-	-	-	19.56
H3361_056_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1548.25	29.58	1379.78	1359.16	323.06	17683.98	18236.98	234.72	207.68	1791.24	728.42	0	41.84	470.89	7095.63	10034.33	204.85	280.18	3900.99	12019.38	331.45	819.43	0	381	391.24	264.43	145.56	17.17	0	0	118.7											50 days 1 to 5	50 days 1 to 5	75 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 75	Eff. copay 0 to 10	Eff. copay 0 to 75	0	0	Eff. copay 0 to 50	Eff. copay 0 to 25	Eff. copay 0 to 10	Eff. copay 15 to 25	10		Eff. copay 20 coins. 0 to 25 copay	Eff. copay 20 coins.						25		0	0	Eff. copay 0 to 50											38.92	38.85	56.9	0	50	0.94	1.27	50	66.67	2.1	17.8	0	0	2.45	0.38	6.35	24	10	0	3.01	30.48	0	0	0	0	0	25	0	0	0	8.06											N/A	38.92	38.85	56.9	0	50	0.94	1.27	50	66.67	2.1	17.8	0	0	2.45	0.38	6.35	24	10	0	3.01	30.48	0	0	0	0	0	25	0	0	0	8.06												5.02	0.1	6.54	-	1.35	1.39	1.93	0.98	1.15	0.31	1.08	-	-	0.1	0.23	5.31	0.41	0.23	-	3.01	0.84	-	-	-	-	-	0.3	-	-	-	0.08	-	-	-	-	-	-	-	-	-	-	30.37	5.02	0.1	6.54	-	1.35	1.39	1.93	0.98	1.15	0.31	1.08	-	-	0.1	0.23	5.31	0.41	0.23	-	3.01	0.84	-	-	-	-	-	0.3	-	-	-	0.08	-	-	-	-	-	-	-	-	-	-	30.37
H3361_057_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1909.1	36.81	1466.96	1671.68	458.61	25226.99	25898.95	260.04	229.66	1976.88	804.49	0	46.41	521.87	8684.44	12197.81	258.38	330.13	4781.11	15047.17	367.63	891.22	0	381	423.55	343.7	181.52	22.22	0	0	142.27											50 days 1 to 10	50 days 1 to 10	50 days 8 to 100	0	50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 75	Eff. copay 0 to 10	Eff. copay 0 to 75	0	0	Eff. copay 0 to 50	Eff. copay 0 to 25	Eff. copay 0 to 25	10	10	0	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25	0	0	25	25	25	0	0	0	Eff. copay 0 to 50											42.13	42.08	37.93	0	50	1.01	1.3	50	66.67	2.11	17.82	0	0	2.44	0.38	6.39	10	10	0	2.68	28.71	19.92	0	0	25	25	25	0	0	0	4.34											N/A	42.13	42.08	37.93	0	50	1.01	1.3	50	66.67	2.11	17.82	0	0	2.44	0.38	6.39	10	10	0	2.68	28.71	19.92	0	0	25	25	25	0	0	0	4.34												6.7	0.13	4.64	-	1.91	2.13	2.8	1.08	1.28	0.35	1.19	-	-	0.11	0.27	6.5	0.22	0.28	-	3.36	0.88	1.48	-	-	0.88	0.72	0.38	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	37.33	6.7	0.13	4.64	-	1.91	2.13	2.8	1.08	1.28	0.35	1.19	-	-	0.11	0.27	6.5	0.22	0.28	-	3.36	0.88	1.48	-	-	0.88	0.72	0.38	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	37.33
H3361_058_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1496.47	28.37	1133.35	1731.93	331.13	18113.53	18618.04	198.95	174.42	1536.55	629.69	0	35.66	399.78	7315.8	10389.89	242.89	310.19	3728.48	14437.25	282.53	797.56	0	381	392.99	257.82	146.63	16.79	0	0	131.84											50 days 1 to 5	50 days 1 to 5	50 days 8 to 100		50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 75	Eff. copay 0 to 5	Eff. copay 0 to 75	0	0	Eff. copay 0 to 50	Eff. copay 0 to 5	Eff. copay 0 to 5	Eff. copay 5	5		Eff. copay 20 coins. 0 to 25 copay	Eff. copay 20 coins.						25		0	0	Eff. copay 0 to 50											38.92	38.85	37.93	0	50	1.01	1.35	50	66.67	1.04	17.7	0	0	2.42	0.27	3.42	5	5	0	2.54	36	0	0	0	0	0	25	0	0	0	4.28											N/A	38.92	38.85	37.93	0	50	1.01	1.35	50	66.67	1.04	17.7	0	0	2.42	0.27	3.42	5	5	0	2.54	36	0	0	0	0	0	25	0	0	0	4.28												4.85	0.09	3.58	-	1.38	1.53	2.1	0.83	0.97	0.13	0.93	-	-	0.08	0.16	2.96	0.1	0.13	-	3.05	0.85	-	-	-	-	-	0.31	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	24.08	4.85	0.09	3.58	-	1.38	1.53	2.1	0.83	0.97	0.13	0.93	-	-	0.08	0.16	2.96	0.1	0.13	-	3.05	0.85	-	-	-	-	-	0.31	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	24.08
H3361_059_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1928.74	40.71	1630.03	1540.25	455.73	25602	26429.79	373.5	342.94	3077.01	1234.16	0	65.02	744.26	8705.29	12097.29	262.67	328.45	4854.55	14821.55	515.13	1033.06	0	381	454.23	282.87	158.62	17.68	0	0	165											100 days 1 to 10	100 days 1 to 10	100 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 10	Eff. copay 0 to 75	0		Eff. copay 0 to 100	Eff. copay 0 to 25	Eff. copay 0 to 10	Eff. copay 10 to 10	10		Eff. copay 20 coins. 0 to 35 coins.	Eff. copay 20 coins.						35		0	0	Eff. copay 0 to 50											80.08	79.95	75.87	10	100	1.05	1.31	50	116.67	1.9	17.46	0	0	5.12	0.37	6	10	10	0	2.77	19.91	0	0	0	0	0	35	0	0	0	8.56											N/A	80.08	79.95	75.87	10	100	1.05	1.31	50	116.67	1.9	17.46	0	0	5.12	0.37	6	10	10	0	2.77	19.91	0	0	0	0	0	35	0	0	0	8.56												12.87	0.27	10.31	1.28	3.8	2.23	2.88	1.56	3.33	0.49	1.8	-	-	0.32	0.27	6.05	0.22	0.27	-	3.43	0.85	-	-	-	-	-	0.46	-	-	-	0.12	-	-	-	-	-	-	-	-	-	-	52.81	12.87	0.27	10.31	1.28	3.8	2.23	2.88	1.56	3.33	0.49	1.8	-	-	0.32	0.27	6.05	0.22	0.27	-	3.43	0.85	-	-	-	-	-	0.46	-	-	-	0.12	-	-	-	-	-	-	-	-	-	-	52.81
H3361_060_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1964.54	41.47	1609.77	1528.28	467.59	26268.29	27117.44	383.09	351.75	3156.06	1265.87	0	66.7	763.38	8931.85	12412.13	269.51	336.99	4980.89	15207.28	528.37	1059.86	0	381	466.05	290.23	162.75	18.14	0	0	169.29											100 days 1 to 10	100 days 1 to 10	100 days 8 to 100	10	100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 50 to 150	Eff. copay 0 to 10	Eff. copay 0 to 75	0	0	Eff. copay 0 to 100	Eff. copay 0 to 10	Eff. copay 0 to 10	10	10		Eff. copay 20 coins. 0 to 35 copay	Eff. copay 20 coins.						35		0	0	Eff. copay 0 to 50											80.08	79.95	75.87	10	100	1.06	1.33	50	116.67	1.9	17.46	0	0	5.12	0.37	6	10	10	0	2.81	20.26	0	0	0	0	0	35	0	0	0	8.56											N/A	80.08	79.95	75.87	10	100	1.06	1.33	50	116.67	1.9	17.46	0	0	5.12	0.37	6	10	10	0	2.81	20.26	0	0	0	0	0	35	0	0	0	8.56												13.11	0.28	10.18	1.27	3.9	2.33	3.01	1.6	3.42	0.5	1.84	-	-	0.33	0.28	6.21	0.22	0.28	-	3.56	0.89	-	-	-	-	-	0.47	-	-	-	0.12	-	-	-	-	-	-	-	-	-	-	53.8	13.11	0.28	10.18	1.27	3.9	2.33	3.01	1.6	3.42	0.5	1.84	-	-	0.33	0.28	6.21	0.22	0.28	-	3.56	0.89	-	-	-	-	-	0.47	-	-	-	0.12	-	-	-	-	-	-	-	-	-	-	53.8
H3361_061_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1551.56	29.69	1386.2	1358.01	323.82	17732.06	18285.75	234.96	207.99	1741.34	703.66	0	41.87	471.35	6893.8	9835.32	205.45	262.81	3760.59	11685.17	331.7	820.49	0	381	391.68	264.45	145.61	17.16	0	0	111.24											75 days 1 to 11	75 days 1 to 11	75 days 8 to 100	0	50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 75	Eff. copay 0 to 25	Eff. copay 0 to 75	0	0	Eff. copay 0 to 50	Eff. copay 0 to 50	Eff. copay 0 to 30	Eff. copay 15 to 25	30	0	Eff. copay 20 coins. Eff. Copay 0 to 30	Eff. copay 20 coins.	0	0	0	0	0	25	0	0	0	Eff. copay 0 to 50											71.19	71.16	56.9	0	50	0.94	1.27	50	66.67	5.41	17.87	0	0	2.45	3.94	18.34	24	30	0	4.83	30.47	0	0	0	0	0	25	0	0	0	19.23											N/A	71.19	71.16	56.9	0	50	0.94	1.27	50	66.67	5.41	17.87	0	0	2.45	3.94	18.34	24	30	0	4.83	30.47	0	0	0	0	0	25	0	0	0	19.23												9.2	0.18	6.57	-	1.35	1.39	1.94	0.98	1.16	0.79	1.05	-	-	0.1	2.26	15.03	0.41	0.66	-	4.7	0.84	-	-	-	-	-	0.3	-	-	-	0.18	-	-	-	-	-	-	-	-	-	-	49.08	9.2	0.18	6.57	-	1.35	1.39	1.94	0.98	1.16	0.79	1.05	-	-	0.1	2.26	15.03	0.41	0.66	-	4.7	0.84	-	-	-	-	-	0.3	-	-	-	0.18	-	-	-	-	-	-	-	-	-	-	49.08
H3361_062_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1328.41	24.12	1453.18	2325.2	338.49	18452.6	19210.43	363.35	324.18	2730.77	1099.61	0	64.43	727.88	6207.61	8902.46	162.77	210.76	3506.98	8530.25	510.46	893.15	0	381	384.67	297.44	147.15	18.77	0	0	84.81											19 days 0 to 999	19 days 0 to 999	50 days 8 to 100		0	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 100	Eff. copay 0 to 25	Eff. copay 0 to 75	0		Eff. copay 0 to 50	Eff. Copay 0 to	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											19.59	19.04	37.93	0	0	0.99	1.31	50	75	5.31	17.8	0	0	2.47	4.12	18.83	24	30	0	4.96	19.69	0	0	0	0	0	20	0	0	0	17.4											N/A	19.59	19.04	37.93	0	0	0.99	1.31	50	75	5.31	17.8	0	0	2.47	4.12	18.83	24	30	0	4.96	19.69	0	0	0	0	0	20	0	0	0	17.4												2.17	0.04	4.59	-	-	1.53	2.1	1.51	2.03	1.21	1.63	-	-	0.15	2.13	13.97	0.33	0.53	-	3.52	0.84	-	-	-	-	-	0.25	-	-	-	0.12	-	-	-	-	-	-	-	-	-	-	38.64	2.17	0.04	4.59	-	-	1.53	2.1	1.51	2.03	1.21	1.63	-	-	0.15	2.13	13.97	0.33	0.53	-	3.52	0.84	-	-	-	-	-	0.25	-	-	-	0.12	-	-	-	-	-	-	-	-	-	-	38.64
H3361_063_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1459.75	28.09	1518.93	2317.57	363.94	20048.99	20884.38	407.79	367.76	3123.76	1251.9	0	71.82	815.3	6383.96	9152.31	167.4	214.41	3728.39	8737.27	569	937.07	0	381	390.31	301.42	146.27	18.68	0	0	94.31											19 days 0 to 999	19 days 0 to 999	50 days 8 to 100		0	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 100	Eff. copay 0 to 25	Eff. copay 0 to 75			Eff. copay 0 to 50	Eff. Copay 0 to	Eff. copay 0 to 30	Eff. copay 15 to 25	30		Eff. copay 20 coins. 0 to 30	Eff. copay 20 coins.						20		0	0	Eff. copay 0 to 50											11.9	19.04	37.93	0	0	0.94	1.24	50	78.26	5.17	17.7	0	0	2.51	4.05	18.18	24	30	0	4.95	18.24	0	0	0	0	0	20	0	0	0	18.35											N/A	11.9	19.04	37.93	0	0	0.94	1.24	50	78.26	5.17	17.7	0	0	2.51	4.05	18.18	24	30	0	4.95	18.24	0	0	0	0	0	20	0	0	0	18.35												1.45	0.04	4.8	-	-	1.57	2.15	1.7	2.4	1.35	1.85	-	-	0.17	2.15	13.87	0.33	0.54	-	3.61	0.86	-	-	-	-	-	0.24	-	-	-	0.14	-	-	-	-	-	-	-	-	-	-	39.23	1.45	0.04	4.8	-	-	1.57	2.15	1.7	2.4	1.35	1.85	-	-	0.17	2.15	13.87	0.33	0.54	-	3.61	0.86	-	-	-	-	-	0.24	-	-	-	0.14	-	-	-	-	-	-	-	-	-	-	39.23
H3361_064_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2209.72	43	1729.69	2553.49	1454.92	26681.98	27395.97	283.89	245.09	2185.51	838.37	0	49.46	556.42	10743.08	15411.7	332.54	492.07	5463.87	21956.11	391.84	1139.58	0	381	0	0	0	0	0	0	339.96											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.11	175.1	54.11	0	13.58	0	0	43.7	228.8	0	72.73	0	3.85	44.2	0	0	17.65	0	0	1.67	35.03	0	0	0	0	0	0	0	0	0	0.16											N/A	180.11	175.1	54.11	0	13.58	0	0	43.7	228.8	0	72.73	0	3.85	44.2	0	0	17.65	0	0	1.67	35.03	0	0	0	0	0	0	0	0	0	0.16												33.17	0.63	7.8	-	1.65	-	-	1.03	4.67	-	5.08	-	0.02	2.05	-	-	0.49	-	-	3.06	1.14	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	60.79	33.17	0.63	7.8	-	1.65	-	-	1.03	4.67	-	5.08	-	0.02	2.05	-	-	0.49	-	-	3.06	1.14	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	60.79
H3361_065_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2343.82	47.97	1922.27	2043.57	1816.07	33773.22	34885.65	563.72	455.93	4239.46	1595.66	0	87.69	999.69	12317.46	17155.76	339.49	491.25	6830.43	20652.86	694.72	1410.37	0	381	0	0	0	0	0	0	361.17											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100	0	14	Eff. copay 00 coins.	Eff. copay 00 coins.	25	126	0	40.19	0	Eff. copay 0 to 0	Eff. copay 0 to 126	0	0	Eff. copay 0 to 0	0	0	Eff. copay 00 to 20 coins.	Eff. copay 20 coins.	0	0	0	0	0	0	0	0	0	Eff. copay 0 to 25											180.13	175.1	54.11	0	14.03	0	0	25.22	126.43	0	40.19	0	2.18	25.28	0	0	15.39	0	0	1.52	19.84	0	0	0	0	0	0	0	0	0	0.09											N/A	180.13	175.1	54.11	0	14.03	0	0	25.22	126.43	0	40.19	0	2.18	25.28	0	0	15.39	0	0	1.52	19.84	0	0	0	0	0	0	0	0	0	0.09												35.18	0.7	8.67	-	2.12	-	-	1.18	4.8	-	5.34	-	0.02	2.11	-	-	0.44	-	-	2.61	1.15	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	64.33	35.18	0.7	8.67	-	2.12	-	-	1.18	4.8	-	5.34	-	0.02	2.11	-	-	0.44	-	-	2.61	1.15	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	64.33
H3361_066_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2469.93	51.01	2057.74	2117.22	1891.92	35252.32	36408.37	587.34	475.41	4435.32	1665.11	0	91.08	1039.42	12791.45	17801.48	353.24	511.64	7117.14	21547.79	721.52	1458.56	0	381	0	0	0	0	0	0	374.4											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.13	175.1	54.11	0	14.27	0	0	25.39	127.65	0	40.67	0	2.2	25.6	0	0	15.65	0	0	1.53	20.07	0	0	0	0	0	0	0	0	0	0.09											N/A	180.13	175.1	54.11	0	14.27	0	0	25.39	127.65	0	40.67	0	2.2	25.6	0	0	15.65	0	0	1.53	20.07	0	0	0	0	0	0	0	0	0	0.09												37.08	0.74	9.28	-	2.25	-	-	1.24	5.06	-	5.64	-	0.02	2.22	-	-	0.46	-	-	2.75	1.21	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	67.95	37.08	0.74	9.28	-	2.25	-	-	1.24	5.06	-	5.64	-	0.02	2.22	-	-	0.46	-	-	2.75	1.21	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	67.95
H3361_067_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2263.79	44.54	2125.91	1870.62	1385.47	25450.8	26226.48	349.45	293.24	2653.28	1007.65	0	58.23	657.92	10552.42	14892.37	310.18	446.78	5919.17	18426.91	461.27	1148.21	0	381	0	0	0	0	0	0	322.92											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.11	175.1	54.11	0	11.99	0	0	34.81	178.98	0	56.7	0	3.06	35.24	0	0	15.96	0	0	1.66	27.86	0	0	0	0	0	0	0	0	0	0.13											N/A	180.11	175.1	54.11	0	11.99	0	0	34.81	178.98	0	56.7	0	3.06	35.24	0	0	15.96	0	0	1.66	27.86	0	0	0	0	0	0	0	0	0	0.13												33.98	0.65	9.59	-	1.38	-	-	1.01	4.37	-	4.76	-	0.01	1.93	-	-	0.41	-	-	2.55	1.07	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	61.73	33.98	0.65	9.59	-	1.38	-	-	1.01	4.37	-	4.76	-	0.01	1.93	-	-	0.41	-	-	2.55	1.07	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	61.73
H3361_068_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2043.39	39.36	1576.02	1815.89	1494.51	27403.2	28133.12	297.53	249.48	2222.07	853.06	0	50.41	566.89	9821.42	13774.01	273.76	393.24	5437.66	17147.53	399.34	1091.5	0	381	0	0	0	0	0	0	293.99											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.11	175.1	54.11	0	13.9	0	0	35.72	184.57	0	58.71	0	3.11	35.68	0	0	15.95	0	0	1.58	28.3	0	0	0	0	0	0	0	0	0	0.15											N/A	180.11	175.1	54.11	0	13.9	0	0	35.72	184.57	0	58.71	0	3.11	35.68	0	0	15.95	0	0	1.58	28.3	0	0	0	0	0	0	0	0	0	0.15												30.67	0.57	7.11	-	1.73	-	-	0.89	3.84	-	4.17	-	0.01	1.69	-	-	0.36	-	-	2.25	0.94	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	54.24	30.67	0.57	7.11	-	1.73	-	-	0.89	3.84	-	4.17	-	0.01	1.69	-	-	0.36	-	-	2.25	0.94	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	54.24
H3361_069_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2182.23	41.09	1796.1	2758.73	1466.3	26707.73	27457.03	301.21	259.36	2279.87	883.25	0	53.15	595.48	10855.9	15564.47	329.08	484.59	5502.84	21371.28	421.09	1182.57	0	381	0	0	0	0	0	0	328.01											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.1	175.1	54.11	0	13.96	0	0	45.03	235.58	0	74.73	0	3.93	45	0	0	18.14	0	0	1.78	35.79	0	0	0	0	0	0	0	0	0	0.18											N/A	180.1	175.1	54.11	0	13.96	0	0	45.03	235.58	0	74.73	0	3.93	45	0	0	18.14	0	0	1.78	35.79	0	0	0	0	0	0	0	0	0	0.18												32.75	0.6	8.1	-	1.71	-	-	1.13	5.09	-	5.5	-	0.02	2.23	-	-	0.5	-	-	3.17	1.26	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.05	32.75	0.6	8.1	-	1.71	-	-	1.13	5.09	-	5.5	-	0.02	2.23	-	-	0.5	-	-	3.17	1.26	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.05
H3361_070_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2198.1	44.45	1776.36	2118.38	1514.22	28056.95	29229.53	660.56	526.56	4890.31	1855.09	0	101.43	1155.77	10052.53	14031.66	250.53	361.59	5933.28	13328.12	803.51	1311.54	0	381	0	0	0	0	0	0	295.82											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.13	175.1	54.11	0	12.29	0	0	22.71	111.78	0	35.28	0	1.92	22.25	0	0	15.34	0	0	1.74	17.48	0	0	0	0	0	0	0	0	0	0.1											N/A	180.13	175.1	54.11	0	12.29	0	0	22.71	111.78	0	35.28	0	1.92	22.25	0	0	15.34	0	0	1.74	17.48	0	0	0	0	0	0	0	0	0	0.1												32.99	0.65	8.01	-	1.55	-	-	1.25	4.9	-	5.45	-	0.02	2.14	-	-	0.32	-	-	1.93	1.17	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	60.4	32.99	0.65	8.01	-	1.55	-	-	1.25	4.9	-	5.45	-	0.02	2.14	-	-	0.32	-	-	1.93	1.17	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	60.4
H3361_071_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2171.1	40.71	2175.16	2218.28	1414.64	25718.29	26535.93	363.03	306.55	2718.99	1046.85	0	62.22	698.88	10757.58	15211.62	309.62	443.92	5910.55	18093.6	492.93	1209.88	0	381	0	0	0	0	0	0	161.11											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.1	175.1	54.11	0	12.92	0	0	38.11	196.25	0	61.86	0	3.33	38.18	0	0	17.2	0	0	1.82	30.36	0	0	0	0	0	0	0	0	0	0.31											N/A	180.1	175.1	54.11	0	12.92	0	0	38.11	196.25	0	61.86	0	3.33	38.18	0	0	17.2	0	0	1.82	30.36	0	0	0	0	0	0	0	0	0	0.31												32.58	0.59	9.81	-	1.52	-	-	1.15	5.01	-	5.4	-	0.02	2.22	-	-	0.44	-	-	2.74	1.25	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.75	32.58	0.59	9.81	-	1.52	-	-	1.15	5.01	-	5.4	-	0.02	2.22	-	-	0.44	-	-	2.74	1.25	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.75
H3361_072_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1722.02	31.22	1443.4	2452.73	1485.86	27000.63	28114.19	589.01	477.2	4313.68	1655.42	0	94.85	1071.46	9716.24	13759.74	246.97	352.58	5542.93	13305.63	751.42	1309.11	0	381	0	0	0	0	0	0	265.41											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.08	175.1	54.11	0	13.32	0	0	25.72	125.83	0	38.81	0	2.13	24.43	0	0	16.11	0	0	1.87	19.37	0	0	0	0	0	0	0	0	0	0.14											N/A	180.08	175.1	54.11	0	13.32	0	0	25.72	125.83	0	38.81	0	2.13	24.43	0	0	16.11	0	0	1.87	19.37	0	0	0	0	0	0	0	0	0	0.14												25.84	0.46	6.51	-	1.65	-	-	1.26	5	-	5.35	-	0.02	2.18	-	-	0.33	-	-	2.07	1.21	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	51.89	25.84	0.46	6.51	-	1.65	-	-	1.26	5	-	5.35	-	0.02	2.18	-	-	0.33	-	-	2.07	1.21	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	51.89
H3361_073_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1941.58	37.01	1794.07	2839.19	1578.22	28933.31	30138.34	658.3	528.54	4840.43	1848.91	0	103.5	1173.99	10029.73	14178.4	253.99	364.26	5886.49	13616.31	819.94	1360.84	0	381	0	0	0	0	0	0	281.77											912 annual deductible228/day days 61 - 90 456/day days 91+	912 annual deductible228/day days 61 - 90 456/day days 91+	114 days 21 to 100		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0	Eff. copay 20 coins.	Eff. copay 20 coins.			Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											180.1	175.1	54.11	0	12.74	0	0	23.83	116.54	0	36.27	0	1.98	22.87	0	0	15.42	0	0	1.77	18.05	0	0	0	0	0	0	0	0	0	0.12											N/A	180.1	175.1	54.11	0	12.74	0	0	23.83	116.54	0	36.27	0	1.98	22.87	0	0	15.42	0	0	1.77	18.05	0	0	0	0	0	0	0	0	0	0.12												29.14	0.54	8.09	-	1.68	-	-	1.31	5.13	-	5.59	-	0.02	2.24	-	-	0.33	-	-	2.01	1.23	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.3	29.14	0.54	8.09	-	1.68	-	-	1.31	5.13	-	5.59	-	0.02	2.24	-	-	0.33	-	-	2.01	1.23	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.3
H3361_074_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1167.51	20.67	1283.46	2117.07	304.77	16550.5	17226.77	353.22	286.15	2387.2	962.38	0	57.27	645.68	5620.16	8115.89	148.87	193.49	3148.49	7801.79	453.66	811.38	0	0	0	0	0	0	0	0	75.4											152 days 0 to 999	152 days 0 to 999	114 days 21 to 100		0	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. Copay 150 to 200	Eff. copay 0 to 35	Eff. copay 0 to 50	0		Eff. copay 0 to 150	Eff. Copay 0 to	Eff. copay 0 to 35	Eff. copay 25 to 35	35		Eff. copay 20 coins. 0 to 35 coins.	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											152.68	152.36	54.11	0	0	0.97	1.27	25.73	183.33	7.56	11.92	0	0	7.39	8.3	19.23	34	35	0	4.15	19.27	0	0	0	0	0	0	0	0	0	0.3											N/A	152.68	152.36	54.11	0	0	0.97	1.27	25.73	183.33	7.56	11.92	0	0	7.39	8.3	19.23	34	35	0	4.15	19.27	0	0	0	0	0	0	0	0	0	0.3												14.85	0.26	5.79	-	-	1.33	1.83	0.76	4.37	1.5	0.96	-	-	0.4	3.89	13.01	0.42	0.56	-	2.7	0.73	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	53.36	14.85	0.26	5.79	-	-	1.33	1.83	0.76	4.37	1.5	0.96	-	-	0.4	3.89	13.01	0.42	0.56	-	2.7	0.73	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	53.36
H3361_075_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1139.72	20.62	1183.31	1935.03	299.74	16334.34	17005.6	356.99	286.98	2400.64	966.13	0	57.08	644.67	5447.88	7871.64	144.36	186.99	3084.14	7583.44	452.19	791.97	0	381	341.33	263.93	130.66	16.67	0	0	75.01											152 days 0 to 999	152 days 0 to 999	114 days 21 to 100		0	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. Copay 150 to 200	Eff. copay 0 to 35	Eff. copay 0 to 50	0		Eff. copay 0 to 150	Eff. Copay 0 to	Eff. copay 0 to 35	Eff. copay 25 to 35	35		Eff. copay 20 coins. 0 to 35 coins.	Eff. copay 20 coins.						20		0	0	Eff. copay 20 coins.											152.68	152.36	54.11	0	0	0.9	1.19	23.98	183.33	7.49	11.9	0	0	7.42	8.16	18.8	34	35	0	4.01	17.9	0	0	0	0	0	20	0	0	0	0.27											N/A	152.68	152.36	54.11	0	0	0.9	1.19	23.98	183.33	7.49	11.9	0	0	7.42	8.16	18.8	34	35	0	4.01	17.9	0	0	0	0	0	20	0	0	0	0.27												14.5	0.26	5.34	-	-	1.23	1.68	0.71	4.38	1.5	0.96	-	-	0.4	3.7	12.33	0.41	0.55	-	2.53	0.67	-	-	-	-	-	0.22	-	-	-	0	-	-	-	-	-	-	-	-	-	-	51.38	14.5	0.26	5.34	-	-	1.23	1.68	0.71	4.38	1.5	0.96	-	-	0.4	3.7	12.33	0.41	0.55	-	2.53	0.67	-	-	-	-	-	0.22	-	-	-	0	-	-	-	-	-	-	-	-	-	-	51.38
H3361_076_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1574.28	31	1377.62	1208.96	316.56	17445.36	17976	224.43	200.36	1711.3	690.63	0	39.78	449.53	6808.64	9665.78	212.61	270.26	3768.04	11773.8	315.17	786.54	0	381	374.35	247.73	137.23	15.95	0	0	119.67											75 days 1 to 5	75 days 1 to 5	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 75	Eff. copay 0 to 15	Eff. copay 0 to 100	0		Eff. copay 0 to 50	Eff. copay 0 to 05	Eff. copay 0 to 15	Eff. copay 05 to 15	15		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.						25		0	0	Eff. copay 0 to 50											48.74	48.56	37.93	0	100	0.88	1.18	50	58.33	3.14	23.66	0	0	2.48	3.66	9.1	14	15	0	3.19	28.29	0	0	0	0	0	25	0	0	0	12.14											N/A	48.74	48.56	37.93	0	100	0.88	1.18	50	58.33	3.14	23.66	0	0	2.48	3.66	9.1	14	15	0	3.19	28.29	0	0	0	0	0	25	0	0	0	12.14												6.39	0.13	4.35	-	2.64	1.28	1.76	0.94	0.97	0.45	1.36	-	-	0.09	2.07	7.33	0.25	0.34	-	3.13	0.74	-	-	-	-	-	0.29	-	-	-	0.12	-	-	-	-	-	-	-	-	-	-	34.63	6.39	0.13	4.35	-	2.64	1.28	1.76	0.94	0.97	0.45	1.36	-	-	0.09	2.07	7.33	0.25	0.34	-	3.13	0.74	-	-	-	-	-	0.29	-	-	-	0.12	-	-	-	-	-	-	-	-	-	-	34.63
H3361_077_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1512.41	29.61	1117.51	1225.59	350.15	19321.79	19822.92	191.55	169.99	1444.08	584.26	0	34.08	384.09	6440.87	9086.51	191.72	244.28	3549.46	11280.98	270	751.89	0	381	367.33	255.71	134.98	16.46	0	0	107.96											75 days 1 to 5	75 days 1 to 5	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 75	Eff. copay 0 to 15	Eff. copay 0 to 100	0	0	Eff. copay 0 to 50	Eff. copay 0 to 5	Eff. copay 0 to 15	Eff. copay 5 to 15	15		Eff. copay 20 coins. 0 to 25 copay	Eff. copay 20 coins.						25		0	0	Eff. copay 0 to 50											48.74	48.56	37.93	0	100	1.02	1.3	50	58.33	3.19	23.74	0	0	2.46	3.74	9.23	14	15	0	3	28.71	0	0	0	0	0	25	0	0	0	11.89											N/A	48.74	48.56	37.93	0	100	1.02	1.3	50	58.33	3.19	23.74	0	0	2.46	3.74	9.23	14	15	0	3	28.71	0	0	0	0	0	25	0	0	0	11.89												6.14	0.12	3.53	-	2.92	1.65	2.15	0.8	0.83	0.38	1.16	-	-	0.08	2.01	6.99	0.22	0.31	-	2.82	0.65	-	-	-	-	-	0.28	-	-	-	0.11	-	-	-	-	-	-	-	-	-	-	33.14	6.14	0.12	3.53	-	2.92	1.65	2.15	0.8	0.83	0.38	1.16	-	-	0.08	2.01	6.99	0.22	0.31	-	2.82	0.65	-	-	-	-	-	0.28	-	-	-	0.11	-	-	-	-	-	-	-	-	-	-	33.14
H3361_078_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1559.37	31.92	1179.43	1366.87	343.07	19123.97	19923.7	396.2	361.27	3143.91	1257.84	0	69.29	790.52	6321.69	8893.9	169	213.26	3722.07	8399.32	548.92	885.58	0	381	361.39	255.47	129.07	16.17	0	0	104.24											75 days 1 to 5	75 days 1 to 5	50 days 8 to 100		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. Copay 25 to 75	Eff. copay 0 to 15	Eff. copay 0 to 100	0		Eff. copay 0 to 50	Eff. copay 0 to 05	Eff. copay 0 to 15	Eff. copay 05 to 15	15		Eff. copay 20 coins. 0 to 25 coins.	Eff. copay 20 coins.						25		0	0	Eff. copay 0 to 50											48.74	48.56	37.93	0	100	0.9	1.17	50	58.33	2.98	23.4	0	0	2.54	3.66	8.78	14	15	0	3.53	17.41	0	0	0	0	0	25	0	0	0	12.01											N/A	48.74	48.56	37.93	0	100	0.9	1.17	50	58.33	2.98	23.4	0	0	2.54	3.66	8.78	14	15	0	3.53	17.41	0	0	0	0	0	25	0	0	0	12.01												6.33	0.13	3.73	-	2.86	1.43	1.95	1.65	1.76	0.78	2.45	-	-	0.17	1.93	6.51	0.2	0.27	-	2.47	0.8	-	-	-	-	-	0.27	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	35.78	6.33	0.13	3.73	-	2.86	1.43	1.95	1.65	1.76	0.78	2.45	-	-	0.17	1.93	6.51	0.2	0.27	-	2.47	0.8	-	-	-	-	-	0.27	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	35.78
H3361_079_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2164.44	42.95	2024.29	1707.07	429.39	23708.23	24425.02	303.19	271.38	2370.48	959.69	0	53.66	607	9405.97	13276.55	297.56	377.51	5258.19	16374.19	425.07	933.5	0	381	429.49	331.66	184.07	21.3	0	0	168.69											50 days 1 to 10	50 days 1 to 10	50 days 8 to 100	0	50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 75	Eff. copay 0 to 10	Eff. copay 0 to 75	0	0	Eff. copay 0 to 50	Eff. copay 0 to 25	Eff. copay 0 to 25	10	10	0	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25	0	0	25	25	25	0	0	0	Eff. copay 0 to 50											42.13	42.08	37.93	0	50	0.88	1.17	50	66.67	2.04	17.69	0	0	2.48	0.39	6.24	10	10	0	2.83	28.23	19.39	0	0	25	25	25	0	0	0	4.85											N/A	42.13	42.08	37.93	0	50	0.88	1.17	50	66.67	2.04	17.69	0	0	2.48	0.39	6.24	10	10	0	2.83	28.23	19.39	0	0	25	25	25	0	0	0	4.85												7.6	0.15	6.4	-	1.79	1.73	2.38	1.26	1.51	0.4	1.41	-	-	0.13	0.3	6.91	0.25	0.31	-	3.85	1	1.51	-	-	0.89	0.69	0.38	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	40.93	7.6	0.15	6.4	-	1.79	1.73	2.38	1.26	1.51	0.4	1.41	-	-	0.13	0.3	6.91	0.25	0.31	-	3.85	1	1.51	-	-	0.89	0.69	0.38	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	40.93
H3361_080_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2216.15	43.75	1719.4	2457.21	470.84	25985.54	26665.24	261.56	232.29	1915.56	776	0	46.52	524.4	9788.46	14105.8	325.53	413.06	4931.74	19983.49	368.51	695.39	0	381	538.96	340.81	197.15	21.94	0	0	181.75											75 days 1 to 10	75 days 1 to 10	50 days 8 to 100	0	50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	100	Eff. copay 15 to 20	Eff. copay 15 to 75	0	0	Eff. copay 0 to 100	Eff. copay 0 to 25	Eff. copay 0 to 25	20	20	0	Eff. copay 20 coins.	Eff. copay 20 coins.	0	0	0	0	0	35	0	0	0	Eff. copay 0 to 50											63.2	63.11	37.93	0	50	0.99	1.3	50	100	16.09	29.65	0	0	4.92	3.85	12.15	20	20	0	6.49	35.54	0	0	0	0	0	35	0	0	0	16.28											N/A	63.2	63.11	37.93	0	50	0.99	1.3	50	100	16.09	29.65	0	0	4.92	3.85	12.15	20	20	0	6.49	35.54	0	0	0	0	0	35	0	0	0	16.28												11.67	0.23	5.44	-	1.96	2.15	2.9	1.09	1.94	2.57	1.92	-	-	0.22	3.14	14.28	0.54	0.69	-	10.81	1.09	-	-	-	-	-	0.58	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	63.45	11.67	0.23	5.44	-	1.96	2.15	2.9	1.09	1.94	2.57	1.92	-	-	0.22	3.14	14.28	0.54	0.69	-	10.81	1.09	-	-	-	-	-	0.58	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	63.45
H3361_081_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2152.04	41.47	1745.89	2573.25	461.66	25341.16	26029.88	269.03	236.99	2034.07	828.6	0	48.09	540.15	9837.6	14119.29	331.57	422.4	4970.58	19739.26	380.94	970.44	0	381	466.93	349.64	200.11	22.67	0	0	180.93											50 days 1 to 10	50 days 1 to 10	50 days 8 to 100	0	50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 75	Eff. copay 0 to 10	Eff. copay 0 to 75	0	0	Eff. copay 0 to 50	Eff. copay 0 to 25	Eff. copay 0 to 25	10	10	0	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25	0	0	25	25	25	0	0	0	Eff. copay 0 to 50											42.13	42.08	37.93	0	50	1.01	1.34	50	66.67	2.13	17.84	0	0	2.44	0.41	6.43	10	10	0	2.87	36	20.17	0	0	25	25	25	0	0	0	0.2											N/A	42.13	42.08	37.93	0	50	1.01	1.34	50	66.67	2.13	17.84	0	0	2.44	0.41	6.43	10	10	0	2.87	36	20.17	0	0	25	25	25	0	0	0	0.2												7.56	0.15	5.52	-	1.92	2.13	2.91	1.12	1.32	0.36	1.23	-	-	0.11	0.33	7.56	0.28	0.35	-	4.71	1.14	1.63	-	-	0.97	0.73	0.42	-	-	-	0	-	-	-	-	-	-	-	-	-	-	42.46	7.56	0.15	5.52	-	1.92	2.13	2.91	1.12	1.32	0.36	1.23	-	-	0.11	0.33	7.56	0.28	0.35	-	4.71	1.14	1.63	-	-	0.97	0.73	0.42	-	-	-	0	-	-	-	-	-	-	-	-	-	-	42.46
H3361_082_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2101.5	43.02	1682.68	1925.2	468.5	26115.71	27210.48	542.84	494.98	4409.51	1773	0	94.94	1083.1	8828	12333.85	237.56	299.72	5228.04	11688.64	752.09	1069.77	0	381	411.26	348.87	176.25	22.08	0	0	145.86											50 days 1 to 10	50 days 1 to 10	50 days 8 to 100	0	50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 75	Eff. copay 0 to 10	Eff. copay 0 to 75	0	0	Eff. copay 0 to 50	Eff. copay 0 to 25	Eff. copay 0 to 25	10	10	0	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25	0	0	25	25	25	0	0	0	Eff. copay 0 to 50											42.13	42.08	37.93	0	50	0.89	1.17	50	66.67	1.94	17.52	0	0	2.54	0.35	6.07	10	10	0	3.11	17.41	16.34	0	0	25	25	25	0	0	0	0.22											N/A	42.13	42.08	37.93	0	50	0.89	1.17	50	66.67	1.94	17.52	0	0	2.54	0.35	6.07	10	10	0	3.11	17.41	16.34	0	0	25	25	25	0	0	0	0.22												7.38	0.15	5.32	-	1.95	1.93	2.64	2.26	2.75	0.71	2.59	-	-	0.23	0.26	6.24	0.2	0.25	-	3.03	1.09	1.46	-	-	0.86	0.73	0.37	-	-	-	0	-	-	-	-	-	-	-	-	-	-	42.39	7.38	0.15	5.32	-	1.95	1.93	2.64	2.26	2.75	0.71	2.59	-	-	0.23	0.26	6.24	0.2	0.25	-	3.03	1.09	1.46	-	-	0.86	0.73	0.37	-	-	-	0	-	-	-	-	-	-	-	-	-	-	42.39
H3361_083_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2157.65	41.63	2121.5	1983.39	443.96	24352.68	25108.83	320.88	284.69	2462.94	1000.5	0	57.1	643.44	9744.74	13774.35	302.77	386.31	5379.14	16612.69	452.36	996.08	0	381	461.26	358.44	197.68	23.21	0	0	165.85											50 days 1 to 10	50 days 1 to 10	75 days 8 to 100	0	50	Eff. copay 20 coins.	Eff. copay 20 coins.	50	Eff. copay 50 to 75	Eff. copay 0 to 10	Eff. copay 0 to 75	0	0	Eff. copay 0 to 50	Eff. copay 0 to 25	Eff. copay 0 to 25	10	10	0	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 0 to 25	0	0	25	25	25	0	0	0	Eff. copay 0 to 50											42.13	42.08	56.9	0	50	0.94	1.26	50	66.67	2.09	17.77	0	0	2.46	0.38	6.32	10	10	0	2.99	30.42	19.41	0	0	25	25	25	0	0	0	0.21											N/A	42.13	42.08	56.9	0	50	0.94	1.26	50	66.67	2.09	17.77	0	0	2.46	0.38	6.32	10	10	0	2.99	30.42	19.41	0	0	25	25	25	0	0	0	0.21												7.58	0.15	10.06	-	1.85	1.9	2.64	1.34	1.58	0.43	1.48	-	-	0.13	0.31	7.26	0.25	0.32	-	4.13	1.15	1.61	-	-	0.96	0.75	0.41	-	-	-	0	-	-	-	-	-	-	-	-	-	-	46.29	7.58	0.15	10.06	-	1.85	1.9	2.64	1.34	1.58	0.43	1.48	-	-	0.13	0.31	7.26	0.25	0.32	-	4.13	1.15	1.61	-	-	0.96	0.75	0.41	-	-	-	0	-	-	-	-	-	-	-	-	-	-	46.29
H3361_084_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1532.56	27.83	1307.86	2147.26	433.6	23637.88	24612.75	468.26	417.77	3776.44	1538.15	0	83.04	938.02	8495.92	12014.88	239.05	308.66	4852.59	11615.87	657.83	1146.07	0	381	492.77	368.89	188.5	24.05	0	0	127.3											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100	0	0	Eff. copay 20 coins.	Eff. copay 20 coins.	50	0	0	Eff. copay 0 to 50	0	0	0	0	0	0	0	0	Eff. copay 20 coins.	Eff. copay 20 coins.	0	0	0	0	0	20	0	0	0	Eff. copay 0 to 50											0	0	0	0	0	0.96	1.27	50	0	0	11.66	0	0	0	0	0	0	0	0	2.38	19.37	0	0	0	0	0	20	0	0	0	0.25											N/A	0	0	0	0	0	0.96	1.27	50	0	0	11.66	0	0	0	0	0	0	0	0	2.38	19.37	0	0	0	0	0	20	0	0	0	0.25												-	-	-	-	-	1.89	2.6	1.95	-	-	1.49	-	-	-	-	-	-	-	-	2.31	1.06	-	-	-	-	-	0.31	-	-	-	0	-	-	-	-	-	-	-	-	-	-	11.62	-	-	-	-	-	1.89	2.6	1.95	-	-	1.49	-	-	-	-	-	-	-	-	2.31	1.06	-	-	-	-	-	0.31	-	-	-	0	-	-	-	-	-	-	-	-	-	-	11.62
H3361_085_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1730.39	33.2	1631.83	2473.45	458.73	25254.57	26307.71	513.85	463.12	4247.18	1724.05	0	90.54	1027.47	8703.85	12279.59	247.64	316.63	5132.87	11784.38	717.29	1183.8	0	381	493.81	367.26	185.31	23.66	0	0	141.78											00 days 1 to 999	00 days 1 to 999	00 days 1 to 100	0	0	Eff. copay 20 coins.	Eff. copay 20 coins.	50	0	0	Eff. copay 0 to 50	0	0	0	0	0	0	0	0	Eff. copay 20 coins.	Eff. copay 20 coins.	0	0	0	0	0	20	0	0	0	Eff. copay 0 to 50											0	0	0	0	0	0.92	1.21	50	0	0	11.59	0	0	0	0	0	0	0	0	2.26	18	0	0	0	0	0	20	0	0	0	0.24											N/A	0	0	0	0	0	0.92	1.21	50	0	0	11.59	0	0	0	0	0	0	0	0	2.26	18	0	0	0	0	0	20	0	0	0	0.24												-	-	-	-	-	1.93	2.64	2.14	-	-	1.66	-	-	-	-	-	-	-	-	2.22	1.08	-	-	-	-	-	0.31	-	-	-	0	-	-	-	-	-	-	-	-	-	-	11.99	-	-	-	-	-	1.93	2.64	2.14	-	-	1.66	-	-	-	-	-	-	-	-	2.22	1.08	-	-	-	-	-	0.31	-	-	-	0	-	-	-	-	-	-	-	-	-	-	11.99
H3361_086_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1595.65	29.92	1420.55	2110.42	338.56	18479.84	19001.12	245.32	180.39	1582.24	660.82	0	37.05	414.86	7518.88	10730.28	261.6	334.41	3811.33	14684.1	293.55	822.42	200	381	405.28	268.13	154.11	17.5	0	100	262.57											00 days 0 to 0	00 days 0 to 0	00 days 1 to 100		0	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	0	Eff. Copay 00 to 00		0	0	Eff. copay 20 coins.	Eff. copay 00 coins.		Eff. copay 0 to 05	Eff. copay 00 to 00	5		Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20		0	0	0											0	0	0	0	0	1.05	1.39	0	0	0	0	0	0	0	0	2.83	0	5	0	3.3	35.27	0	0	0	0	0	20	0	0	0	0											N/A	0	0	0	0	0	1.05	1.39	0	0	0	0	0	0	0	0	2.83	0	5	0	3.3	35.27	0	0	0	0	0	20	0	0	0	0												-	-	-	-	-	1.62	2.21	-	-	-	-	-	-	-	-	2.53	-	0.14	-	4.04	0.86	-	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.66	-	-	-	-	-	1.62	2.21	-	-	-	-	-	-	-	-	2.53	-	0.14	-	4.04	0.86	-	-	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.66
H3361_087_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1416.82	25.63	1240.61	1939.47	319.06	17300.17	17810.56	239.82	178.03	1542.17	644.9	0	37.05	413.39	7104.57	10137.96	239.59	308.02	3589.38	13365.46	293.53	796.67	200	381	391.87	265.6	150.77	17.46	0	100	245.76											00 days 0 to 0	00 days 0 to 0	00 days 1 to 100		0	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	0			0	0				Eff. copay 0 to 05		5		Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20		0	0	0											0	0	0	0	0	1.03	1.39	0	0	0	0	0	0	0	0	2.87	0	5	0	3.51	34.75	0	0	0	0	0	20	0	0	0	0											N/A	0	0	0	0	0	1.03	1.39	0	0	0	0	0	0	0	0	2.87	0	5	0	3.51	34.75	0	0	0	0	0	20	0	0	0	0												-	-	-	-	-	1.49	2.06	-	-	-	-	-	-	-	-	2.42	-	0.13	-	3.9	0.85	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.11	-	-	-	-	-	1.49	2.06	-	-	-	-	-	-	-	-	2.42	-	0.13	-	3.9	0.85	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.11
H3361_088_0	2006											N/A											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1561.91	29.35	1365.34	2024.56	335.03	18293.99	18809.39	242.82	178.44	1566.35	654.14	0	36.63	410.17	7439.42	10616.95	259.28	331.34	3771.75	14558.75	290.17	812.91	200	381	400.48	264.58	152.18	17.26	0	100	261.58											00 days 0 to 0	00 days 0 to 0	00 days 1 to 100		0	Eff. copay 20 coins.	Eff. copay 10 to 20 coins.	0	Eff. Copay 00 to 00		0	0				Eff. copay 0 to 05	Eff. copay 00 to 00	5		Eff. copay 10 to 20 coins. 0 to 20 coins.	Eff. copay 20 coins.						20		0	0	0											0	0	0	0	0	1.03	1.38	0	0	0	0	0	0	0	0	2.83	0	5	0	4.29	36.42	0	0	0	0	0	20	0	0	0	0											N/A	0	0	0	0	0	1.03	1.38	0	0	0	0	0	0	0	0	2.83	0	5	0	4.29	36.42	0	0	0	0	0	20	0	0	0	0												-	-	-	-	-	1.57	2.16	-	-	-	-	-	-	-	-	2.5	-	0.14	-	5.2	0.88	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.71	-	-	-	-	-	1.57	2.16	-	-	-	-	-	-	-	-	2.5	-	0.14	-	5.2	0.88	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.71
H3361_089_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1622.17	31.58	1289.34	1898.68	1022.71	18755.64	19256.55	198.34	171.69	1426.99	551.41	0	34.65	389.78	6948.7	10165.79	233.75	291.98	3491.68	14191.47	274.49	800.58	0	0	0	0	0	0	0	0	27.23											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0		Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.										Eff. copay 20 coins.											118.52	117.92	54.11	0	13.98	1.01	1.33	44.42	232.8	0	74.01	0	0	44.97	6.21	18.58	18.17	35	0	4.14	35.65	0	0	0	0	0	0	0	0	0	1.39											N/A	118.52	117.92	54.11	0	13.98	1.01	1.33	44.42	232.8	0	74.01	0	0	44.97	6.21	18.58	18.17	35	0	4.14	35.65	0	0	0	0	0	0	0	0	0	1.39												16.02	0.31	5.81	-	1.19	1.57	2.13	0.73	3.33	-	3.4	-	-	1.46	3.6	15.74	0.35	0.85	-	4.89	0.82	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.22	16.02	0.31	5.81	-	1.19	1.57	2.13	0.73	3.33	-	3.4	-	-	1.46	3.6	15.74	0.35	0.85	-	4.89	0.82	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.22
H3361_090_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1522.86	29.72	1326.54	1215.25	936.81	17175.46	17702.2	236.31	198.59	1659.37	636.75	0	39.6	446.95	6567.05	9458.91	208.85	254.32	3614.07	11371.39	313.72	780.62	0	0	0	0	0	0	0	0	25.61											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35 copay	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											128.87	128.22	54.11	0	12.24	0.88	1.18	35.44	182.31	0	57.69	0	0	35.81	6.9	17.25	16.29	35	0	3.99	28.34	0	0	0	0	0	0	0	0	0	1.15											N/A	128.87	128.22	54.11	0	12.24	0.88	1.18	35.44	182.31	0	57.69	0	0	35.81	6.9	17.25	16.29	35	0	3.99	28.34	0	0	0	0	0	0	0	0	0	1.15												16.35	0.32	5.98	-	0.96	1.26	1.74	0.7	3.02	-	3.06	-	-	1.33	3.78	13.6	0.28	0.74	-	3.78	0.74	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.64	16.35	0.32	5.98	-	0.96	1.26	1.74	0.7	3.02	-	3.06	-	-	1.33	3.78	13.6	0.28	0.74	-	3.78	0.74	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.64
H3361_091_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1487.79	28.67	1103.83	1280.3	1056.36	19369.28	19883.55	208.47	175.32	1456.37	563.17	0	35.43	398.39	6391.95	9153.86	193.5	237.04	3497.68	11151.71	280.64	770.7	0	0	0	0	0	0	0	0	26.22											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											126.19	125.55	54.11	0	14.41	1.04	1.32	36.56	189.25	0	60.2	0	0	36.58	6.36	18.37	16.53	35	0	3.78	29.02	0	0	0	0	0	0	0	0	0	1.24											N/A	126.19	125.55	54.11	0	14.41	1.04	1.32	36.56	189.25	0	60.2	0	0	36.58	6.36	18.37	16.53	35	0	3.78	29.02	0	0	0	0	0	0	0	0	0	1.24												15.65	0.3	4.98	-	1.27	1.67	2.19	0.64	2.76	-	2.83	-	-	1.21	3.39	14.02	0.27	0.69	-	3.51	0.68	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	56.05	15.65	0.3	4.98	-	1.27	1.67	2.19	0.64	2.76	-	2.83	-	-	1.21	3.39	14.02	0.27	0.69	-	3.51	0.68	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	56.05
H3361_092_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1535.33	28.98	1160.46	1800.99	1030.97	18785.31	19311.14	210.65	181.95	1502.28	585.58	0	37.26	417.53	7064.22	10315.18	231.6	291.31	3544.06	13916.3	295.19	830.26	0	0	0	0	0	0	0	0	28.88											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0		Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.										Eff. copay 20 coins.											115.34	114.76	54.11	0	14.27	1.03	1.37	45.87	240.29	0	76.24	0	0	45.92	6.35	19.07	18.54	35	0	4.24	36.52	0	0	0	0	0	0	0	0	0	1.44											N/A	115.34	114.76	54.11	0	14.27	1.03	1.37	45.87	240.29	0	76.24	0	0	45.92	6.35	19.07	18.54	35	0	4.24	36.52	0	0	0	0	0	0	0	0	0	1.44												14.76	0.28	5.23	-	1.23	1.61	2.21	0.81	3.64	-	3.72	-	-	1.6	3.74	16.39	0.36	0.85	-	4.91	0.9	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.23	14.76	0.28	5.23	-	1.23	1.61	2.21	0.81	3.64	-	3.72	-	-	1.6	3.74	16.39	0.36	0.85	-	4.91	0.9	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	62.23
H3361_093_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1588.85	32.14	1171.58	1417.67	1075.61	19930.02	20760.26	463.09	372.39	3158.26	1197.49	0	71.73	817.37	6482.82	9295.64	177.96	214.72	3783.46	8677.05	568.25	930.41	0	0	0	0	0	0	0	0	25.42											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.										Eff. copay 20 coins.											129.7	129.04	54.11	0	13.31	0.96	1.26	24.19	120	0	37.87	0	0	23.89	6.24	17.56	16.62	35	0	4.59	18.76	0	0	0	0	0	0	0	0	0	0.87											N/A	129.7	129.04	54.11	0	13.31	0.96	1.26	24.19	120	0	37.87	0	0	23.89	6.24	17.56	16.62	35	0	4.59	18.76	0	0	0	0	0	0	0	0	0	0.87												17.17	0.35	5.28	-	1.19	1.59	2.17	0.93	3.72	-	3.78	-	-	1.63	3.37	13.6	0.25	0.63	-	3.32	0.89	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.87	17.17	0.35	5.28	-	1.19	1.59	2.17	0.93	3.72	-	3.78	-	-	1.63	3.37	13.6	0.25	0.63	-	3.32	0.89	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.87
H3361_094_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1512.41	30.59	1143.93	1381.81	1018.73	18876.08	19663.05	442.54	353.09	2994.59	1138.23	0	68.01	775.01	6141.47	8809.93	168.55	203.37	3583.38	8276.23	538.8	881.5	0	0	0	0	0	0	0	0	24.07											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	0		Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.								0	0	Eff. copay 20 coins.											124.6	123.97	54.11	0	12.49	0.9	1.18	22.87	112.65	0	35.56	0	0	22.43	6.82	16.89	15.6	35	0	4.41	17.61	0	0	0	0	0	0	0	0	0	0.82											N/A	124.6	123.97	54.11	0	12.49	0.9	1.18	22.87	112.65	0	35.56	0	0	22.43	6.82	16.89	15.6	35	0	4.41	17.61	0	0	0	0	0	0	0	0	0	0.82												15.7	0.32	5.16	-	1.06	1.41	1.93	0.84	3.31	-	3.37	-	-	1.45	3.49	12.4	0.22	0.59	-	3.04	0.79	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.1	15.7	0.32	5.16	-	1.06	1.41	1.93	0.84	3.31	-	3.37	-	-	1.45	3.49	12.4	0.22	0.59	-	3.04	0.79	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	55.1
H3361_095_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1335.25	24.22	1457.01	2355.75	1028.8	18695.03	19462.82	404.64	328.43	2748.2	1057.7	0	65.28	737.44	6233.71	9023.29	171	213.53	3526.99	8640.48	517.17	904.89	0	0	0	0	0	0	0	0	28.1											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.										Eff. copay 20 coins.											124.83	124.2	54.11	0	13.89	1	1.32	26.21	128.49	0	39.63	0	0	24.95	6.76	19.01	16.8	35	0	4.26	19.77	0	0	0	0	0	0	0	0	0	0.92											N/A	124.83	124.2	54.11	0	13.89	1	1.32	26.21	128.49	0	39.63	0	0	24.95	6.76	19.01	16.8	35	0	4.26	19.77	0	0	0	0	0	0	0	0	0	0.92												13.89	0.25	6.57	-	1.19	1.56	2.13	0.88	3.52	-	3.49	-	-	1.53	3.51	14.3	0.24	0.62	-	3.07	0.85	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.61	13.89	0.25	6.57	-	1.19	1.56	2.13	0.88	3.52	-	3.49	-	-	1.53	3.51	14.3	0.24	0.62	-	3.07	0.85	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	57.61
H3361_096_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1474.29	28.37	1530.87	2362.92	1113.18	20441.36	21293.11	466.28	374.96	3161.48	1208.5	0	73.23	831.25	6444.84	9343.88	178.05	218.6	3769.37	8896.9	580.14	955.41	0	0	0	0	0	0	0	0	27.58											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.										Eff. copay 20 coins.											118.31	117.71	54.11	0	13.18	0.95	1.24	24.14	118.39	0	36.91	0	0	23.29	7.26	17.71	15.95	35	0	4.28	18.36	0	0	0	0	0	0	0	0	0	0.87											N/A	118.31	117.71	54.11	0	13.18	0.95	1.24	24.14	118.39	0	36.91	0	0	23.29	7.26	17.71	15.95	35	0	4.28	18.36	0	0	0	0	0	0	0	0	0	0.87												14.54	0.28	6.9	-	1.22	1.61	2.21	0.94	3.7	-	3.72	-	-	1.61	3.9	13.79	0.24	0.64	-	3.17	0.89	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.36	14.54	0.28	6.9	-	1.22	1.61	2.21	0.94	3.7	-	3.72	-	-	1.61	3.9	13.79	0.24	0.64	-	3.17	0.89	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	59.36
H3361_097_0	2006											N/A											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1527.65	28.66	1375.8	1430.82	987.73	17957.14	18527.14	252.14	213.49	1769.77	686.21	0	43.33	486.73	6966.76	10033.26	210.97	266.38	3776.54	11752.8	343.3	844.33	0	0	0	0	0	0	0	0	28.7											200 days 1 to 5	200 days 1 to 5	114 days 21 to 100		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. Copay 0 to 30	Eff. copay 0 to 35	Eff. copay 20 coins.	35		Eff. copay 20 coins. 0 to 35	Eff. copay 20 coins.										Eff. copay 20 coins.											120.28	119.67	54.11	0	13.3	0.96	1.3	38.89	200.56	0	63.22	0	0	39.02	6.33	18.72	17.71	35	0	4.3	31.02	0	0	0	0	0	0	0	0	0	1.26											N/A	120.28	119.67	54.11	0	13.3	0.96	1.3	38.89	200.56	0	63.22	0	0	39.02	6.33	18.72	17.71	35	0	4.3	31.02	0	0	0	0	0	0	0	0	0	1.26												15.31	0.29	6.2	-	1.09	1.43	2	0.82	3.57	-	3.61	-	-	1.58	3.67	15.66	0.31	0.78	-	4.21	0.89	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	61.42	15.31	0.29	6.2	-	1.09	1.43	2	0.82	3.57	-	3.61	-	-	1.58	3.67	15.66	0.31	0.78	-	4.21	0.89	-	-	-	-	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	61.42
H3362_003_0	2006											0											A	A		V	T	Coin		V	P		P			P	V	V	Coin	V	V	V	Coin	P			V	P	V																																																									-	217.28	4.48		1200	86.4	6.85		244.8	466.29		612			762	4721.47	3253.63	0.92	456	888	1554	7.55	102			545	545	18															375 per admission limited to 1200 per year	375 per admission limited to 1200 per year		5 copayment	25 copayment	20		50 copayment	35 copayment		20 copayment			20 copayment	5 copayment	20 copayment	50	20 copayment	20 copayment	20 copayment	20	20 copayment			5 copayment	Mixture of copays and coinsurance	20 copayment																																																									375	375		5	25	0.2		50	35		20			20	5	20	0.5	20	20	20	0.2	20			5	36.33	20																6.79	0.14	-	0.5	0.18	1.37	-	1.02	1.36	-	1.02	-	-	1.27	1.97	5.42	0.46	0.76	1.48	2.59	1.51	0.17	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.92	6.79	0.14	-	0.5	0.18	1.37	-	1.02	1.36	-	1.02	-	-	1.27	1.97	5.42	0.46	0.76	1.48	2.59	1.51	0.17	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.92
H3362_004_0	2006																						A	A		V	T	Coin		V	P		P			P	V	V	Coin	V	V	V	Coin	P			V	P	V																																																									-	217.2	4.32		1188	86.4	6.85		244.8	466.29		600			756	4633.54	3215.23	0.92	456	870	1974	7.55	102			545	545	18															500 per admission limited to 1200 per year	500 per admission limited to 1200 per year		10 copayment	25 copayment	20		50 copayment	35 copayment		20 copayment			20 copayment	10 copayment	20 copayment	50	20 copayment	20 copayment	20 copayment	20	20 copayment			5 copayment	Mixture of copays and coinsurance	20 copayment																																																									500	500		10	25	0.2		50	35		20			20	10	20	0.5	20	20	20	0.2	20			5	36.33	20																9.05	0.18	-	0.99	0.18	1.37	-	1.02	1.36	-	1	-	-	1.26	3.86	5.36	0.46	0.76	1.45	3.29	1.51	0.17	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.18	9.05	0.18	-	0.99	0.18	1.37	-	1.02	1.36	-	1	-	-	1.26	3.86	5.36	0.46	0.76	1.45	3.29	1.51	0.17	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.18
H3362_016_0	2006											0											A	A		V	T	Coin		V	P		P			P	V	V	Coin	V	V	V	Coin	P			V	P	V																																																									-	217.28	4.48		1200	86.4	6.85		244.8	466.29		612			762	4721.47	3253.63	0.92	456	888	1554	7.55	102			545	545	18															375 per admission limited to 1200 per year	375 per admission limited to 1200 per year		5 copayment	25 copayment	20		50 copayment	35 copayment		20 copayment			20 copayment	5 copayment	20 copayment	50	20 copayment	20 copayment	20 copayment	20	20 copayment			5 copayment	Mixture of copays and coinsurance	20 copayment																																																									375	375		5	25	0.2		50	35		20			20	5	20	0.5	20	20	20	0.2	20			5	36.33	20																6.79	0.14	-	0.5	0.18	1.37	-	1.02	1.36	-	1.02	-	-	1.27	1.97	5.42	0.46	0.76	1.48	2.59	1.51	0.17	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.92	6.79	0.14	-	0.5	0.18	1.37	-	1.02	1.36	-	1.02	-	-	1.27	1.97	5.42	0.46	0.76	1.48	2.59	1.51	0.17	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.92
H3362_017_0	2006																						A	A	Coin	V	T	Coin	Coin	V	P		P		P	P	V	V	Coin	V	V	V	Coin	P			V	P	V																																																									-	214.4	4.3	28.02	1152	86	6.7	1.35	237.6	456		566		13	700	4165	2895	0.9	456	822	2170.29	7.4	136			545	545	7															700 per admission limited to 3000 per year	700 per admission limited to 3000 per year	20	15 copayment	50 copayment	20	0	50 copayment	75 copayment		35 copayment		35 Copayment	35 copayment	25 copayment	35 copayment	50	15 copayment	35 copayment	35 copayment	20	15 copayment			5 Copayment	Mixure of copays and coinsurance	35 copayment																																																									700	700	0.2	15	50	0.2	0.2	50	75		35		35	35	25	35	0.5	15	35	35	0.2	15			5	36.33	35																12.51	0.25	5.6	1.44	0.36	1.34	0.27	0.99	2.85	-	1.65	-	0.04	2.04	8.68	8.44	0.45	0.57	2.4	6.33	1.48	0.17	-	-	0.23	1.65	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.76	12.51	0.25	5.6	1.44	0.36	1.34	0.27	0.99	2.85	-	1.65	-	0.04	2.04	8.68	8.44	0.45	0.57	2.4	6.33	1.48	0.17	-	-	0.23	1.65	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.76
H3362_018_0	2006																						A	A	Coin	V	T	Coin	Coin	V	P		P		P	P	V	V	Coin	V	V	V	Coin	P			V	P	V																																																									-	214.4	4.3	28.02	1152	86	6.7	1.35	237.6	456		566		13	700	4165	2895	0.9	456	822	2170.29	7.4	136			545	545	7															750 per admission limited to 3000 per year	750 per admission limited to 3000 per year	20	15 copayment	50 copayment	20	0	50 copayment	75 copayment		35 copayment		35 Copayment	35 copayment	25 copayment	35 copayment	50	15 copayment	35 copayment	35 copayment	20	15 copayment			5 Copayment	Mixure of copays and coinsurance	35 copayment																																																									750	750	0.2	15	50	0.2	0.2	50	75		35		35	35	25	35	0.5	15	35	35	0.2	15			5	36.33	35																13.4	0.27	5.6	1.44	0.36	1.34	0.27	0.99	2.85	-	1.65	-	0.04	2.04	8.68	8.44	0.45	0.57	2.4	6.33	1.48	0.17	-	-	0.23	1.65	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.67	13.4	0.27	5.6	1.44	0.36	1.34	0.27	0.99	2.85	-	1.65	-	0.04	2.04	8.68	8.44	0.45	0.57	2.4	6.33	1.48	0.17	-	-	0.23	1.65	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.67
H3362_801_0	2006																						A	A	Coin	V	T	Coin		V	P		P			P	V	V	Coin	V	V	V	Coin	P			V	P	V																																																									-	189.92	2.56	19.55	928	62.4	8.25		199.2	507.2		521.14			816	4343.97	3349.73	0.96	704	939.43	2605.71	7.52	72			545	545	17.14															700 per admission	700 per admission	20 Coinsurance	15 copayment	50 copayment	20 Coinsurance		50 copayment	75 copayment		35 copayment			35 copayment	25 copayment	35 copayment	50 Coinsurance	15 copayment	35 copayment	35 copayment	20 Coinsurance	35 copayment			5 copayment	Mixture of copays and coinsurance	35 copayment															700	700	0.2	15	50	0.2		50	75		35			35	25	35	0.5	15	35	35	0.2	35			5	36.39	35																700	700	0.2	15	50	0.2		50	75		35			35	25	35	0.5	15	35	35	0.2	35			5	36.39	35																11.08	0.15	3.91	1.16	0.26	1.65	-	0.83	3.17	-	1.52	-	-	2.38	9.05	9.77	0.48	0.88	2.74	7.6	1.5	0.21	-	-	0.23	1.65	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.27	11.08	0.15	3.91	1.16	0.26	1.65	-	0.83	3.17	-	1.52	-	-	2.38	9.05	9.77	0.48	0.88	2.74	7.6	1.5	0.21	-	-	0.23	1.65	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.27
H3362_807_0	2006																						A	A	A	V	T	Coin	Coin	V	P		P			P	V	V	Coin	V	V	V	Coin	P			V	P	V		Coin																																																							-	190.56	2.64	6.96	918	62.4	6.44	1.81	199.2	507.2		528			822	4028.28	2307.72	1.05	684	954	4950	7.52	126			545	545	18		13.39													500 per admission	500 per admission	500 per admission	20 copayment	50 copayment	20 Coinsurance	20 Coinsurance	50 copayment	75 copayment		20 copayment			20 copayment	20 copayment	20 copayment	20 Coinsurance	20 copayment	20 copayment	20 copayment	20 Coinsurance	20 copayment			5 copayment	Mixture of copays and coinsurance	20 copayment		Ded/Coin													500	500	500	20	50	0.2	0.2	50	75		20			20	20	20	0.2	20	20	20	0.2	20			5	36.39	20		0.53														500	500	500	20	50	0.2	0.2	50	75		20			20	20	20	0.2	20	20	20	0.2	20			5	36.39	20		0.53														7.94	0.11	0.29	1.53	0.26	1.29	0.36	0.83	3.17	-	0.88	-	-	1.37	6.71	3.85	0.21	1.14	1.59	8.25	1.5	0.21	-	-	0.23	1.65	0.03	-	7.07	-	-	-	-	-	-	-	-	-	-	-	-	50.47	7.94	0.11	0.29	1.53	0.26	1.29	0.36	0.83	3.17	-	0.88	-	-	1.37	6.71	3.85	0.21	1.14	1.59	8.25	1.5	0.21	-	-	0.23	1.65	0.03	-	7.07	-	-	-	-	-	-	-	-	-	-	-	-	50.47
H3362_811_0	2006																						A	A	Coin	V	T	Coin		V	P		P			P	V	V	Coin	V	V	V	Coin	P			V	P	V																																																									-	189.92	2.56	19.55	928	62.4	8.25		199.2	507.2		528			834	4508.28	3621.72	0.96	704	954	3210	7.52	126			545	545	18															750 per admission	750 per admission	20 Coinsurance	15 copayment	50 copayment	20 Coinsurance		50 copayment	75 copayment		20 copayment			20 copayment	20 copayment	20 copayment	50 Coinsurance	15 copayment	20 copayment	20 copayment	20 Coinsurance	20 copayment			5 copayment	Mixture of copays and coinsurance	20 copayment																																																									750	750	0.2	15	50	0.2		50	75		20			20	20	20	0.5	15	20	20	0.2	20			5	36.39	20																11.87	0.16	3.91	1.16	0.26	1.65	-	0.83	3.17	-	0.88	-	-	1.39	7.51	6.04	0.48	0.88	1.59	5.35	1.5	0.21	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.75	11.87	0.16	3.91	1.16	0.26	1.65	-	0.83	3.17	-	0.88	-	-	1.39	7.51	6.04	0.48	0.88	1.59	5.35	1.5	0.21	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.75
H3362_812_0	2006																						A	A	A	V	T	Coin	Coin	V	P		P			P	V	V	Coin	V	V	V	Coin	P			V	P	V																																																									-	190.56	2.64	6.96	918	62.4	6.45	1.8	199.2	507.2		528			822	4028.28	2307.72	1.05	684	954	4950	7.52	126			545	545	18															500 per admission	500 per admission	500 per admission	20 copayment	50 copayment	20 Coinsurance	20 Coinsurance	50 copayment	75 copayment		20 copayment			20 copayment	20 copayment	20 copayment	20 Coinsurance	20 copayment	20 copayment	20 copayment	20 Coinsurance	20 copayment			5 copayment	Mixture of copays and coinsurance	20 copayment															500	500	500	20	50	0.2	0.2	50	75		20			20	20	20	0.2	20	20	20	0.2	20			5	36.39	20																500	500	500	20	50	0.2	0.2	50	75		20			20	20	20	0.2	20	20	20	0.2	20			5	36.39	20																7.94	0.11	0.29	1.53	0.26	1.29	0.36	0.83	3.17	-	0.88	-	-	1.37	6.71	3.85	0.21	1.14	1.59	8.25	1.5	0.21	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.4	7.94	0.11	0.29	1.53	0.26	1.29	0.36	0.83	3.17	-	0.88	-	-	1.37	6.71	3.85	0.21	1.14	1.59	8.25	1.5	0.21	-	-	0.23	1.65	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.4
H3366_008_0	2006											none											D	D	D	V	T	P	P	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1704.46	20.62	0	0	0	21159.49	17948.46	264.88	28.19	0	0	0	0.34	547.73	5317.76	7760.76	309.91	440.33	0	216.17	8.5	858.49	0	2000	0	0	0	0	0	0	0											50 Per Day: 1-10	50 Per Day: 1-10	0			100 first 200 DME/year 20 thereafter	100 first 200 Prosthetics/year 20 thereafter	50 ER / 25 UC	0 ASC / 0 OP				20	20 OP SA / 20 Cardiac Rehab	10 PCP	15 SCP / 15 Chiro / 15 Podiatrist	25 MH	20 Therapy		0 Hearing / 0 Preventive	20	15 Vision								0	0											50	50	0	0	0	0.54	0.66	41.57	0	0	0	0	0.2	20	10	14.28	25	20	0	0	0.2	14	0	5	0	0	0	0	0	0	0											none	50	50	0	0	0	0.54	0.66	41.57	0	0	0	0	0.2	20	10	14.28	25	20	0	0	0.2	14	0	5	0	0	0	0	0	0	0											0	7.1	0.09	-	-	-	0.95	0.99	0.92	-	-	-	-	0.07	0.91	4.43	9.24	0.65	0.73	-	-	1.7	1	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.61	7.1	0.09	-	-	-	0.95	0.99	0.92	-	-	-	-	0.07	0.91	4.43	9.24	0.65	0.73	-	-	1.7	1	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.61
H3366_019_0	2006											none											D	D	D	V	T	P	P	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	1518.67	20.42	0	0	0	21159.49	17948.46	238.51	23.73	0	726.75	0	0.29	547.73	4686.87	6809.51	309.91	440.33	0	190.89	7.16	749.38	0	1800	0	0	0	0	0	0	0											100 Per Day: 1-10	100 Per Day: 1-10	0			100 first 200 DME/year 20 thereafter	100 first 200 Prosthetics/year 20 thereafter	50 ER / 25 UC	0 ASC / 0 OP		25 Per Visit		20	20 OP SA / 20 Cardiac Rehab	10 PCP	20 SCP / 20 Chiro / 20 Podiatrist	25 MH	20 Therapy		0 Hearing / 0 Preventive	20	20 Vision								0	0											100	100	0	0	0	0.51	0.62	41.57	0	0	7.38	0	0.2	20	9.54	19.35	25	20	0	0	0.2	18.62	0	5	0	0	0	0	0	0	0											none	100	100	0	0	0	0.51	0.62	41.57	0	0	7.38	0	0.2	20	9.54	19.35	25	20	0	0	0.2	18.62	0	5	0	0	0	0	0	0	0											0	12.66	0.17	-	-	-	0.89	0.92	0.83	-	-	0.45	-	0.06	0.91	3.73	10.98	0.65	0.73	-	0	1.43	1.16	-	0.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.32	12.66	0.17	0	0	-	0.89	0.92	0.83	-	-	0.45	-	0.06	0.91	3.73	10.98	0.65	0.73	-	0	1.43	1.16	-	0.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.32
H3366_021_0	2006											none											A	A	D	V	T	P	P	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	21159.49	17948.46	296.41	27.17	0	0	0	0.33	547.73	0	0	309.91	440.33	0	22.7	8.2	57.44	0	2000	0	0	0	0	0	0	0													0			100 first 200 DME/year 20 thereafter	100 first 200 Prosthetics/year 20 thereafter	25 ER / 10 UC	0 ASC / 0 OP				0.2	20 OP SA / 20 Cardiac Rehab	0 PCP	0 SCP / 0 Chiro / 0 Podiatrist	25 MH	20 Therapy		0 Hearing / 0 Preventive	20	0 Vision		0						0	0											0	0	0	0	0	0.52	0.64	19.94	0	0	0	0	0.2	20	0	0	25	20	0	0	0.2	0	0	5	0	0	0	0	0	0	0											none	0	0	0	0	0	0.52	0.64	19.94	0	0	0	0	0.2	20	0	0	25	20	0	0	0.2	0	0	5	0	0	0	0	0	0	0											0	-	-	-	-	-	0.92	0.95	0.49	-	-	-	-	0.07	0.91	-	-	0.65	0.73	-	-	1.64	-	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.19	-	-	-	-	-	0.92	0.95	0.49	-	-	-	-	0.07	0.91	-	-	0.65	0.73	-	-	1.64	-	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.19
H3366_022_0	2006											none											A	A	D	V	T	coin	coin	V	coin	P	P	O	coin	P	V	V	V	V	P	V	S	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	9	8.95	301.35	27.76	0	0	0	0.31	547.21	0	0	285.92	407.95	0	21.11	0	0	0	2051.7	0	0	0	0	0	0	0																100 of first 200; 20 coins thereafter	100 of first 200; 20 coins thereafter	25 ER / 10 UC	0 ASC / 0 OP				20 coinsurance	20 OP SA20 / Cardiac Rehab			25 MH	20 Therapy		0 Hearing / 0 Preventive				5 copay							0											0	0	0	0	0	0.1	0.1	19.94	0	0	0	0	0.2	20	0	0	25	20	0	0	0	0	0	5	0	0	0	0	0	0	0											none	0	0	0	0	0	0.1	0.1	19.94	0	0	0	0	0.2	20	0	0	25	20	0	0	0	0	0	5	0	0	0	0	0	0	0											0	-	-	-	-	-	0.88	0.91	0.5	-	-	-	-	0.06	0.91	-	-	0.6	0.68	-	-	-	-	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.39	-	-	-	-	-	0.88	0.91	0.5	-	-	-	-	0.06	0.91	-	-	0.6	0.68	-	-	-	-	-	0.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.39
H3366_803_0	2006											none											A	A	D	V	T	P	P	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	269.69	2.35	0	0	0	21159.49	17948.46	264.88	27.81	0	0	0	0.34	547.73	5043.26	7023.15	309.91	440.33	0	314.95	8.39	815.42	0	0	0	0	0	0	0	0	0													0			100 first 200 DME/year 20 thereafter	100 first 200 Prosthetics/year 20 thereafter	50 ER / 25 UC	0 ASC / 0 OP				0.2	20 OP SA / 20 Cardiac Rehab	15 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	20 Therapy		25 Hearing / 0 Preventive	20	25 Vision		0						0	0											500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											none	500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											0	11.24	0.1	-	-	-	0.94	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.68	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.34	11.24	0.1	-	-	-	0.94	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.68	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.34
H3366_804_0	2006											none											A	A	D	V	T	P	P	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	269.69	2.35	0	0	0	21159.49	17948.46	264.88	27.81	0	0	0	0.34	547.73	5043.26	7023.15	309.91	440.33	0	314.95	8.39	815.42	0	0	0	0	0	0	0	0	0													0			100 first 200 DME/year 20 thereafter	100 first 200 Prosthetics/year 20 thereafter	50 ER / 25 UC	0 ASC / 0 OP				0.2	20 OP SA / 20 Cardiac Rehab	15 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	20 Therapy		25 Hearing / 0 Preventive	20	25 Vision		0						0	0											500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											none	500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											0	11.24	0.1	-	-	-	0.94	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.68	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.34	11.24	0.1	-	-	-	0.94	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.68	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.34
H3366_805_0	2006											none											A	A	D	V	T	P	P	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	269.69	2.35	0	0	0	21159.49	17948.46	264.88	27.86	0	0	0	0.34	547.73	5043.26	7023.15	309.91	440.33	0	314.95	8.4	815.42	0	0	0	0	0	0	0	0	0													0			100 first 200 DME/year 20 thereafter	100 first 200 Prosthetics/year 20 thereafter	50 ER / 25 UC	0 ASC / 0 OP				0.2	20 OP SA / 20 Cardiac Rehab	15 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	20 Therapy		25 Hearing / 0 Preventive	20	25 Vision		0						0	0											500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											none	500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											0	11.24	0.1	-	-	-	0.94	0.98	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.68	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.35	11.24	0.1	-	-	-	0.94	0.98	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.68	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.35
H3366_806_0	2006											none											A	A	D	V	T	P	P	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	269.69	2.35	0	0	0	21159.49	17948.46	264.88	27.59	0	0	0	0.34	547.73	5043.26	7023.15	309.91	440.33	0	314.95	8.32	815.42	0	0	0	0	0	0	0	0	0													0			100 first 200 DME/year 20 thereafter	100 first 200 Prosthetics/year 20 thereafter	50 ER / 25 UC	0 ASC / 0 OP				0.2	20 OP SA / 20 Cardiac Rehab	15 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	20 Therapy		25 Hearing / 0 Preventive	20	25 Vision		0						0	0											500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											none	500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											0	11.24	0.1	-	-	-	0.93	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.66	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.32	11.24	0.1	-	-	-	0.93	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.66	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.32
H3366_807_0	2006											none											A	A	D	V	T	P	P	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	269.69	2.35	0	0	0	21159.49	17948.46	264.88	27.59	0	0	0	0.34	547.73	5043.26	7023.15	309.91	440.33	0	314.95	8.32	815.42	0	0	0	0	0	0	0	0	0													0			100 first 200 DME/year 20 thereafter	100 first 200 Prosthetics/year 20 thereafter	50 ER / 25 UC	0 ASC / 0 OP				0.2	20 OP SA / 20 Cardiac Rehab	15 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	20 Therapy		25 Hearing / 0 Preventive	20	25 Vision		0						0	0											500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											none	500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											0	11.24	0.1	-	-	-	0.93	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.66	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.32	11.24	0.1	-	-	-	0.93	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.66	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.32
H3366_808_0	2006											none											A	A	D	V	T	P	P	V	coin	P	P	O	coin	P	V	V	V	V	P	V	coin	O	T	P	V	P	V	P	O	O	V											none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	269.69	2.35	0	0	0	21159.49	17948.46	264.88	27.77	0	0	0	0.34	547.73	5043.26	7023.15	309.91	440.33	0	314.95	8.38	815.42	0	0	0	0	0	0	0	0	0													0			100 first 200 DME/year 20 thereafter	100 first 200 Prosthetics/year 20 thereafter	50 ER / 25 UC	0 ASC / 0 OP				0.2	20 OP SA / 20 Cardiac Rehab	15 PCP	25 SCP / 25 Chiro / 25 Podiatrist	25 MH	20 Therapy		25 Hearing / 0 Preventive	20	25 Vision		0						0	0											500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											none	500	500	0	0	0	0.53	0.65	41.46	0	0	0	0	0.2	20	14.99	23.98	25	20	0	8.65	0.2	23.24	0	0	0	0	0	0	0	0	0											0	11.24	0.1	-	-	-	0.94	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.68	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.34	11.24	0.1	-	-	-	0.94	0.97	0.92	-	-	-	-	0.07	0.91	6.3	14.03	0.65	0.73	-	0.23	1.68	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.34
H3370_001_0	2006																								D					V								V	V	V			S				V	P																																																										-			1134.53					166.59								6226.93	253.17	566.82			530.8				132.41	149.39																		25/Day					50								15	25	15			0-177				10	15-85																		25					50								12.97	25	15			18.85				10	29																			25					50								12.97	25	15			18.85				10	29																	-	-	2.36	-	-	-	-	0.69	-	-	-	-	-	-	-	6.73	0.53	0.71	-	-	0.83	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.33	-	-	2.36	-	-	-	-	0.69	-	-	-	-	-	-	-	6.73	0.53	0.71	-	-	0.83	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.33
H3370_002_0	2006																						D		D					V	V						V	V	V	V			S				V	P																																																										-	1738.17		852.73					216.66	247.8						4699.47	7039.1	266.17	683.95			421.03				132.39	149.39																100 Days 1-8		25					50	200						10	25	25	25			0-177				10	15-85																77.05		25					50	200						10	22.03	25	25			18.85				10	29																	77.05		25					50	200						10	22.03	25	25			18.85				10	29																	11.16	-	1.78	-	-	-	-	0.9	4.13	-	-	-	-	-	3.92	12.92	0.55	1.42	-	-	0.66	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.92	11.16	-	1.78	-	-	-	-	0.9	4.13	-	-	-	-	-	3.92	12.92	0.55	1.42	-	-	0.66	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.92
H3370_003_0	2006																						D		D					V	V						V	V	V	V			S				V	P																																																										-	2225.23		1101.91					167.31	227.66						4585.71	6909.15	250.61	745.25			446.25				132.3	149.39																100 Days 1-8		25					50	200						10	25	25	25			0-177				10	15-85																64.7		25					50	200						10	21.74	25	25			18.85				10	29																	64.7		25					50	200						10	21.74	25	25			18.85				10	29																	12	-	2.3	-	-	-	-	0.7	3.79	-	-	-	-	-	3.82	12.52	0.52	1.55	-	-	0.7	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.37	12	-	2.3	-	-	-	-	0.7	3.79	-	-	-	-	-	3.82	12.52	0.52	1.55	-	-	0.7	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.37
H3370_004_0	2006																						D		D					V	V						V	V	V	V			S				V	P																																																										-	2372.68		1104.47					214.2	275.4						5450.38	7330.74	194.36	702.44			383.17				132.56	149.39																100 Days 1-8		25					50	200						10	25	25	25			0-177				10	15-85																70.85		25					50	200						10	21.7	25	25			18.85				10	29																	70.85		25					50	200						10	21.7	25	25			18.85				10	29																	14.01	-	2.3	-	-	-	-	0.89	4.59	-	-	-	-	-	4.54	13.26	0.4	1.46	-	-	0.6	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.53	14.01	-	2.3	-	-	-	-	0.89	4.59	-	-	-	-	-	4.54	13.26	0.4	1.46	-	-	0.6	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.53
H3370_009_0	2006																						D		D					V	V						V	V	V	V			S				V	P																																																										-	2372.68		1104.47					214.2	275.4						5450.38	7330.74	194.36	702.44			383.17				132.56	149.39																100 Days 1-8		25					50	200						10	25	25	25			0-177				10	15-85																70.85		25					50	200						10	21.7	25	25			18.85				10	29																	70.85		25					50	200						10	21.7	25	25			18.85				10	29																	14.01	-	2.3	-	-	-	-	0.89	4.59	-	-	-	-	-	4.54	13.26	0.4	1.46	-	-	0.6	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.53	14.01	-	2.3	-	-	-	-	0.89	4.59	-	-	-	-	-	4.54	13.26	0.4	1.46	-	-	0.6	-	-	-	0.11	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.53
H3370_801_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																										0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0																					0	271.3	3.68	29.45		6.62	5.17	9.76	191.54	37.05	13.02	26.93	2.05	0.37	5.4	38.37	156.19	2.55	11.96	33.3	14.24	35.14																					FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin		FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	50	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin																					0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					110	15.57	0.21	4.76	-	1.54	1.2	2.27	0.8	8.63	3.03	6.28	0.48	0.09	1.26	8.94	36.39	0.59	2.79	7.76	3.32	8.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.1	15.57	0.21	4.76	-	1.54	1.2	2.27	0.8	8.63	3.03	6.28	0.48	0.09	1.26	8.94	36.39	0.59	2.79	7.76	3.32	8.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.1
H3370_802_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																										0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0																					0	271.3	3.68	29.45		6.62	5.17	9.76	191.54	37.05	13.02	26.93	2.05	0.37	5.4	38.37	156.19	2.55	11.96	33.3	14.24	35.14																					FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin		FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	50	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin																					0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					110	15.57	0.21	4.76	-	1.54	1.2	2.27	0.8	8.63	3.03	6.28	0.48	0.09	1.26	8.94	36.39	0.59	2.79	7.76	3.32	8.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.1	15.57	0.21	4.76	-	1.54	1.2	2.27	0.8	8.63	3.03	6.28	0.48	0.09	1.26	8.94	36.39	0.59	2.79	7.76	3.32	8.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.1
H3370_803_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																										0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0																					0	271.3	3.68	29.45		6.62	5.17	9.76	191.54	37.05	13.02	26.93	2.05	0.37	5.4	38.37	156.19	2.55	11.96	33.3	14.24	35.14																					FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin		FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	50	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin																					0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					110	15.57	0.21	4.76	-	1.54	1.2	2.27	0.8	8.63	3.03	6.28	0.48	0.09	1.26	8.94	36.39	0.59	2.79	7.76	3.32	8.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.1	15.57	0.21	4.76	-	1.54	1.2	2.27	0.8	8.63	3.03	6.28	0.48	0.09	1.26	8.94	36.39	0.59	2.79	7.76	3.32	8.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.1
H3370_804_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																										0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0																					0	271.3	3.68	29.45		6.62	5.17	9.76	191.54	37.05	13.02	26.93	2.05	0.37	5.4	38.37	156.19	2.55	11.96	33.3	14.24	35.14																					FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin		FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	50	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin	FFS Ded/Coin																					0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					110	15.57	0.21	4.76	-	1.54	1.2	2.27	0.8	8.63	3.03	6.28	0.48	0.09	1.26	8.94	36.39	0.59	2.79	7.76	3.32	8.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.1	15.57	0.21	4.76	-	1.54	1.2	2.27	0.8	8.63	3.03	6.28	0.48	0.09	1.26	8.94	36.39	0.59	2.79	7.76	3.32	8.19	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.1
H3379_001_0	2006											2000											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V			O																																																						-	2138.87	224.89	1262.23		604.33	5.28	10.8	255.82	36.36	6956.66	51.93	0.64	4.27	0.18	5563.39	4933.59	954.01	8.72			15.45	2003.75			17.59		86.09															215	175	95		150	20	20	50	20	10	20-Oct	20	20	20/40/30	May-00	15	40/30	20			20	0/15			15		15															215	175	95		150	0.2	0.2	50	0.2	10	0.13	0.2	0.2	0.19	5	15	37.5	0.2			0.2	15			15		15																98.59	80.25	43.56		68.78	0.09	0.1	22.93	0.09	4.59	0.06	0.09	0.09	0.12	5	15	37.5	0.09			0.09	15			15		15																17.57	1.5	4.58	-	3.46	0.48	1.1	0.49	3.33	2.66	3.2	0.06	0.39	0.02	2.32	6.17	2.98	0.8	-	-	1.42	2.5	-	-	0.02	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.18	17.57	1.5	4.58	-	3.46	0.48	1.1	0.49	3.33	2.66	3.2	0.06	0.39	0.02	2.32	6.17	2.98	0.8	-	-	1.42	2.5	-	-	0.02	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.18
H3379_002_0	2006	Professional	Professional	OP Facility - Other								2100	Specialist excl. MH	Specialist excl. MH	Other								D	D	D	P	P	Coin	Coin	V	V	V	V	V	Coin	V	P	P	V	P		P	Coin	P	P		P	P	P					P	P	P																																																		-	3036.94	183.29			2451.41	51.22	4.31	137.15	82.19	2924.26	112.39	3.96	2.06	101	47685.8	47372.03	2956.04	2.4		4163.27	2.65	1306.66			2.4							84.82	336.4	4.95								250/day 1-20	250/day 1-20			100 per trip	0	0	50	0/100 SNF/Non-SNF	0/10/25 SNF/Non-SNF	0/25 SNF/Non-SNF	0/100 SNF/Non-SNF	0.2	0/100 SNF/Non-SNF	0/25 SNF/Non-SNF	0/25 SNF/Non-SNF	0/35/25 SNF/Non-SNF	0/25 SNF/Non-SNF		0/25 SNF/Non-SNF	0.2	0/25 SNF/Non-SNF			0/25 SNF/Non-SNF		0/25 SNF/Non-SNF					25	0/25 SNF/Non-SNF	0/35/25 SNF/Non-SNF								250	250			34.17	0.2	0.2	50	5	0.75	1.25	5	0.2	5	1.25	1.25	1.5	1.25		1.25	0.2	1.25			1.25		1.25					25	1.25	1.5									191.99	191.99			26.24	0.15	0.15	38.4	3.84	0.58	0.96	3.84	0.15	3.84	1.25	0.96	1.15	0.96		0.96	0.15	0.96			1.25		0.96					19.2	1.25	1.5									48.59	2.93	-	-	5.36	7.87	0.66	0.44	0.03	0.14	0.01	0	0.32	0.03	4.97	3.79	0.28	0	-	0.33	0.41	0.1	-	-	0	-	-	-	-	-	-	0.14	0.04	0	-	-	-	-	-	-	-	76.43	48.59	2.93	-	-	5.36	7.87	0.66	0.44	0.03	0.14	0.01	0	0.32	0.03	4.97	3.79	0.28	0	-	0.33	0.41	0.1	-	-	0	-	-	-	-	-	-	0.14	0.04	0	-	-	-	-	-	-	-	76.43
H3379_005_0	2006											950											D	D	D	V	T	Coin	Coin	V	P	V	Coin	V	Coin	Coin	V	V	Coin	P	P	P	Coin	V			V		V			O																																																						-						1.7	7.32	89.52		6159.89			0.93	0.06		3991.44	3.98				14.64	1766.94			7.79		86.09																				20	20	50		5	May-00		20	0/50		10	50				20	0/10			10		10																				0.2	0.2	50		5			0.2	0.5		10	0.5				0.2	10			10		10																					0.12	0.13	30.68		5			0.12	0.49		10	0.5				0.12	10			10		10																-	-	-	-	-	0.21	0.98	0.23	-	2.57	-	-	0.11	0.03	-	3.33	1.99	-	-	-	1.8	1.47	-	-	0.01	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.79	-	-	-	-	-	0.21	0.98	0.23	-	2.57	-	-	0.11	0.03	-	3.33	1.99	-	-	-	1.8	1.47	-	-	0.01	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.79
H3379_007_0	2006											3000											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V			O																																																						-	1784.64	179.13	1000.32		394.69	3.37	8.29	166.38	28.7		42.83	0.44	2.56	0.14	5219.38	4049.17	716.1	13.84			14.61	1705.27			12.02		86.09															325	175	180		150	30	30	50	30		0/30	30	30	30/40/30	15/0	30	40/30	30			30	0/30			30		30															325	175	180		150	0.3	0.3	50	0.3		0.2	0.3	0.3	0.25	15	30	37.5	0.3			0.3	30			30		30																170.5	91.81	94.43		78.69	0.16	0.17	26.23	0.16		0.1	0.16	0.16	0.16	15	30	37.5	0.16			0.16	30			30		30																25.36	1.37	7.87	-	2.59	0.53	1.44	0.36	4.52	-	4.45	0.07	0.4	0.02	6.52	10.12	2.24	2.18	-	-	2.3	4.26	-	-	0.03	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.85	25.36	1.37	7.87	-	2.59	0.53	1.44	0.36	4.52	-	4.45	0.07	0.4	0.02	6.52	10.12	2.24	2.18	-	-	2.3	4.26	-	-	0.03	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.85
H3379_012_0	2006											3000											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V			O																																																						-	1793.08	182.16	996.74		399.37	3.33	8.25	169.56	29.05		43.11	0.48	2.54	0.15	5192.79	4017.02	726.02	13.73			16.87	1670			12.39		86.09															325	175	180		150	30	30	50	30		0/30	30	30	30/40/30	15/0	30	40/30	30			30	0/30			30		30															325	175	180		150	0.3	0.3	50	0.3		0.2	0.3	0.3	0.25	15	30	37.5	0.3			0.3	30			30		30																169.62	91.33	93.94		78.29	0.16	0.17	26.1	0.16		0.1	0.16	0.16	0.16	15	30	37.5	0.16			0.16	30			30		30																25.35	1.39	7.8	-	2.61	0.52	1.43	0.37	4.55	-	4.47	0.08	0.4	0.02	6.49	10.04	2.27	2.15	-	-	2.64	4.17	-	-	0.03	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.98	25.35	1.39	7.8	-	2.61	0.52	1.43	0.37	4.55	-	4.47	0.08	0.4	0.02	6.49	10.04	2.27	2.15	-	-	2.64	4.17	-	-	0.03	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.98
H3379_022_0	2006	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional							1700	Other	Other	Other	Specialist excl. MH							D	D	D	P	P	Coin	Coin	V	V	V	V	V	Coin	V	P	P	V	P		P	Coin	P	P		P	P	P					V	P	V	P																																																	-	2422.47	172.23			1797.15	17.27	6.51	99.95	103.52	3094.54	160.69	25.16	0.15	0.07	51.07	21825.32	13.85	5.69		2009.83	3.9	1215.26			23.72		222.8					228.46	0.07	0.14	3.5							175/day	150/day			50/trip	20	20	50	0/100 SNF/Non-SNF	0/10/25 SNF/Non-SNF	0/25 SNF/Non-SNF	0/100 SNF/Non-SNF	20	35	0/25 SNF/Non-SNF	0/25 SNF/Non-SNF	0/35/25 SNF/Non-SNF	0/25 SNF/Non-SNF		0/25 SNF/Non-SNF	20	0/25 SNF/Non-SNF			0/25 SNF/Non-SNF		0/25 SNF/Non-SNF					0/100 SNF/Non-SNF	0/35/25 SNF/Non-SNF	0/25 SNF/Non-SNF	25							175	150			16.67	0.2	0.2	50	5	0.75	1.25	5	0.2	35	1.25	1.25	1.5	1.25		1.25	0.2	1.25			1.25		1.25					5	1.5	1.25	25								79.5	68.15			7.57	0.09	0.09	22.72	2.27	0.34	0.57	2.27	0.09	15.9	0.57	0.57	0.68	0.57		0.57	0.2	0.57			1.25		1.25					2.27	0.68	0.57	11.36								16.05	0.98	-	-	1.13	1.57	0.59	0.19	0.02	0.09	0.01	0	0.01	0	0	1.03	0	0	-	0.1	0.78	0.06	-	-	0	-	0.02	-	-	-	-	0.04	0	0	0	-	-	-	-	-	-	22.69	16.05	0.98	-	-	1.13	1.57	0.59	0.19	0.02	0.09	0.01	0	0.01	0	0	1.03	0	0	-	0.1	0.78	0.06	-	-	0	-	0.02	-	-	-	-	0.04	0	0	0	-	-	-	-	-	-	22.69
H3379_023_0	2006											925											D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		P			T	V	V	P	V	P																																																								-	2296.57	527.4	890.64		293.27	26.82	23.62	818.18	328.11	1662.26	817.93	56.02	2.62	2128.48	116.36	3390.62	974.95	633.01		762.79																						25/day	25/day	114/day		100	20	20	35	25	10	10	50	20	50		25	35 indiv/25 group	10		25																						25	25	60.08		100	0.2	0.2	35	25	10	10	50	0.2	46.38	25	25	32.5	13.49		25																							12.88	12.88	30.96		51.52	0.1	0.1	18.03	12.88	5.15	5.15	25.76	0.1	23.9	25	12.88	16.75	6.95		12.88																							2.47	0.57	2.3	-	1.26	2.76	2.43	1.23	0.35	0.71	0.35	0.12	0.27	4.24	0.24	3.64	1.36	0.37	-	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.49	2.47	0.57	2.3	-	1.26	2.76	2.43	1.23	0.35	0.71	0.35	0.12	0.27	4.24	0.24	3.64	1.36	0.37	-	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.49
H3379_024_0	2006											3200											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V		Coin	O																																																						-	1703.43	173.06	946.9		379.4	4.06	10.06	161.08	27.6		40.96	0.46	3.1	0.14	4933.15	3811.87	689.72	12.18			14.97	1586.5			11.77		86.09		25.27													325	175	170		150	30	30	50	30		0/30	30	30	30/40/30	Oct-00	30	40/30	30			30	0/30			30		30		See PBP													325	175	170		150	0.3	0.3	50	0.3		0.2	0.3	0.3	0.25	10	30	37.5	0.3			0.3	30			30		30		0.28														179.53	96.67	93.91		82.86	0.17	0.18	27.62	0.17		0.11	0.17	0.17	0.17	10	30	37.5	0.17			0.17	30			30		30		0.28														25.48	1.39	7.41	-	2.62	0.67	1.82	0.37	4.57	-	4.49	0.08	0.51	0.02	4.11	9.53	2.16	2.02	-	-	2.48	3.97	-	-	0.03	-	0.22	-	7.12	-	-	-	-	-	-	-	-	-	-	-	-	81.07	25.48	1.39	7.41	-	2.62	0.67	1.82	0.37	4.57	-	4.49	0.08	0.51	0.02	4.11	9.53	2.16	2.02	-	-	2.48	3.97	-	-	0.03	-	0.22	-	7.12	-	-	-	-	-	-	-	-	-	-	-	-	81.07
H3379_026_0	2006											3500											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V		Coin	O																																																						-	1703.43	173.06	946.9		379.4	4.05	10.02	161.08	27.6		40.96	0.46	3.08	0.14	4933.15	3811.87	689.72	12.13			14.91	1586.5			11.77		86.09		25.27													295	175	150		150	30	30	50	30		0/30	30	30	30/40/30	Oct-00	25	40/30	30			30	0/25			25		25		See PBP													295	175	150		150	0.3	0.3	50	0.3		0.2	0.3	0.3	0.25	10	25	37.5	0.3			0.3	25			25		25		0.27														174.22	103.35	88.58		88.58	0.18	0.19	29.53	0.18		0.12	0.18	0.18	0.17	10	25	37.5	0.18			0.18	25			25		25		0.27														24.73	1.49	6.99	-	2.8	0.72	1.91	0.4	4.89	-	4.8	0.08	0.55	0.02	4.11	7.94	2.16	2.15	-	-	2.64	3.31	-	-	0.02	-	0.18	-	6.92	-	-	-	-	-	-	-	-	-	-	-	-	78.8	24.73	1.49	6.99	-	2.8	0.72	1.91	0.4	4.89	-	4.8	0.08	0.55	0.02	4.11	7.94	2.16	2.15	-	-	2.64	3.31	-	-	0.02	-	0.18	-	6.92	-	-	-	-	-	-	-	-	-	-	-	-	78.8
H3379_030_0	2006											2200											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V			O																																																						-	1784.62	179.13	1000.31		394.69	3.37	8.29	166.38	28.7		42.82	0.44	2.56	0.14	5219.35	4049.14	716.09	13.84			14.61	1705.26			12.02		86.09															265	175	150		150	20	20	50	20		0/20	20	20	20/40/30	Oct-00	20	40/30	20			20	0/20			20		20															265	175	150		150	0.2	0.2	50	0.2		0.13	0.2	0.2	0.19	10	20	37.5	0.2			0.2	20			20		20																134.28	88.67	76.01		76.01	0.1	0.11	25.34	0.1		0.07	0.1	0.1	0.13	10	20	37.5	0.1			0.1	20			20		20																19.97	1.32	6.34	-	2.5	0.34	0.93	0.35	2.91	-	2.87	0.04	0.26	0.02	4.35	6.75	2.24	1.4	-	-	1.48	2.84	-	-	0.02	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.07	19.97	1.32	6.34	-	2.5	0.34	0.93	0.35	2.91	-	2.87	0.04	0.26	0.02	4.35	6.75	2.24	1.4	-	-	1.48	2.84	-	-	0.02	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.07
H3379_031_0	2006											2200											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V			O																																																						-	1793.09	182.16	996.74		399.37	3.33	8.25	169.56	29.05		43.11	0.48	2.54	0.15	5192.81	4017.04	726.02	13.73			16.87	1670.01			12.39		86.09															265	175	150		150	20	20	50	20		0/20	20	20	20/40/30	Oct-00	20	40/30	20			20	0/20			20		20															265	175	150		150	0.2	0.2	50	0.2		0.13	0.2	0.2	0.19	10	20	37.5	0.2			0.2	20			20		20																133.67	88.27	75.66		75.66	0.1	0.11	25.22	0.1		0.07	0.1	0.1	0.13	10	20	37.5	0.1			0.1	20			20		20																19.97	1.34	6.28	-	2.52	0.34	0.93	0.36	2.93	-	2.88	0.05	0.26	0.02	4.33	6.7	2.27	1.39	-	-	1.7	2.78	-	-	0.02	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.19	19.97	1.34	6.28	-	2.52	0.34	0.93	0.36	2.93	-	2.88	0.05	0.26	0.02	4.33	6.7	2.27	1.39	-	-	1.7	2.78	-	-	0.02	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.19
H3379_034_0	2006											2650											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V		Coin	O																																																						-	1703.42	173.05	946.9		379.4	4.06	10.06	161.08	27.6		40.95	0.46	3.1	0.14	4933.12	3811.85	689.71	12.18			14.97	1586.49			11.77		86.09		25.27													265	175	150		150	20	20	50	20		0/20	20	20	20/40/30	May-00	25	40/30	20			20	0/25			25		25		See PBP													265	175	150		150	0.2	0.2	50	0.2		0.13	0.2	0.2	0.19	5	25	37.5	0.2			0.2	25			25		25		0.22														148.99	98.39	84.33		84.33	0.11	0.12	28.11	0.11		0.07	0.11	0.11	0.13	5	25	37.5	0.11			0.11	25			25		25		0.22														21.15	1.42	6.65	-	2.67	0.46	1.23	0.38	3.1	-	3.05	0.05	0.35	0.02	2.06	7.94	2.16	1.37	-	-	1.68	3.31	-	-	0.02	-	0.18	-	5.63	-	-	-	-	-	-	-	-	-	-	-	-	64.87	21.15	1.42	6.65	-	2.67	0.46	1.23	0.38	3.1	-	3.05	0.05	0.35	0.02	2.06	7.94	2.16	1.37	-	-	1.68	3.31	-	-	0.02	-	0.18	-	5.63	-	-	-	-	-	-	-	-	-	-	-	-	64.87
H3379_035_0	2006											2800											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V		Coin	O																																																						-	1703.43	173.06	946.91		379.4	4.05	10.02	161.08	27.6		40.96	0.46	3.08	0.14	4933.17	3811.88	689.72	12.13			14.91	1586.5			11.77		86.09		25.27													250	175	100		150	20	20	50	20		0/20	20	20	20/40/30	May-00	15	40/30	20			20	0/15			15		15		See PBP													250	175	100		150	0.2	0.2	50	0.2		0.13	0.2	0.2	0.19	5	15	37.5	0.2			0.2	15			15		15		0.25														149.28	104.5	59.71		89.57	0.12	0.13	29.86	0.12		0.08	0.12	0.12	0.14	5	15	37.5	0.12			0.12	15			15		15		0.25														21.19	1.51	4.71	-	2.83	0.48	1.29	0.4	3.3	-	3.24	0.05	0.37	0.02	2.06	4.76	2.16	1.45	-	-	1.78	1.98	-	-	0.01	-	0.11	-	6.34	-	-	-	-	-	-	-	-	-	-	-	-	60.04	21.19	1.51	4.71	-	2.83	0.48	1.29	0.4	3.3	-	3.24	0.05	0.37	0.02	2.06	4.76	2.16	1.45	-	-	1.78	1.98	-	-	0.01	-	0.11	-	6.34	-	-	-	-	-	-	-	-	-	-	-	-	60.04
H3384_013_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	Coin	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	296.51	2.14	67.4	133.05	759.17	12.15	1.11	326.73	428.18	568.53	6.16	7.13	0	39.68	6103.13	4215.78	0.42	493.42	1495.12	1358.55	2.61				0	672.51	0																																																								500	500	500	25	50	0.3	0.3	50	100	100	25	0.5	25	0.2	10	25	0.5	25	25	25	0.2				25	25	25															none	500	500	500	25	50	0.3	0.3	50	100	100	25	0.5	25	0.2	10	25	0.5	25	25	25	0.2				25	25	25															0	12.35	0.09	2.81	0.28	3.16	3.65	0.33	1.36	3.57	4.74	0.01	3.56	-	7.94	5.09	8.78	0.21	1.03	3.11	2.83	0.52	-	-	-	-	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.82	12.35	0.09	2.81	0.28	3.16	3.65	0.33	1.36	3.57	4.74	0.01	3.56	-	7.94	5.09	8.78	0.21	1.03	3.11	2.83	0.52	-	-	-	-	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.82
H3384_015_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	Coin	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	308.73	1.38	57.56	119.21	797.23	12.57	0.58	308.3	373.53	855.69	21.85	7.82	2.21	42.21	5710.86	4710.94	0.22	610.64	1064.73	1394.22	7.17				0	782.85	0.82																																																								500	500	500	25	50	0.3	0.3	50	100	100	25	0.5	25	0.2	10	25	0.5	25	25	25	0.2				25	25	25															none	500	500	500	25	50	0.3	0.3	50	100	100	25	0.5	25	0.2	10	25	0.5	25	25	25	0.2				25	25	25															0	12.86	0.06	2.4	0.25	3.32	3.77	0.17	1.28	3.11	7.13	0.05	3.91	0	8.44	4.76	9.81	0.11	1.27	2.22	2.9	1.43	-	-	-	-	1.63	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.91	12.86	0.06	2.4	0.25	3.32	3.77	0.17	1.28	3.11	7.13	0.05	3.91	0	8.44	4.76	9.81	0.11	1.27	2.22	2.9	1.43	-	-	-	-	1.63	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.91
H3384_019_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	Coin	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	295.61	3.64	58.02	92.78	1101.89	14.69	1.24	256.51	407.37	590.97		0.87	0	19.63	5940.86	4723.42	0.77	516.59	1498.11	1405.64	6.73				0	708.06	0																																																								1000	1000	1000	20	75	0.3	0.2	50	75	75		0.5	20	0.2	5	20	0.5	20	20	20	0.2				20	20	20															none	1000	1000	1000	20	75	0.3	0.2	50	75	75		0.5	20	0.2	5	20	0.5	20	20	20	0.2				20	20	20															0	24.63	0.3	4.84	0.15	6.89	4.41	0.25	1.07	2.55	3.69	-	0.43	-	3.93	2.48	7.87	0.38	0.86	2.5	2.34	1.35	-	-	-	-	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.09	24.63	0.3	4.84	0.15	6.89	4.41	0.25	1.07	2.55	3.69	-	0.43	-	3.93	2.48	7.87	0.38	0.86	2.5	2.34	1.35	-	-	-	-	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.09
H3384_022_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V		Coin	V	Coin	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	294.15	1.44	59.69	113.28	1180.05	13.72	1.06	266.39	400.54	568.11		1.01	0.15	20.94	5884.21	4718.88	0.43	588.73	1509.35	1491.81	4.81				0	846.74	0.62																																																								1000	1000	1000	20	75	0.3	0.2	50	75	75		0.5	20	0.2	5	20	0.5	20	20	20	0.2				20	20	20															none	1000	1000	1000	20	75	0.3	0.2	50	75	75		0.5	20	0.2	5	20	0.5	20	20	20	0.2				20	20	20																24.51	0.12	4.97	0.19	7.38	4.12	0.21	1.11	2.5	3.55	-	0.5	0	4.19	2.45	7.86	0.21	0.98	2.52	2.49	0.96	-	-	-	-	1.41	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.24	24.51	0.12	4.97	0.19	7.38	4.12	0.21	1.11	2.5	3.55	-	0.5	0	4.19	2.45	7.86	0.21	0.98	2.52	2.49	0.96	-	-	-	-	1.41	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.24
H3384_037_0	2006											none											A	A	Coin	V	T	Coin	Coin	V	V			Coin	V	V			V	V			Coin																					none																																										-	284.24	4.2	42.96	121.62	1254.32	13.78	1.04	257.41	425.75			1.07	0.15	1472.02			19.91	632.11			4.68																							Oct-40																																							500	500	0.17	5	50	0.2	0.2	50	50			0.5	20	50			5	5			0.2																					none	500	500	0.17	5	50	0.2	0.2	50	50			0.5	20	50			5	5			0.2																						11.84	0.18	7.38	0.05	5.23	2.76	0.21	1.07	1.77	-	-	0.53	0	6.13	-	-	0.01	0.26	-	-	0.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.36	11.84	0.18	7.38	0.05	5.23	2.76	0.21	1.07	1.77	-	-	0.53	0	6.13	-	-	0.01	0.26	-	-	0.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.36
H3384_038_0	2006											none											A	A	Coin	V	T	Coin	Coin	V	V			Coin	V	V			V	V			Coin																					none																																										-	284.24	4.2	42.96	121.62	1254.32	13.78	1.04	257.41	425.75			1.07	0.15	1472.02			19.91	632.11			4.68																							Oct-40																																							500	500	0.17	5	50	0.2	0.2	50	50			0.5	20	50			5	5			0.2																					none	500	500	0.17	5	50	0.2	0.2	50	50			0.5	20	50			5	5			0.2																						11.84	0.18	7.38	0.05	5.23	2.76	0.21	1.07	1.77	-	-	0.53	0	6.13	-	-	0.01	0.26	-	-	0.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.36	11.84	0.18	7.38	0.05	5.23	2.76	0.21	1.07	1.77	-	-	0.53	0	6.13	-	-	0.01	0.26	-	-	0.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.36
H3384_039_0	2006											none											A	A	D	V	T	Coin	Coin	V	V	V	V	Coin	V	Coin	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	277.86	1.38	1132.63	121.92	670.39	12.57	0.58	308.3	358.39	855.69	21.85	7.82	2.21	42.21	5234.96	4710.94	0.22	610.64	1064.73	1394.22	7.17				0	782.85	0.82																																																								1500	1500	50	20	100	0.3	0.3	50	150	100	25	0.5	25	0.2	25	25	0.5	25	25	25	0.2				25	25	25															none	1500	1500	50	20	100	0.3	0.3	50	150	100	25	0.5	25	0.2	25	25	0.5	25	25	25	0.2				25	25	25															0	34.73	0.17	4.72	0.2	5.59	3.77	0.17	1.28	4.48	7.13	0.05	3.91	0	8.44	10.91	9.81	0.11	1.27	2.22	2.9	1.43	-	-	-	-	1.63	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	104.95	34.73	0.17	4.72	0.2	5.59	3.77	0.17	1.28	4.48	7.13	0.05	3.91	0	8.44	10.91	9.81	0.11	1.27	2.22	2.9	1.43	-	-	-	-	1.63	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	104.95
H3384_040_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	Coin	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	296.51	2.14	67.4	133.05	759.17	12.15	1.11	326.73	428.18	568.53	6.16	7.13	0	39.68	6103.13	4215.78	0.42	493.42	1495.12	1358.55	2.61				0	672.51	0																																																								500	500	500	25	50	0.3	0.3	50	100	100	25	0.5	25	0.2	10	25	0.5	25	25	25	0.2				25	25	25															none	500	500	500	25	50	0.3	0.3	50	100	100	25	0.5	25	0.2	10	25	0.5	25	25	25	0.2				25	25	25															0	12.35	0.09	2.81	0.28	3.16	3.65	0.33	1.36	3.57	4.74	0.01	3.56	-	7.94	5.09	8.78	0.21	1.03	3.11	2.83	0.52	-	-	-	-	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.82	12.35	0.09	2.81	0.28	3.16	3.65	0.33	1.36	3.57	4.74	0.01	3.56	-	7.94	5.09	8.78	0.21	1.03	3.11	2.83	0.52	-	-	-	-	1.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.82
H3384_041_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	Coin	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	295.61	3.64	58.02	92.78	1101.89	14.69	1.24	256.51	407.37	590.97		0.87	0	19.63	5940.86	4723.42	0.77	516.59	1498.11	1405.64	6.73				0	708.06	0																																																								1000	1000	1000	20	75	0.3	0.2	50	75	75		0.5	20	0.2	5	20	0.5	20	20	20	0.2				20	20	20															none	1000	1000	1000	20	75	0.3	0.2	50	75	75		0.5	20	0.2	5	20	0.5	20	20	20	0.2				20	20	20															0	24.63	0.3	4.84	0.15	6.89	4.41	0.25	1.07	2.55	3.69	-	0.43	-	3.93	2.48	7.87	0.38	0.86	2.5	2.34	1.35	-	-	-	-	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.09	24.63	0.3	4.84	0.15	6.89	4.41	0.25	1.07	2.55	3.69	-	0.43	-	3.93	2.48	7.87	0.38	0.86	2.5	2.34	1.35	-	-	-	-	1.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.09
H3387_005_0	2006											-											D	D	D	P	P	P	P	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	O	P											-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	310.91	0	0	0	0	0	0	4487.49	10328.01	370.57	745.91	749.42	0	19.12	0	0	0	0	0	0	6.32	0	0	0																		50 ER 10 Urgent Care							0 PCP 10 chiro and podiatry																											0	0	0	0	0	0	0	46	0	0	0	0	0	0	1.6	10	20	10	10	10	0.2	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	46	0	0	0	0	0	0	1.6	10	20	10	10	10	0.2	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	1.19	-	-	-	-	-	-	0.6	8.61	0.62	0.62	0.62	-	3.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.09	-	-	-	-	-	-	-	1.19	-	-	-	-	-	-	0.6	8.61	0.62	0.62	0.62	-	3.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.09
H3388_001_0	2006											none											d	d			t	coin	coin	v	v	v	v		v	o	v	v	v	v				o			v	coin	v															none																																										-	2111.53	46.72			524.4	9.76	4.84	711.51	342.09	8465.86	4881.77		20.84	1696.22	4008.63	19153.42	233.47	896.65				0.5			769.97	0.77	114.3			363.83												250 per stay	250 per stay			50 copay	20 min. / 20 max	20 or 10	50 ER with world wide coverage  12 or 35 UC with wold wide coverage	100 surgery 0 or 12 non-surgery / 100 ASC Services	12 copay			12 copay	10/25 indiv; 5/10 group for Substance Abuse    12 for Cardiac Rehab	12 copay		10/25 indiv; 5/10 group	12 copay							12 every 12 months	50 every 24 months; 20 after cataract surgery	12 every 12 months			12 copay																																																					none	39.26	24.67			23.72	0.2	0.2	23.76	125.4	1.73	0.9		23.16	5.4	10.85	4.35	12.3	11.86				0.2			3.75	0.2	3.43			3.75													6.91	0.1	-	-	1.04	1.95	0.97	1.41	3.57	1.22	0.36	-	0.04	0.76	3.62	6.94	0.24	0.89	-	-	-	0	-	-	0.24	0.15	0.03	-	-	0.11	-	-	-	-	-	-	-	-	-	-	-	30.57	6.91	0.1	-	-	1.04	1.95	0.97	1.41	3.57	1.22	0.36	-	0.04	0.76	3.62	6.94	0.24	0.89	-	-	-	0	-	-	0.24	0.15	0.03	-	-	0.11	-	-	-	-	-	-	-	-	-	-	-	30.57
H3388_002_0	2006											none											d	d			t	coin	coin	v	v	v	v		v	o	v	v	v	v				o			v	coin	v															none																																										-	2070.01	50.46			524.4	9.76	4.84	711.51	342.09	8465.86	4881.77		20.83	1696.22	4008.63	19153.42	233.47	896.65				0.5			769.97	0.77	114.3			363.83												250 per stay	250 per stay			50 copay	20 min. / 20 max	20 or 10	50 ER with world wide coverage  12 or 35 UC with wold wide coverage	100 surgery 0 or 12 non-surgery / 100 ASC Services	12 copay			12 copay	10/25 indiv; 5/10 group for Substance Abuse    12 for Cardiac Rehab	12 copay		10/25 indiv; 5/10 group	12 copay							12 every 12 months	20 after cataract surgery	12 every 12 months			12 copay																																																					none	39.29	24.67			23.72	0.2	0.2	23.76	125.4	1.73	0.9		23.16	5.4	10.85	4.37	12.3	11.86							3.75	0.2	3.43			3.75													6.78	0.1	-	-	1.04	1.95	0.97	1.41	3.57	1.22	0.36	-	0.04	0.76	3.62	6.98	0.24	0.89	-	-	-	-	-	-	0.24	0.15	0.03	-	-	0.11	-		-	-	-	-	-	-	-	-	-	30.47	6.78	0.1	-	-	1.04	1.95	0.97	1.41	3.57	1.22	0.36	-	0.04	0.76	3.62	6.98	0.24	0.89	-	-	-	-	-	-	0.24	0.15	0.03	-	-	0.11	-	-	-	-	-	-	-	-	-	-	-	30.47
H3388_801_0	2006											none											d	d			t	coin	coin	v	v	v	v		v	o	v	v	v	v				o			v	coin	v															none																																										-	2070.01	50.46			524.4	9.76	4.84	705.32	358.51	7986.4	4605.29		19.66	1582.76	4008.66	19170.95	70.1	896.65				0.5			769.97	0.77	114.3			363.83												250 per stay	250 per stay			50 copay	20 min. / 20 max	20 or 10	50 ER with world wide coverage  12 or 35 UC with wold wide coverage	100 surgery 0 or 12 non-surgery / 100 ASC Services	12 copay			12 copay	10/25 indiv; 5/10 group for Substance Abuse    12 for Cardiac Rehab	12 copay		10/25 indiv; 5/10 group	12 copay							12 every 12 months	20 after cataract surgery	12 every 12 months			12 copay																																																					none	39.29	24.67			23.72	0.2	0.2	23.76	125.4	1.73	0.9		23.16	5.43	10.85	4.37	13.01	11.86							3.75	0.2	3.43			3.75													6.78	0.1	-	-	1.04	1.95	0.97	1.4	3.75	1.15	0.34	-	0.04	0.72	3.62	6.98	0.08	0.89	-	-	-	-	-	-	0.24	0.15	0.03	-	-	0.11	-		-	-	-	-	-	-	-	-	-	30.34	6.78	0.1	-	-	1.04	1.95	0.97	1.4	3.75	1.15	0.34	-	0.04	0.72	3.62	6.98	0.08	0.89	-	-	-	-	-	-	0.24	0.15	0.03	-	-	0.11	-	-	-	-	-	-	-	-	-	-	-	30.34
H3388_803_0	2006											none											d	d			t	coin	coin	v	v	v	v		v	o	v	v	v	v				o			v	coin	v															none																																										-	2070.01	50.46			524.4	9.76	4.84	705.32	358.51	7986.4	4605.29		19.66	1582.76	4008.66	19170.95	70.1	896.65				0.5			769.97	0.77	114.3			363.83												250 per stay	250 per stay			50 copay	20 min. / 20 max	20 or 10	50 ER with world wide coverage  12 or 35 UC with wold wide coverage	100 surgery 0 or 12 non-surgery / 100 ASC Services	12 copay			12 copay	10/25 indiv; 5/10 group for Substance Abuse    12 for Cardiac Rehab	12 copay		10/25 indiv; 5/10 group	12 copay							12 every 12 months	20 after cataract surgery	12 every 12 months			12 copay																																																					none	39.29	24.67			23.72	0.2	0.2	23.76	125.4	1.73	0.9		23.16	5.43	10.85	4.37	13.01	11.86							3.75	0.2	3.43			3.75													6.78	0.1	-	-	1.04	1.95	0.97	1.4	3.75	1.15	0.34	-	0.04	0.72	3.62	6.98	0.08	0.89	-	-	-	-	-	-	0.24	0.15	0.03	-	-	0.11	-		-	-	-	-	-	-	-	-	-	30.34	6.78	0.1	-	-	1.04	1.95	0.97	1.4	3.75	1.15	0.34	-	0.04	0.72	3.62	6.98	0.08	0.89	-	-	-	-	-	-	0.24	0.15	0.03	-	-	0.11	-	-	-	-	-	-	-	-	-	-	-	30.34
H3388_804_0	2006											none											d	d			t	coin	coin	v	v	v	v		v	o	v	v	v	v				o			v	coin	v															none																																										-	2070.01	50.46			524.4	9.76	4.84	705.32	358.51	7986.4	4605.29		19.66	1582.76	4008.66	19170.95	70.1	896.65				0.5			769.97	0.77	114.3			363.83												250 per stay	250 per stay			50 copay	20 min. / 20 max	20 or 10	50 ER with world wide coverage  12 or 35 UC with wold wide coverage	100 surgery 0 or 12 non-surgery / 100 ASC Services	12 copay			12 copay	10/25 indiv; 5/10 group for Substance Abuse    12 for Cardiac Rehab	12 copay		10/25 indiv; 5/10 group	12 copay							12 every 12 months	20 after cataract surgery	12 every 12 months			12 copay																																																					none	39.29	24.67			23.72	0.2	0.2	23.76	125.4	1.73	0.9		23.16	5.43	10.85	4.37	13.01	11.86							3.75	0.2	3.43			3.75													6.78	0.1	-	-	1.04	1.95	0.97	1.4	3.75	1.15	0.34	-	0.04	0.72	3.62	6.98	0.08	0.89	-	-	-	-	-	-	0.24	0.15	0.03	-	-	0.11	-		-	-	-	-	-	-	-	-	-	30.34	6.78	0.1	-	-	1.04	1.95	0.97	1.4	3.75	1.15	0.34	-	0.04	0.72	3.62	6.98	0.08	0.89	-	-	-	-	-	-	0.24	0.15	0.03	-	-	0.11	-	-	-	-	-	-	-	-	-	-	-	30.34
H3404_001_0	2006																						A		D		T	Coin		V						V	V										V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	263.57		132.69		211.39	15.21		326.47						687.23	15773.65										270.07																	450		100 - days 1-24 0 - 24+		50	0		50						30	15										20																	433.31		243.01		52.24	0.18		45.47						1.66	8.58										24.37																	2960	433.31		243.01		52.24	0.18		45.47						1.66	8.58										24.37																	0	9.52	-	2.69	-	0.92	2.68	-	1.24	-	-	-	-	-	0.1	11.28	-	-	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.97	9.52	-	2.69	-	0.92	2.68	-	1.24	-	-	-	-	-	0.1	11.28	-	-	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.97
H3404_002_0	2006																						A		D		T	Coin		V						V	V										V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	263.57		132.69		211.39	15.21		326.47						687.23	15773.65										270.07																	450		100 - days 1-24 0 - 24+		50	0		50						30	15										20																	433.31		243.01		52.24	0.18		45.47						1.66	8.58										24.37																	2960	433.31		243.01		52.24	0.18		45.47						1.66	8.58										24.37																	0	9.52	-	2.69	-	0.92	2.68	-	1.24	-	-	-	-	-	0.1	11.28	-	-	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.97	9.52	-	2.69	-	0.92	2.68	-	1.24	-	-	-	-	-	0.1	11.28	-	-	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.97
H3404_801_0	2006																						A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	203.71		68.23		135.68	13.59		238.57	7.67					55.57	16425.26						0.76				242.04																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																	2500	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83	12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83
H3404_803_0	2006																						A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	203.71		68.23		135.68	13.59		238.57	7.67					55.57	16425.26						0.76				242.04																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																	2500	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83	12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83
H3404_804_0	2006																						A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	203.71		68.23		135.68	13.59		238.57	7.67					55.57	16425.26						0.76				242.04																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																	2500	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83	12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83
H3404_805_0	2006																						A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	203.71		68.23		135.68	13.59		238.57	7.67					55.57	16425.26						0.76				242.04																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																	2500	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83	12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83
H3404_806_0	2006																						A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	203.71		68.23		135.68	13.59		238.57	7.67					55.57	16425.26						0.76				242.04																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																	2500	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83	12.26	-	1.8	-	1.18	2.39	-	0.88	0.77	-	-	-	-	5.56	19.48	-	-	-	-	-	0.15	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.83
H3405_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1000.19	21.19	1047.08	488.06	136.82	16.41	1.23	385.53	305.46				16.65	1882.25	6038.53	10530.94					4.45			7.24	0		0					52.64	1.12	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100				0	0-50	Oct-50	35-50					20			25								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	10	100	0.2	0.2	40.7	100				0	37.23	10.78	35.29					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	10	100	0.2	0.2	40.7	100				0	37.23	10.78	35.29					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0				0	9.92	0.21	1.03	0.41	1.14	3.28	0.25	1.31	2.55	-	-	-	-	5.84	5.43	30.97	-	-	-	-	0.89	-	-	2.56	-	-	-	-	-	-	-	0.52	0.01	-	-	-	-	-	-	-	-	66.31	9.92	0.21	1.03	0.41	1.14	3.28	0.25	1.31	2.55	-	-	-	-	5.84	5.43	30.97	-	-	-	-	0.89	-	-	2.56	-	-	-	-	-	-	-	0.52	0.01	-	-	-	-	-	-	-	-	66.31
H3405_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	248.33	5.64	1094.11	509.98	142.96	18.21	1.37	402.85	319.18				17.4	1966.79	6309.75	11003.94					4.45			0	0		0					13.07	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.57	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.57	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.42	0.28	0.8	0.42	1.19	4.55	0.34	1.52	5.32	-	-	-	-	5.67	13.25	32.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	79.42	12.42	0.28	0.8	0.42	1.19	4.55	0.34	1.52	5.32	-	-	-	-	5.67	13.25	32.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	79.42
H3405_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	248.33	5.64	1094.11	509.98	142.96	18.21	1.37	402.85	319.18				17.4	1966.79	6309.74	11003.93					4.45			0	0		0					13.07	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.57	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.57	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.42	0.28	0.8	0.42	1.19	4.55	0.34	1.52	5.32	-	-	-	-	5.67	13.25	32.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	79.42	12.42	0.28	0.8	0.42	1.19	4.55	0.34	1.52	5.32	-	-	-	-	5.67	13.25	32.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	79.42
H3405_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	248.33	5.64	1094.11	509.98	142.96	18.21	1.37	402.85	319.18				17.4	1966.79	6309.75	11003.94					4.45			0	0		0					13.07	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.57	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.57	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.42	0.28	0.8	0.42	1.19	4.55	0.34	1.52	5.32	-	-	-	-	5.67	13.25	32.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	79.42	12.42	0.28	0.8	0.42	1.19	4.55	0.34	1.52	5.32	-	-	-	-	5.67	13.25	32.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	79.42
H3405_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	248.33	5.64	1094.11	509.98	142.96	18.21	1.37	402.85	319.18				17.4	1966.79	6309.74	11003.93					4.45			0	0		0					13.07	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.57	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.57	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.42	0.28	0.8	0.42	1.19	4.55	0.34	1.52	5.32	-	-	-	-	5.67	13.25	32.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	79.42	12.42	0.28	0.8	0.42	1.19	4.55	0.34	1.52	5.32	-	-	-	-	5.67	13.25	32.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	79.42
H3449_005_0	2006											2960											A		D		T	Coin		V						V	V										V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	275.8		138.85		221.2	15.84		344.95						726.13	16715.2										287.59																	250		75 - days 1-10 0 - 10+		50	0		50						30	15										15																	240.73		155.02		52.24	0.18		44.35						1.66	8.69										18.28																		240.73		155.02		52.24	0.18		44.35						1.66	8.69										18.28																	0	5.53	-	1.79	-	0.96	2.79	-	1.27	-	-	-	-	-	0.1	12.11	-	-	-	-	-	-	-	-	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25	5.53	-	1.79	-	0.96	2.79	-	1.27	-	-	-	-	-	0.1	12.11	-	-	-	-	-	-	-	-	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25
H3449_012_0	2006											2960											A		D		T	Coin		V						V	V										V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	275.8		138.85		221.2	15.84		344.95						726.13	16715.2										287.59																	250		75 - days 1-10 0 - 10+		50	0		50						30	15										15																	240.73		155.02		52.24	0.18		44.35						1.66	8.69										18.28																		240.73		155.02		52.24	0.18		44.35						1.66	8.69										18.28																	0	5.53	-	1.79	-	0.96	2.79	-	1.27	-	-	-	-	-	0.1	12.11	-	-	-	-	-	-	-	-	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25	5.53	-	1.79	-	0.96	2.79	-	1.27	-	-	-	-	-	0.1	12.11	-	-	-	-	-	-	-	-	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25
H3449_013_0	2006											2960											A		D		T	Coin		V	Coin	Coin				Coin	V										V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	275.8		138.85		221.2	15.84		344.95	6.91					55.11	16715.2										287.59																	750		100.00 - days 1-30 0 - 31+		100	0		50	0					0	20 pcp/30 spec										15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	13.04										18.28																		722.19		315.82		104.47	0.18		44.35	0.1					0.1	13.04										18.28																	0	16.6	-	3.65	-	1.93	2.79	-	1.27	0.69	-	-	-	-	5.51	18.17	-	-	-	-	-	-	-	-	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.05	16.6	-	3.65	-	1.93	2.79	-	1.27	0.69	-	-	-	-	5.51	18.17	-	-	-	-	-	-	-	-	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.05
H3449_801_0	2006											2960											A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	213.16		71.4	806.01	141.97	13.9		252.08	7.92					57.39	17405.7						0.79				257.74																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05	12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05
H3449_805_0	2006											2960											A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	213.16		71.4	806.01	141.97	13.9		252.08	7.92					57.39	17405.7						0.79				257.74																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05	12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05
H3449_807_0	2006											2960											A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	213.16		71.4	806.01	141.97	13.9		252.08	7.92					57.39	17405.7						0.79				257.74																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05	12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05
H3449_808_0	2006											2960											A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	213.16		71.4	806.01	141.97	13.9		252.08	7.92					57.39	17405.7						0.79				257.74																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05	12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05
H3449_809_0	2006											2960											A		A		T	Coin		V	Coin					Coin	V						Coin				V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	213.16		71.4	806.01	141.97	13.9		252.08	7.92					57.39	17405.7						0.79				257.74																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec						20				15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23						0.2				18.28																		12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05	12.83	-	1.88	-	1.24	2.45	-	0.93	0.79	-	-	-	-	5.74	20.64	-	-	-	-	-	0.16	-	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.05
H3449_810_0	2006											2960											A		A		T	Coin		V	Coin					V	V							Coin			V																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	240.48		56.04		161.97	17.97		209.37	8.93					611.1	17370.86							1.74			147.78																	750		100.00 - days 1-30 0 - 31+		100	20		50	10					10	20 pcp/40 spec							20			15																	722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23							0.2			18.28																		722.19		315.82		104.47	0.18		44.35	0.1					0.1	14.23							0.2			18.28																		14.47	-	1.48	-	1.41	3.17	-	0.77	0.89	-	-	-	-	0.01	20.6	-	-	-	-	-	-	0.35	-	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.37	14.47	-	1.48	-	1.41	3.17	-	0.77	0.89	-	-	-	-	0.01	20.6	-	-	-	-	-	-	0.35	-	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.37
H3456_001_0	2006											3100											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	1954.68	7.47	598.33		113.48	12.75	6.03	473.46	67.9		39.47		9.54	0.58	4683.23	3286.91	0.47	1.91			25.72	1002.98			172.9		214.21															295	17500	150	0	150	0	0	40/50	0	0	0/30	30 (included in g)	0.3	30/40 / 30	15/0	30	30/40	0	0	0	0.3	0/30			30		30			0												295	175	150	0	150	0.3	0.3	40/50	0.3		0/30	30 -included in g	0.3	30/40 / 30	15/0	30	30/40	0.3	0		0.3	0/30			30		30			0													146.78	91.22	78.19		78.19	0.16	0.18	25.26	0.16		0.1		0.16	0.16	15	30	37.5	0.16			0.16	29.91			30		30																23.91	0.06	3.9	-	0.74	1.99	1.11	1	10.62	-	4.04	-	1.49	0.09	5.85	8.22	0	0.3	-	-	4.02	2.5	-	-	0.43	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.8	23.91	0.06	3.9	-	0.74	1.99	1.11	1	10.62	-	4.04	-	1.49	0.09	5.85	8.22	0	0.3	-	-	4.02	2.5	-	-	0.43	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.8
H3456_010_0	2006	OP Facility - Emergency	OP Facility - Other	Professional								1600		Other	Specialist excl. MH								D	D	D	P	P	Coin	Coin	V	Coin	V	V	Coin	Coin	Coin	Coin	Coin	P	P		Coin	Coin	Coin	P		P	P	Coin					V	V	P	Coin																																																	-	2116.68	150.49			1932.67	19.97	7.53	193.97		3327.89	172.81	1.99	0.17	7.88	160.27	129.32				11.75	3.9	7.75										107.49	0.07	3.54	0.72							100	10000			100	20	20	50	20	10	10	20	20	20	20	20				20	20	20			20		20					40/50	40	20	20							100	100			33.33	0.2	0.2	50	0.2	10	10	0.2	0.2	0.2	0.2	0.2				0.2	0.2	0.2			20		0.2					45	40	20	0.2								62.2	62.2			20.73	0.12	0.12	31.1	0.12	6.22	6.22	0.12	0.12	0.12	0.12	0.12				0.12	0.12	0.12			20		0.12					27.99	24.88	12.44	0.2								10.97	0.78	-	-	3.34	2.48	0.94	0.5	-	1.72	0.09	0.25	0.02	0.98	19.94	16.09	-	-	-	1.46	0.49	0.96	-	-	-	-	-	-	-	-	-	0.25	0	0	0.14	-	-	-	-	-	-	61.41	10.97	0.78	-	-	3.34	2.48	0.94	0.5	-	1.72	0.09	0.25	0.02	0.98	19.94	16.09	-	-	-	1.46	0.49	0.96	-	-	-	-	-	-	-	-	-	0.25	0	0	0.14	-	-	-	-	-	-	61.41
H3456_016_0	2006											600											D	D	D	V	T	Coin	Coin	V	V	O	O	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	2508.95	227.02	758.87		144.08	16.84	7.26	623.75	83.44		49.77		1.1	0.84	6217.08	4324.56	966.69	2.5			34.13	1330.58			229.63	92.19	283.85															25	2500	15	0	100	0	0	40	15	0	0/10	15 (included in g)	0.2	4/8 / 10 / 15	Feb-00	4	08-Apr	10	0	0	0.2	0/4/5	0	0	04-May	0	4	0		0												25	25	15		100	0.2	0.2	40	15		0/10		0.2	4/8 / 10 / 15	Feb-00	4	08-Apr	10			0.2	0/4/5			04-May	0	4																14.39	14.54	8.72		58.16	0.12	0.13	23.26	8.72		3.9		0.12	8	2	4	7	0			0.12	4.03			4	15	4																3.01	0.28	0.55	-	0.7	1.96	0.98	1.21	0.06	-	0.02	-	0.13	0	1.04	1.44	0.56	0	-	-	3.97	0.45	-	-	0.08	0.12	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.63	3.01	0.28	0.55	-	0.7	1.96	0.98	1.21	0.06	-	0.02	-	0.13	0	1.04	1.44	0.56	0	-	-	3.97	0.45	-	-	0.08	0.12	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.63
H3456_020_0	2006											2800											D	D	D	V	T	Coin	Coin	V	V	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	1954.68	7.47	598.33		113.48	12.75	6.03	473.46	790.87		39.47		9.54	0.58	4683.23	3286.91	0.47	1.91			25.72	1002.98			172.9		214.21															265	175	125	0	150	0	0	40/50	20 / 100	0	0/20	100 (included in g)	0.2	30/40 / 20	Oct-00	20	30/40	0	0	0	0.2	0/20			20		20			0												265	175	125	0	150	0.2	0.2	40/50	20 / 100		0/20	100 -included in g	0.2	30/40 / 20	Oct-00	20	30/40	0.2	0		0.2	0/20			20		20			0													143.48	99.26	70.9		85.08	0.11	0.13	27.49	68.88		0.07		0.11	0.11	10	20	37.5	0.11			0.11	19.94			20		20																23.37	0.06	3.54	-	0.8	1.45	0.79	1.08	4.54	-	2.93	-	1.08	0.07	3.9	5.48	0	0.22	-	-	2.92	1.67	-	-	0.29	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.53	23.37	0.06	3.54	-	0.8	1.45	0.79	1.08	4.54	-	2.93	-	1.08	0.07	3.9	5.48	0	0.22	-	-	2.92	1.67	-	-	0.29	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.53
H3456_801_0	2006											3100											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	1954.68	7.47	598.33		113.48	12.75	6.03	473.46	67.9	10465.2	39.47		9.54	0.58	4683.23	3286.91	0.47	1.91			25.72	1002.98			172.9		214.21															295	17500	150	0	150	0	0	50	0	10	30-Oct	30 (included in g)	0.3	30/40 / 30	30/0	30	30/40	0	0	0	0.3	0/30			30		30			0												295	175	150	0	150	0.3	0.3	50	0.3	10	30-Oct	30 -included in g	0.3	30/40 / 30	30/0	30	30/40	0.3	0		0.3	0/30			30		30			0													144.37	89.72	76.9		76.9	0.15	0.18	25.63	0.15	2.05	0.1		0.15	0.15	30	30	37.5	0.15			0.15	29.91			30		30																23.52	0.06	3.83	-	0.73	1.96	1.1	1.01	10.44	1.79	4.07	-	1.47	0.09	11.71	8.22	0	0.29	-	-	3.96	2.5	-	-	0.43	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.71	23.52	0.06	3.83	-	0.73	1.96	1.1	1.01	10.44	1.79	4.07	-	1.47	0.09	11.71	8.22	0	0.29	-	-	3.96	2.5	-	-	0.43	-	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.71
H3619_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	979.4	20.75	512.66	477.92	133.97	17.02	1.28	377.52	299.11				16.31	1843.13	5913.04	10312.09					4.45			6.84	0		0					51.55	1.09	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-75	Oct-50	35-50					20			25								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.36	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.36	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0				0	9.72	0.21	1.01	0.4	1.12	3.4	0.26	1.28	2.9	-	-	-	-	7.58	5.31	30.33	-	-	-	-	0.89	-	-	2.41	-	-	-	-	-	-	-	0.51	0.01	-	-	-	-	-	-	-	-	67.34	9.72	0.21	1.01	0.4	1.12	3.4	0.26	1.28	2.9	-	-	-	-	7.58	5.31	30.33	-	-	-	-	0.89	-	-	2.41	-	-	-	-	-	-	-	0.51	0.01	-	-	-	-	-	-	-	-	67.34
H3619_004_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1015.51	21.51	531.56	495.53	138.91	18.73	1.41	391.44	310.14				16.91	1911.08	6131.04	10692.28					4.45			0	0		0					53.45	1.13	0	0	0	0	0				180 per day (1-5)	180 per day (1-5)	0 per day (1-6) 100 per day (7-100)	10	100	20	20	35-50	100-150				0	0-75	15-100	40-100					20			0								180 per day (1-5)	180 per day (1-5)	0	0	0	0	0				122.44	122.44	58.18	10	100	0.2	0.2	40.7	116.5				0	49.56	16.67	41.18					20			0	0		0					122.44	122.44	0	0	0	0	0					122.44	122.44	58.18	10	100	0.2	0.2	40.7	116.5				0	49.56	16.67	41.18					20			0	0		0					122.44	122.44	0	0	0	0	0				0	10.36	0.22	2.58	0.41	1.16	3.75	0.28	1.33	3.01	-	-	-	-	7.89	8.52	36.69	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.55	0.01	-	-	-	-	-	-	-	-	77.64	10.36	0.22	2.58	0.41	1.16	3.75	0.28	1.33	3.01	-	-	-	-	7.89	8.52	36.69	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.55	0.01	-	-	-	-	-	-	-	-	77.64
H3619_005_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	997.56	21.13	522.16	486.77	136.46	17.38	1.31	384.52	304.65				16.61	1877.3	6022.65	10503.25					4.45			6.84	0		0					52.5	1.11	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-75	Oct-50	35-50					20			25								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.46	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.46	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0				0	9.9	0.21	1.03	0.41	1.14	3.48	0.26	1.3	2.96	-	-	-	-	7.74	5.41	30.89	-	-	-	-	0.89	-	-	2.41	-	-	-	-	-	-	-	0.52	0.01	-	-	-	-	-	-	-	-	68.55	9.9	0.21	1.03	0.41	1.14	3.48	0.26	1.3	2.96	-	-	-	-	7.74	5.41	30.89	-	-	-	-	0.89	-	-	2.41	-	-	-	-	-	-	-	0.52	0.01	-	-	-	-	-	-	-	-	68.55
H3619_006_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1014.34	21.49	530.95	494.97	138.75	17.17	1.29	390.99	309.78				16.89	1908.89	6123.99	10679.99					4.45			6.84	0		0					53.39	1.13	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-75	Oct-50	35-50					20			25								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.56	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.56	10.78	35.29					20			0.35	0		0					119.04	119.04	0	0	0	0	0				0	10.06	0.21	1.04	0.41	1.16	3.43	0.26	1.33	3.01	-	-	-	-	7.88	5.5	31.41	-	-	-	-	0.89	-	-	2.41	-	-	-	-	-	-	-	0.53	0.01	-	-	-	-	-	-	-	-	69.55	10.06	0.21	1.04	0.41	1.16	3.43	0.26	1.33	3.01	-	-	-	-	7.88	5.5	31.41	-	-	-	-	0.89	-	-	2.41	-	-	-	-	-	-	-	0.53	0.01	-	-	-	-	-	-	-	-	69.55
H3619_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	245.82	5.59	1071.63	499.5	140.02	18.71	1.41	394.57	312.62				17.05	1926.37	6180.09	10777.83					4.45			0	0		0					12.94	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.46	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.46	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.29	0.28	0.79	0.42	1.17	4.68	0.35	1.49	5.21	-	-	-	-	5.53	12.98	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	78.16	12.29	0.28	0.79	0.42	1.17	4.68	0.35	1.49	5.21	-	-	-	-	5.53	12.98	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	78.16
H3619_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	245.82	5.59	1071.62	499.5	140.02	18.71	1.41	394.57	312.61				17.05	1926.36	6180.04	10777.73					4.45			0	0		0					12.94	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.46	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.46	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.29	0.28	0.79	0.42	1.17	4.68	0.35	1.49	5.21	-	-	-	-	5.53	12.98	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	78.16	12.29	0.28	0.79	0.42	1.17	4.68	0.35	1.49	5.21	-	-	-	-	5.53	12.98	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	78.16
H3619_806_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	245.82	5.59	1071.63	499.5	140.02	18.71	1.41	394.57	312.62				17.05	1926.37	6180.09	10777.83					4.45			0	0		0					12.94	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.46	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.46	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.29	0.28	0.79	0.42	1.17	4.68	0.35	1.49	5.21	-	-	-	-	5.53	12.98	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	78.16	12.29	0.28	0.79	0.42	1.17	4.68	0.35	1.49	5.21	-	-	-	-	5.53	12.98	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	78.16
H3619_807_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	245.82	5.59	1071.62	499.5	140.02	18.71	1.41	394.57	312.61				17.05	1926.36	6180.04	10777.73					4.45			0	0		0					12.94	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.46	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.46	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.29	0.28	0.79	0.42	1.17	4.68	0.35	1.49	5.21	-	-	-	-	5.53	12.98	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	78.16	12.29	0.28	0.79	0.42	1.17	4.68	0.35	1.49	5.21	-	-	-	-	5.53	12.98	31.44	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.65	0.01	-	-	-	-	-	-	-	-	78.16
H3620_001_0	2006																						D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V																																																									-	1350.38	26.39	313.14		135.9	10.84	1.2	605.31	194.46					399.85	4196.84	2945.18	173.06	327.24							135		135															120 Days 1-5;  for long-term acute care hospital stays there are copays of 50 for days 6-15 and of 25 for days 16-25	120 Days 1-5	25 Days 16-30		75	20 percent	20 percent	50	175					30 Visits 1-3	15	30	30	30							30		30															120	120	25		75	0.2	0.2	50	175					30	15	30	30	30							30		30																120	120	25		75	0.2	0.2	50	175					30	15	30	30	30							30		30																13.5	0.26	0.65	-	0.85	2.17	0.24	2.52	2.84	-	-	-	-	1	5.25	7.36	0.43	0.82	-	-	-	-	-	-	0.34	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.57	13.5	0.26	0.65	-	0.85	2.17	0.24	2.52	2.84	-	-	-	-	1	5.25	7.36	0.43	0.82	-	-	-	-	-	-	0.34	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.57
H3620_002_0	2006																						D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V																																																									-	1425.4	27.86	330.54		143.45	11.44	1.27	638.94	205.27					422.06	4196.84	3108.8	182.67	345.42							142.5		142.5															120 Days 1-5;  for long-term acute care hospital stays there are copays of 50 for days 6-15 and of 25 for days 16-25	120 Days 1-5	25 Days 16-30		75	20 percent	20 percent	50	175					30 Visits 1-3	15	30	30	30							30		30															120	120	25		75	0.2	0.2	50	175					30	15	30	30	30							30		30																120	120	25		75	0.2	0.2	50	175					30	15	30	30	30							30		30																14.25	0.28	0.69	-	0.9	2.29	0.25	2.66	2.99	-	-	-	-	1.06	5.25	7.77	0.46	0.86	-	-	-	-	-	-	0.36	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.42	14.25	0.28	0.69	-	0.9	2.29	0.25	2.66	2.99	-	-	-	-	1.06	5.25	7.77	0.46	0.86	-	-	-	-	-	-	0.36	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.42
H3620_801_0	2006																						D	D	D		T	COIN	COIN	V	P					V	V	V	V	V																																																																		-	1350.38	26.39	313.14		135.9	10.84	1.2	605.31	194.46					399.85	4196.84	2945.18	173.06	327.24																								120 Days 1-5;  for long-term acute care hospital stays there are copays of 50 for days 6-15 and of 25 for days 16-25	120 Days 1-5	25 Days 16-30		75	20 percent	20 percent	50	175					30 Visits 1-3	15	30	30	30																								120	120	25		75	0.2	0.2	50	175					30	15	30	30	30																									120	120	25		75	0.2	0.2	50	175					30	15	30	30	30																									13.5	0.26	0.65	-	0.85	2.17	0.24	2.52	2.84	-	-	-	-	1	5.25	7.36	0.43	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.9	13.5	0.26	0.65	-	0.85	2.17	0.24	2.52	2.84	-	-	-	-	1	5.25	7.36	0.43	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.9
H3621_001_0	2006											1500											D		D		P	Coin	Coin	V	P		P			P		P	P	P		P	S				V																	3000																																										-	1269.24		160.19		114.82	11.77	1.22	219.41	433.34		1110.25			695.36		2938.67	186.34	381.66		60.54	589.05				544.29																																																										100		75		65	0.2	0.2	47.81	100		54.55			45.14		25	25	22.18		25	50				25																	0	92.68		69.51		60.23	0.19	0.19	44.31	92.68		50.56			41.83		23.17	23.17	20.56		23.17	46.34				23.17																	0	9.8	-	0.93	-	0.58	2.18	0.23	0.81	3.35	-	4.68	-	-	2.42	-	5.67	0.36	0.65	-	0.12	2.27	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.1	9.8	-	0.93	-	0.58	2.18	0.23	0.81	3.35	-	4.68	-	-	2.42	-	5.67	0.36	0.65	-	0.12	2.27	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.1
H3621_801_0	2006											1500											D		D		P	Coin	Coin	V	P		P			P		P	P	P		P	S				V																	3000																																										-	1269.24		160.19		114.82	11.49	1.19	219.41	433.34		1110.25			695.36		2938.67	186.34	381.66		60.54	589.05				544.29																																																										100		75		75	0.2	0.2	47.81	100		54.55			45.14		25	25	22.18		25	50				25																	0	92.68		69.51		69.51	0.19	0.19	44.31	92.68		50.56			41.83		23.17	23.17	20.56		23.17	46.34				23.17																	0	9.8	-	0.93	-	0.67	2.13	0.22	0.81	3.35	-	4.68	-	-	2.42	-	5.67	0.36	0.65	-	0.12	2.27	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.13	9.8	-	0.93	-	0.67	2.13	0.22	0.81	3.35	-	4.68	-	-	2.42	-	5.67	0.36	0.65	-	0.12	2.27	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.13
H3622_001_0	2006											2000											D	D	D		P			V	V						V	V	V	P																								5000																																										-	1390.04	57.05	1169.64		2370.32			291.5	332.36						3617.68	3321.01	175.07	1302.11																								200 per Day	200 per Day	0 1st 10 Days 75 per Day  11-100		75 per Trip			50 per Visit	200 per Visit						10 per Visit	30 per Visit	30 per Visit	30 per Visit																								200	200	43.05		6.08			42.71	183.85						10.51	29.2	19.57	14.58																								7000	124.99	121.5	13.6		5.84			41.06	176.78						10.1	28.08	18.82	14.02																								0	14.48	0.58	1.33	-	1.15	-	-	1	4.9	-	-	-	-	-	3.05	7.77	0.27	1.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.04	14.48	0.58	1.33	-	1.15	-	-	1	4.9	-	-	-	-	-	3.05	7.77	0.27	1.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.04
H3622_003_0	2006											2000											D	D	D		P			V	V						V	V	V	P																								5000																																										-	1390.04	57.05	1169.64		2370.32			291.5	332.36						3617.68	3321.01	175.07	1302.11																								200 per Day	200 per Day	0 1st 10 Days 75 per Day  11-100		75 per Trip			50 per Visit	200 per Visit						10 per Visit	30 per Visit	30 per Visit	30 per Visit																								200	200	43.05		6.08			42.71	183.85						10.51	29.2	19.57	14.58																								7000	124.99	121.5	13.6		5.84			41.06	176.78						10.1	28.08	18.82	14.02																								0	14.48	0.58	1.33	-	1.15	-	-	1	4.9	-	-	-	-	-	3.05	7.77	0.27	1.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.04	14.48	0.58	1.33	-	1.15	-	-	1	4.9	-	-	-	-	-	3.05	7.77	0.27	1.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.04
H3622_004_0	2006											2000											D	D	D		P			V	V						V	V	V	P																								5000																																										-	1390.04	57.05	1169.64		2370.32			291.5	332.36						3617.68	3321.01	175.07	1302.11																								200 per Day	200 per Day	0 1st 10 Days 75 per Day  11-100		75 per Trip			50 per Visit	200 per Visit						10 per Visit	30 per Visit	30 per Visit	30 per Visit																								200	200	43.05		6.08			42.71	183.85						10.51	29.2	19.57	14.58																								7000	124.99	121.5	13.6		5.84			41.06	176.78						10.1	28.08	18.82	14.02																								0	14.48	0.58	1.33	-	1.15	-	-	1	4.9	-	-	-	-	-	3.05	7.77	0.27	1.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.04	14.48	0.58	1.33	-	1.15	-	-	1	4.9	-	-	-	-	-	3.05	7.77	0.27	1.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.04
H3622_801_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0																																										-	241.23		37.21	0.98	8.38	13.78		19.3	35.79	79.96					161.01						11.98	10.87																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07		0.16	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23	0.23																				0	0.07		0.16	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23	0.23																				123	17.79	-	5.97	-	1.95	3.21	-	4.5	8.34	18.63	-	-	-	-	37.52	-	-	-	-	-	2.79	2.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.23	17.79	-	5.97	-	1.95	3.21	-	4.5	8.34	18.63	-	-	-	-	37.52	-	-	-	-	-	2.79	2.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.23
H3623_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1563.18	15.95	1324.21	861.21	177.34	15.72	1.17	156.25	32.7	286.92	227.27	0.35	237.37	19.08	3421.29	7430.65	3.48	879.46	466.95		259.07	764.61			0		0			0												150/d 7	150/d 7	0 for days 1-8 75 for days 9-14 125 for days 15-100																																							107.77	107.77	78.57	20	100	0.2	0.2	47.4	100	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													107.77	107.77	78.57	20	100	0.2	0.2	47.4	100	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													14.04	0.14	8.67	1.44	1.48	3.14	0.23	0.62	0.27	0.72	0.7	0	0.59	0.05	2.85	18.58	0.01	2.2	1.17	-	0.97	1.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.78	14.04	0.14	8.67	1.44	1.48	3.14	0.23	0.62	0.27	0.72	0.7	0	0.59	0.05	2.85	18.58	0.01	2.2	1.17	-	0.97	1.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.78
H3623_002_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1596.79	16.29	1352.67	879.73	181.15	16.06	1.2	159.61	33.4	293.09	232.15	0.36	242.48	19.49	3494.84	7590.4	3.55	898.37	476.99		264.64	781.05			0		0			0												50/d 10	50/d 10	0 for days 1-8 75 for days 9-14 125 for days 15-100																																							40.82	40.82	78.57	20	100	0.2	0.2	46.1	100	20	30.26	20	20	20	10	20	20	20	20		45	20			0		0			0													40.82	40.82	78.57	20	100	0.2	0.2	46.1	100	20	30.26	20	20	20	10	20	20	20	20		45	20			0		0			0													5.43	0.06	8.86	1.47	1.51	3.21	0.24	0.61	0.28	0.49	0.59	0	0.4	0.03	2.91	12.65	0.01	1.5	0.79	-	0.99	1.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.33	5.43	0.06	8.86	1.47	1.51	3.21	0.24	0.61	0.28	0.49	0.59	0	0.4	0.03	2.91	12.65	0.01	1.5	0.79	-	0.99	1.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.33
H3623_003_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1702.08	17.37	1441.87	937.74	193.1	17.11	1.28	170.14	35.6	312.42	247.46	0.38	258.47	20.78	3725.3	8090.94	3.78	957.61	508.45		282.09	832.56			0		0			0														0 for days 1-8 75 for days 9-14 125 for days 15-100																																							0	0	78.57	20	100	0.2	0.2	46.1	100	20	30.26	20	20	20	0	20	20	20	20		45	20			0		0			0													0	0	78.57	20	100	0.2	0.2	46.1	100	20	30.26	20	20	20	0	20	20	20	20		45	20			0		0			0													-	-	9.44	1.56	1.61	3.42	0.26	0.65	0.3	0.52	0.62	0	0.43	0.03	-	13.48	0.01	1.6	0.85	-	1.06	1.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.23	-	-	9.44	1.56	1.61	3.42	0.26	0.65	0.3	0.52	0.62	0	0.43	0.03	-	13.48	0.01	1.6	0.85	-	1.06	1.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.23
H3623_004_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1633.64	16.67	1383.9	900.03	185.33	16.43	1.23	163.3	34.17	299.86	237.51	0.36	248.07	19.94	3575.51	7765.6	3.63	919.1	488		270.74	799.08			0		0			0												150/d 7	150/d 7	0 for days 1-8 75 for days 9-14 125 for days 15-100																																							107.77	107.77	78.57	20	100	0.2	0.2	47.4	100	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													107.77	107.77	78.57	20	100	0.2	0.2	47.4	100	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													14.67	0.15	9.06	1.5	1.54	3.29	0.25	0.65	0.28	0.75	0.73	0	0.62	0.05	2.98	19.41	0.01	2.3	1.22	-	1.02	2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.47	14.67	0.15	9.06	1.5	1.54	3.29	0.25	0.65	0.28	0.75	0.73	0	0.62	0.05	2.98	19.41	0.01	2.3	1.22	-	1.02	2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.47
H3623_005_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1658.65	16.92	1405.08	913.81	188.17	16.68	1.25	165.8	34.69	304.44	241.15	0.37	251.87	20.25	3630.23	7884.46	3.69	933.17	495.47		274.89	811.31			0		0			0												50/d10	50/d10	0 for days 1-8 75 for days 9-14 125 for days 15-100																																							40.82	40.82	78.57	20	100	0.2	0.2	46.1	100	20	30.26	20	20	20	10	20	20	20	20		45	20			0		0			0													40.82	40.82	78.57	20	100	0.2	0.2	46.1	100	20	30.26	20	20	20	10	20	20	20	20		45	20			0		0			0													5.64	0.06	9.2	1.52	1.57	3.34	0.25	0.64	0.29	0.51	0.61	0	0.42	0.03	3.03	13.14	0.01	1.56	0.83	-	1.03	1.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.01	5.64	0.06	9.2	1.52	1.57	3.34	0.25	0.64	0.29	0.51	0.61	0	0.42	0.03	3.03	13.14	0.01	1.56	0.83	-	1.03	1.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.01
H3623_006_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1755.73	17.91	1487.32	967.29	199.18	17.65	1.32	175.5	36.72	322.26	255.26	0.39	266.61	21.43	3842.71	8345.94	3.9	987.79	524.47		290.98	858.8			0		0			0														0 for days 1-8 75 for days 9-14 125 for days 15-100																																							0	0	78.57	20	100	0.2	0.2	46.1	100	20	30.26	20	20	20	0	20	20	20	20		45	20			0		0			0													0	0	78.57	20	100	0.2	0.2	46.1	100	20	30.26	20	20	20	0	20	20	20	20		45	20			0		0			0													-	-	9.74	1.61	1.66	3.53	0.26	0.67	0.31	0.54	0.64	0	0.44	0.04	-	13.91	0.01	1.65	0.87	-	1.09	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.41	-	-	9.74	1.61	1.66	3.53	0.26	0.67	0.31	0.54	0.64	0	0.44	0.04	-	13.91	0.01	1.65	0.87	-	1.09	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.41
H3623_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1583.26	15.99	1217.96	1189.17	213.93	1.98	0.02	223.34	45.3	835.12	256.75		61.64	38.95	2464.52	9349.29	0.38	636.07	567.59		273.1	677.44																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													18.96	0.19	10.15	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.1	-	0.18	0.11	7.19	27.27	0	1.86	1.66	-	1.54	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.98	18.96	0.19	10.15	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.1	-	0.18	0.11	7.19	27.27	0	1.86	1.66	-	1.54	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.98
H3623_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1583.26	15.99	1217.96	1189.17	213.93	1.98	0.02	223.34	45.3	835.12	256.75		61.64	38.95	2464.52	9349.29	0.38	636.07	567.59		273.1	677.44																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													18.96	0.19	10.15	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.1	-	0.18	0.11	7.19	27.27	0	1.86	1.66	-	1.54	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.98	18.96	0.19	10.15	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.1	-	0.18	0.11	7.19	27.27	0	1.86	1.66	-	1.54	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.98
H3623_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1583.26	15.99	1217.96	1189.17	213.93	1.98	0.02	223.34	45.3	835.12	256.75		61.64	38.95	2464.52	9349.29	0.38	636.07	567.59		273.1	677.44																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													18.96	0.19	10.15	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.1	-	0.18	0.11	7.19	27.27	0	1.86	1.66	-	1.54	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.98	18.96	0.19	10.15	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.1	-	0.18	0.11	7.19	27.27	0	1.86	1.66	-	1.54	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.98
H3624_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												5000																																										-	1437.09	14.52	1217.4	791.75	163.03	16.42	1.23	143.65	30.06	263.78	208.94	0.32	218.23	17.54	3145.33	6831.3	3.2	808.52	429.29		238.17	702.94																				100/d 7	100/d 7	0 d 1-8 75 d 9-14 125 d 15-100																																							71.85	71.85	78.57	20	100	0.2	0.2	47.4	200	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													71.85	71.85	78.57	20	100	0.2	0.2	47.4	200	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													8.6	0.09	7.97	1.32	1.36	3.28	0.25	0.57	0.5	0.66	0.64	0	0.55	0.04	2.62	17.08	0.01	2.02	1.07	-	0.89	1.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.28	8.6	0.09	7.97	1.32	1.36	3.28	0.25	0.57	0.5	0.66	0.64	0	0.55	0.04	2.62	17.08	0.01	2.02	1.07	-	0.89	1.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.28
H3624_002_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												5000	0	0							0																																	-	1499.78	15.15	1270.5	826.29	170.15	17.14	1.28	149.92	31.37	275.29	218.05	0.33	227.75	18.31	3282.54	7129.3	3.33	843.79	448.02		248.56	733.6																				100/d 7	100/d 7	0 d 1-8 75 d 9-14 125 d 15-100																																							71.85	71.85	78.57	20	100	0.2	0.2	47.4	200	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													71.85	71.85	78.57	20	100	0.2	0.2	47.4	200	30	36.84	30	30	30	10	30	30	30	30		45	30			0		0			0													8.98	0.09	8.32	1.38	1.42	3.43	0.26	0.59	0.52	0.69	0.67	0	0.57	0.05	2.74	17.82	0.01	2.11	1.12	-	0.93	1.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.52	8.98	0.09	8.32	1.38	1.42	3.43	0.26	0.59	0.52	0.69	0.67	0	0.57	0.05	2.74	17.82	0.01	2.11	1.12	-	0.93	1.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.52
H3624_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1380.06	13.94	1061.64	1036.55	186.47	1.72	0.02	194.67	39.49	727.93	223.8		53.73	33.95	2148.22	8149.36	0.33	554.43	494.74		238.05	590.49																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered					20 coinsurance	20 coinsurance												20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													16.53	0.17	8.85	3.02	2.33	0.52	0.01	0.81	0.49	0.49	1.83	-	0.16	0.1	6.27	23.77	0	1.62	1.44	-	1.34	1.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.46	16.53	0.17	8.85	3.02	2.33	0.52	0.01	0.81	0.49	0.49	1.83	-	0.16	0.1	6.27	23.77	0	1.62	1.44	-	1.34	1.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.46
H3624_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1380.06	13.94	1061.64	1036.55	186.47	1.72	0.02	194.67	39.49	727.93	223.8		53.73	33.95	2148.22	8149.36	0.33	554.43	494.74		238.05	590.49																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													16.53	0.17	8.85	3.02	2.33	0.52	0.01	0.81	0.49	0.49	1.83	-	0.16	0.1	6.27	23.77	0	1.62	1.44	-	1.34	1.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.46	16.53	0.17	8.85	3.02	2.33	0.52	0.01	0.81	0.49	0.49	1.83	-	0.16	0.1	6.27	23.77	0	1.62	1.44	-	1.34	1.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.46
H3624_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1380.06	13.94	1061.64	1036.55	186.47	1.72	0.02	194.67	39.49	727.93	223.8		53.73	33.95	2148.22	8149.36	0.33	554.43	494.74		238.05	590.49																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													16.53	0.17	8.85	3.02	2.33	0.52	0.01	0.81	0.49	0.49	1.83	-	0.16	0.1	6.27	23.77	0	1.62	1.44	-	1.34	1.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.46	16.53	0.17	8.85	3.02	2.33	0.52	0.01	0.81	0.49	0.49	1.83	-	0.16	0.1	6.27	23.77	0	1.62	1.44	-	1.34	1.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.46
H3653_004_0	2006											Unlimited											A	A	D			Coin	Coin	V	V						V	V	V	V		V					V		V															N/A																																										-	395.94	7.42	734.75			11.15	5.8	1098.68	585.42						7516.34	10093.35	18.89	1902.1		28882.47					251.84		5.3															325 per admit OOP 975	325 per admit OOP 975	75 per day after 20 days						100 per visit																																	307.67	289.96	62.66			0.2	0.16	4.83	100						6.39	8.92	0.16	0		0.6					0.2		1.73															Unlimited	285.37	268.93	62.66			0.2	0.16	4.83	100						6.39	8.92	0.16	0		0.6					0.2		1.73																9.42	0.17	3.84	-	-	2.2	0.91	0.44	4.88	-	-	-	-	-	4	7.5	0	0	-	1.45	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.82	9.42	0.17	3.84	-	-	2.2	0.91	0.44	4.88	-	-	-	-	-	4	7.5	0	0	-	1.45	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.82
H3653_006_0	2006											Unlimited											A	A	D			Coin	Coin	V	V						V	V	V	V		V					V		V															N/A																																										-	448.2	8.12	827.43			12.76	6.62	1246.98	676.22						8589.94	11677.13	21.85	3440.25		31951.62					294.61		6.85															325 per admit OOP 975	325 per admit OOP 975	75 per day after 20 days						100 per visit																																	290.71	281.99	60.53			0.19	0.15	4.74	100						6.14	8.91	0.15	0		0.61					0.19		1.8																269.63	261.55	60.53			0.19	0.15	4.74	100						6.14	8.91	0.15	0		0.61					0.19		1.8																10.07	0.18	4.17	-	-	2.46	1.01	0.49	5.64	-	-	-	-	-	4.4	8.67	0	0	-	1.61	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.7	10.07	0.18	4.17	-	-	2.46	1.01	0.49	5.64	-	-	-	-	-	4.4	8.67	0	0	-	1.61	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.7
H3653_008_0	2006											Unlimited											A	A	D			Coin	Coin	V	V						V	V	V	V		V					V		V															N/A																																										-	355.72	5.84	625.23			10.1	5.79	964.44	549.21						6712.35	9262.7	19.24	2380.14		23632.7					216		5.75															325 per admit OOP 975	325 per admit OOP 975	75 per day after 20 days						100 per visit																																	296.96	291.74	60.88			0.19	0.15	4.66	100						6.12	8.88	0.1	0		0.68					0.25		2.71															Unlimited	275.43	270.59	60.88			0.19	0.15	4.66	100						6.12	8.88	0.1	0		0.68					0.25		2.71																8.16	0.13	3.17	-	-	1.95	0.85	0.37	4.58	-	-	-	-	-	3.42	6.86	0	0	-	1.34	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.85	8.16	0.13	3.17	-	-	1.95	0.85	0.37	4.58	-	-	-	-	-	3.42	6.86	0	0	-	1.34	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.85
H3653_015_0	2006											Unlimited											A	A	D			Coin	Coin	V	V						V	V	V	V		V					V		V															N/A																																										-	395.94	7.42	734.75			11.15	5.8	1098.68	585.42						7516.34	10093.35	18.89	1902.1		28882.47					251.84		5.3															325 per admit OOP 975	325 per admit OOP 975	75 per day after 20 days						100 per visit																																	307.67	289.96	62.66			0.2	0.16	4.83	100						6.39	8.92	0.16	0		0.6					0.2		1.73															Unlimited	285.37	268.93	62.66			0.2	0.16	4.83	100						6.39	8.92	0.16	0		0.6					0.2		1.73																9.42	0.17	3.84	-	-	2.2	0.91	0.44	4.88	-	-	-	-	-	4	7.5	0	0	-	1.45	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.82	9.42	0.17	3.84	-	-	2.2	0.91	0.44	4.88	-	-	-	-	-	4	7.5	0	0	-	1.45	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.82
H3653_016_0	2006											Unlimited											A	A	D			Coin	Coin	V	V						V	V	V	V		V					V		V															N/A																																										-	448.2	8.12	827.43			12.76	6.62	1246.98	676.22						8589.94	11677.13	21.85	3440.25		31951.62					294.61		6.85															325 per admit OOP 975	325 per admit OOP 975	75 per day after 20 days						100 per visit																																	290.71	281.99	60.53			0.19	0.15	4.74	100						6.14	8.91	0.15	0		0.61					0.19		1.8															Unlimited	269.63	261.55	60.53			0.19	0.15	4.74	100						6.14	8.91	0.15	0		0.61					0.19		1.8																10.07	0.18	4.17	-	-	2.46	1.01	0.49	5.64	-	-	-	-	-	4.4	8.67	0	0	-	1.61	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.7	10.07	0.18	4.17	-	-	2.46	1.01	0.49	5.64	-	-	-	-	-	4.4	8.67	0	0	-	1.61	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.7
H3653_803_0	2006											Unlimited											A	A	D			Coin	Coin	V	V						V	V	V	V		V					V		V															N/A																																										-	340.85	6.18	629.26			9.7	5.03	948.33	514.27						6532.66	8880.48	16.61	2616.31		24299.26					224.05		5.21															325 per admit	325 per admit	75 per day after 20 days						100 per visit																																	290.71	281.99	60.53			0.19	0.15	4.74	100						9.22	8.91	0.15	0		0.61					0.19		1.8															Unlimited	269.63	261.55	60.53			0.19	0.15	4.74	100						9.22	8.91	0.15	0		0.61					0.19		1.8																7.66	0.13	3.17	-	-	1.87	0.77	0.37	4.29	-	-	-	-	-	5.02	6.59	0	0	-	1.23	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.1	7.66	0.13	3.17	-	-	1.87	0.77	0.37	4.29	-	-	-	-	-	5.02	6.59	0	0	-	1.23	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.1
H3653_804_0	2006											Unlimited											A	A	D			Coin	Coin	V	V						V	V	V	V		V					V		V															N/A																																										-	373.51	6.13	656.5			10.61	6.08	1012.68	576.68						7048.1	9726.02	20.2	2499.2		24814.79					226.81		6.04															325 per admit OOP 975	325 per admit OOP 975	75 per day after 20 days						100 per visit																																	296.96	291.74	60.88			0.19	0.15	4.66	100						9.18	8.88	0.1	0		0.68					0.25		2.71															Unlimited	275.43	270.59	60.88			0.19	0.15	4.66	100						9.18	8.88	0.1	0		0.68					0.25		2.71																8.57	0.14	3.33	-	-	2.05	0.9	0.39	4.81	-	-	-	-	-	5.39	7.2	0	0	-	1.41	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.19	8.57	0.14	3.33	-	-	2.05	0.9	0.39	4.81	-	-	-	-	-	5.39	7.2	0	0	-	1.41	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.19
H3653_806_0	2006											Unlimited											A	A	D			Coin	Coin	V	V						V	V	V	V		V					V		V															N/A																																										-	308.39	5.59	569.33			8.78	4.55	858.02	465.29						5910.53	8034.75	15.03	2367.15		21985.14					202.71		4.71															325 per admit OOP 975	325 per admit OOP 975	75 per day after 20 days						100 per visit																																	290.71	281.99	60.53			0.19	0.15	4.74	100						9.22	8.91	0.15	0		0.61					0.19		1.8															Unlimited	269.63	261.55	60.53			0.19	0.15	4.74	100						9.22	8.91	0.15	0		0.61					0.19		1.8																6.93	0.12	2.87	-	-	1.69	0.69	0.34	3.88	-	-	-	-	-	4.54	5.97	0	0	-	1.11	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.14	6.93	0.12	2.87	-	-	1.69	0.69	0.34	3.88	-	-	-	-	-	4.54	5.97	0	0	-	1.11	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.14
H3655_013_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	362.12	6.43	366.94		291.32	10.69	3.67	331.9	418.55	812.46	1111.52	50.67	34.46	0.62	5999.71	1773.27	6.87	403.66			247.52				23.89		175.45					868.62	22.97	63.22	392.55	113.88	0.04	865.59	3.72			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/30/40/80 copay levels				50 max		50 max					30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			750	750	75		75	0.2	0.2	50	250	51.31	59.45	250	34.28	30	15	30	30	30			26.22				50		50					30	50	30	30	15	0.2	30	30			3250	565.84	625.86	67.86		67.86	0.2	0.2	45.24	226.21	46.43	53.79	226.21	31.02	27.14	13.57	27.14	27.14	27.14			23.72				45.24		45.24					27.14	45.24	27.14	27.14	13.57	0.2	27.14	27.14				17.08	0.34	2.08	-	1.65	2.14	0.73	1.25	7.89	3.14	4.98	0.96	0.09	0	6.79	4.01	0.02	0.91	-	-	0.49	-	-	-	0.09	-	0.66	-	-	-	-	1.96	0.09	0.14	0.89	0.13	0.01	1.96	0.01	-	-	60.47	17.08	0.34	2.08	-	1.65	2.14	0.73	1.25	7.89	3.14	4.98	0.96	0.09	0	6.79	4.01	0.02	0.91	-	-	0.49	-	-	-	0.09	-	0.66	-	-	-	-	1.96	0.09	0.14	0.89	0.13	0.01	1.96	0.01	-	-	60.47
H3655_023_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			D	D	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	2110.03	50.37	365.46		290.14	10.61	3.65	330.56	416.86	809.19	1107.04	50.47	34.32	0.62	5975.51	1766.12	6.84	402.03			246.53				23.79		174.74					865.11	22.88	62.96	390.96	113.42	0.04	862.1	3.71			175/day with 1750 yearly max	175/day with 1750 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	175 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	175 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/30/40/80 copay levels				50 max		50 max					30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			175	175	75		75	0.2	0.2	50	175	51.31	59.45	175	34.28	30	15	30	30	30			26.22				50		50					30	50	30	30	15	0.2	30	30			3250	101.74	120.01	67.65		67.65	0.2	0.2	45.1	157.84	46.28	53.62	157.84	30.92	27.06	13.53	27.06	27.06	27.06			23.65				45.1		45.1					27.06	45.1	27.06	27.06	13.53	0.2	27.06	27.06				17.89	0.5	2.06	-	1.64	2.12	0.73	1.24	5.48	3.12	4.95	0.66	0.09	0	6.74	3.98	0.02	0.91	-	-	0.49	-	-	-	0.09	-	0.66	-	-	-	-	1.95	0.09	0.14	0.88	0.13	0.01	1.94	0.01	-	-	58.51	17.89	0.5	2.06	-	1.64	2.12	0.73	1.24	5.48	3.12	4.95	0.66	0.09	0	6.74	3.98	0.02	0.91	-	-	0.49	-	-	-	0.09	-	0.66	-	-	-	-	1.95	0.09	0.14	0.88	0.13	0.01	1.94	0.01	-	-	58.51
H3655_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			none																																										-	359.01	4	381.18		307.62	10.57	4.8	283.71	529.07	795.7	1382.68	48.63	74.73	0	6758.45	2185.15	1.04	782.22			280.93											902.73	29.45	100.45	492.87	152.37	0.04	976.6	6			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/30/40/80 copay levels											30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			750	750	75		75	0.2	0.2	50	250	51.72	59.66	250	35	30	15	30	30	30			30.66											30	50	30	30	15	0.2	30	30			4000	601.6	700.47	72.31		72.31	0.2	0.2	48.2	241.02	49.86	57.52	241.02	33.74	28.92	14.46	28.92	28.92	28.92			29.56											28.92	48.2	28.92	28.92	14.46	0.2	28.92	28.92				18	0.23	2.3	-	1.85	2.11	0.96	1.14	10.63	3.31	6.63	0.98	0.21	-	8.14	5.27	0	1.89	-	-	0.69	-	-	-	-	-	-	-	-	-	-	2.18	0.12	0.24	1.19	0.18	0.01	2.35	0.01	-	-	70.62	18	0.23	2.3	-	1.85	2.11	0.96	1.14	10.63	3.31	6.63	0.98	0.21	-	8.14	5.27	0	1.89	-	-	0.69	-	-	-	-	-	-	-	-	-	-	2.18	0.12	0.24	1.19	0.18	0.01	2.35	0.01	-	-	70.62
H3657_009_0	2006											2000											D	D	D		P			V	V						V	V	V	P																																																																		-	1544.49	63.39	1299.6		2633.69			323.89	369.29						4019.64	3690.01	194.53	1446.79																								200 per Day	200 per Day	0 1st 10 Days 75 per Day  11-100		75 per Trip			50 per Visit	200 per Visit						10 per Visit	30 per Visit	30 per Visit	30 per Visit																								200	200	43.05		6.08			42.71	183.85						10.51	29.2	19.57	14.58																								2000	124.99	121.5	13.6		5.84			41.06	176.78						10.1	28.08	18.82	14.02																								0	16.09	0.64	1.47	-	1.28	-	-	1.11	5.44	-	-	-	-	-	3.38	8.63	0.31	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.05	16.09	0.64	1.47	-	1.28	-	-	1.11	5.44	-	-	-	-	-	3.38	8.63	0.31	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.05
H3657_010_0	2006											2500											D	D	D		P	Coin	Coin	V	V	Coin	Coin				V	V	V	P	Coin	Coin																																																																-	1544.49	63.39	1299.6		2633.69	10.73	5.23	323.89	369.29	9.86	19.12				4019.64	3690.01	194.53	1446.79	21.11	12.16																						250 per Day	250 per Day	0 1st 10 Days 100 per Day  11-100		75 per Trip	20 Coinsurance	20 Coinsurance	50 per Visit	200 per Visit	20 Coinsurance	20 Coinsurance				10 per Visit	30 per Visit	30 per Visit	30 per Visit	20 Coinsurance	20 Coinsurance																						250	250	57.4		6.34	0.2	0.2	44.23	263.1	0.2	0.2				10.75	28.91	20.23	15.2	0.2	0.2																						2500	155.87	151.52	18.17		6.09	0.19	0.19	42.53	252.98	0.19	0.19				10.33	27.8	19.45	14.62	0.19	0.19																						0	20.06	0.8	1.97	-	1.34	2.06	1.01	1.15	7.79	1.9	3.68	-	-	-	3.46	8.55	0.32	1.76	4.06	2.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.23	20.06	0.8	1.97	-	1.34	2.06	1.01	1.15	7.79	1.9	3.68	-	-	-	3.46	8.55	0.32	1.76	4.06	2.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.23
H3657_013_0	2006											2000											D	D	D		P			V	V						V	V	V	P																																																																		-	1544.49	63.39	1299.6		2633.69			323.89	369.29						4019.64	3690.01	194.53	1446.79																								200 per Day	200 per Day	0 1st 10 Days 75 per Day  11-100		75 per Trip			50 per Visit	200 per Visit						10 per Visit	30 per Visit	30 per Visit	30 per Visit																								200	200	43.05		6.08			42.71	183.85						10.51	29.2	19.57	14.58																								2000	124.99	121.5	13.6		5.84			41.06	176.78						10.1	28.08	18.82	14.02																								0	16.09	0.64	1.47	-	1.28	-	-	1.11	5.44	-	-	-	-	-	3.38	8.63	0.31	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.05	16.09	0.64	1.47	-	1.28	-	-	1.11	5.44	-	-	-	-	-	3.38	8.63	0.31	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.05
H3657_014_0	2006											2000											D	D	D		P			V	V						V	V	V	P																																																																		-	1544.49	63.39	1299.6		2633.69			323.89	369.29						4019.64	3690.01	194.53	1446.79																								200 per Day	200 per Day	0 1st 10 Days 75 per Day  11-100		75 per Trip			50 per Visit	200 per Visit						10 per Visit	30 per Visit	30 per Visit	30 per Visit																								200	200	43.05		6.08			42.71	183.85						10.51	29.2	19.57	14.58																								2000	124.99	121.5	13.6		5.84			41.06	176.78						10.1	28.08	18.82	14.02																								0	16.09	0.64	1.47	-	1.28	-	-	1.11	5.44	-	-	-	-	-	3.38	8.63	0.31	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.05	16.09	0.64	1.47	-	1.28	-	-	1.11	5.44	-	-	-	-	-	3.38	8.63	0.31	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.05
H3657_015_0	2006											2500											D	D	D		P	Coin	Coin	V	V	Coin	Coin				V	V	V	P	Coin	Coin																																																																-	1544.49	63.39	1299.6		2633.69	10.73	5.23	323.89	369.29	9.86	19.12				4019.64	3690.01	194.53	1446.79	21.11	12.16																						250 per Day	250 per Day	0 1st 10 Days 100 per Day  11-100		75 per Trip	20 Coinsurance	20 Coinsurance	50 per Visit	200 per Visit	20 Coinsurance	20 Coinsurance				10 per Visit	30 per Visit	30 per Visit	30 per Visit	20 Coinsurance	20 Coinsurance																						250	250	57.4		6.34	0.2	0.2	44.23	263.1	0.2	0.2				10.75	28.91	20.23	15.2	0.2	0.2																						2500	155.87	151.52	18.17		6.09	0.19	0.19	42.53	252.98	0.19	0.19				10.33	27.8	19.45	14.62	0.19	0.19																						0	20.06	0.8	1.97	-	1.34	2.06	1.01	1.15	7.79	1.9	3.68	-	-	-	3.46	8.55	0.32	1.76	4.06	2.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.23	20.06	0.8	1.97	-	1.34	2.06	1.01	1.15	7.79	1.9	3.68	-	-	-	3.46	8.55	0.32	1.76	4.06	2.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.23
H3657_016_0	2006											2500											D	D	D		P	Coin	Coin	V	V	Coin	Coin				V	V	V	P	Coin	Coin																																																																-	1544.49	63.39	1299.6		2633.69	10.73	5.23	323.89	369.29	9.86	19.12				4019.64	3690.01	194.53	1446.79	21.11	12.16																						250 per Day	250 per Day	0 1st 10 Days 100 per Day  11-100		75 per Trip	20 Coinsurance	20 Coinsurance	50 per Visit	200 per Visit	20 Coinsurance	20 Coinsurance				10 per Visit	30 per Visit	30 per Visit	30 per Visit	20 Coinsurance	20 Coinsurance																						250	250	57.4		6.34	0.2	0.2	44.23	263.1	0.2	0.2				10.75	28.91	20.23	15.2	0.2	0.2																						2500	155.87	151.52	18.17		6.09	0.19	0.19	42.53	252.98	0.19	0.19				10.33	27.8	19.45	14.62	0.19	0.19																						0	20.06	0.8	1.97	-	1.34	2.06	1.01	1.15	7.79	1.9	3.68	-	-	-	3.46	8.55	0.32	1.76	4.06	2.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.23	20.06	0.8	1.97	-	1.34	2.06	1.01	1.15	7.79	1.9	3.68	-	-	-	3.46	8.55	0.32	1.76	4.06	2.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.23
H3657_801_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	268.03		41.34	1.09	9.31	15.31		21.44	39.77	88.84					178.9						13.31	12.08																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07		0.16	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23	0.23																					0.07		0.16	0	0.23	0.23		0.23	0.23	0.23					0.23						0.23	0.23																				123	19.78	-	6.62	-	2.17	3.57	-	5	9.27	20.7	-	-	-	-	41.68	-	-	-	-	-	3.1	2.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.69	19.78	-	6.62	-	2.17	3.57	-	5	9.27	20.7	-	-	-	-	41.68	-	-	-	-	-	3.1	2.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	114.69
H3659_001_0	2006											4800											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2135.5	197.47	1061.12		155.29	13.17	6.88	370.42	68.49	9684.61	49.18		2.48	0.67	4167.08	3907.92	851.49	3.02			33.88	859.08			199.32		246.14															285	17500	150		150	0	0	50 / 35	0	10	20-Oct	20 (included in g)	0.3	20/40/30	28/0	38	40 / 30	0			0.3	0/38			38		38															285	175	150		50	0.2	0.2	48.56	0.2	4	0.15		0.3	0.17	28	38	37.5	0.2			0.3	38			38		38																177.28	108.86	93.31		31.1	0.12	0.15	30.21	0.12	2.49	0.1		0.19	0.11	28	38	37.5	0.12			0.19	38			38		17.77																31.55	1.79	8.25	-	0.4	1.64	1	0.93	8.52	2.01	4.71	-	0.46	0.07	9.72	12.38	2.66	0.38	-	-	6.32	2.72	-	-	0.63	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.51	31.55	1.79	8.25	-	0.4	1.64	1	0.93	8.52	2.01	4.71	-	0.46	0.07	9.72	12.38	2.66	0.38	-	-	6.32	2.72	-	-	0.63	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.51
H3659_003_0	2006											4800											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2503.46	169.85	1743.19		208.04	13.2	4.64	415.27	58.39	9527.85	46.44		0.62	0.7	4488.65	4303.07	689.82	4.39			18.49	989.77			45.91		247.66															280	17500	150		150	0	0	50 / 35	0	10	20-Oct	20 (included in g)	0.3	20/40/30	15/0	35	40 / 30	0			0.3	0/35			35		35															280	175	150		50	0.2	0.2	47.97	0.2	4	0.15		0.3	0.17	15	35	37.5	0.2			0.3	35			35		35																168.8	105.5	90.43		30.14	0.12	0.15	28.92	0.12	2.41	0.09		0.18	0.11	15	35	37.5	0.12			0.18	35			27.46		17.89																35.22	1.49	13.14	-	0.52	1.59	0.7	1	7.04	1.91	4.31	-	0.11	0.07	5.61	12.55	2.16	0.53	-	-	3.34	2.89	-	-	0.11	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.67	35.22	1.49	13.14	-	0.52	1.59	0.7	1	7.04	1.91	4.31	-	0.11	0.07	5.61	12.55	2.16	0.53	-	-	3.34	2.89	-	-	0.11	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.67
H3659_004_0	2006											4800											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2133.99	159.9	1198.25		170.33	12.31	3.44	407.8	54.61	7747.17	31.93		0.74	0.55	3851.49	3227.83	640.81	1.07			14.06	584.29			59.53		243.4															245	17500	125		150	0	0	50 / 35	0	10	20-Oct	20 (included in g)	0.3	20/40/30	Oct-00	30	40 / 30	0			0.3	0/30			30		30															245	175	125		50	0.2	0.2	47.62	0.2	4	0.15		0.3	0.16	10	30	37.5	0.2			0.3	30			30		30																165.93	118.52	84.66		33.86	0.14	0.17	32.25	0.14	2.71	0.1		0.2	0.11	10	30	37.5	0.14			0.2	30			30		17.91																29.51	1.58	8.45	-	0.48	1.67	0.59	1.1	7.4	1.75	3.33	-	0.15	0.06	3.21	8.07	2	0.14	-	-	2.86	1.46	-	-	0.15	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.32	29.51	1.58	8.45	-	0.48	1.67	0.59	1.1	7.4	1.75	3.33	-	0.15	0.06	3.21	8.07	2	0.14	-	-	2.86	1.46	-	-	0.15	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.32
H3659_007_0	2006											4800											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2111.51	171.19	1351.78		213.91	18.37	4.37	506.94	58.8	10518.04	47.09		0.79	0.72	4577.08	3830.4	720.71	1.39			26.05	822.11			137.09		245.87															280	17500	150		150	0	0	50 / 35	0	10	20-Oct	20 (included in g)	0.3	20/40/30	18/0	38	40 / 30	0			0.3	0/38			38		38															280	175	150		50	0.2	0.2	46.92	0.2	4	0.15		0.3	0.17	18	38	37.5	0.2			0.3	38			38		38																175.6	109.75	94.07		31.36	0.13	0.16	29.42	0.13	2.51	0.1		0.19	0.11	18	38	37.5	0.13			0.19	38			31.72		17.78																30.9	1.57	10.6	-	0.56	2.3	0.7	1.24	7.38	2.2	4.55	-	0.15	0.08	6.87	12.13	2.25	0.17	-	-	4.9	2.6	-	-	0.36	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.87	30.9	1.57	10.6	-	0.56	2.3	0.7	1.24	7.38	2.2	4.55	-	0.15	0.08	6.87	12.13	2.25	0.17	-	-	4.9	2.6	-	-	0.36	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.87
H3659_031_0	2006											1900											D	D	D	V	P	Coin	Coin	V	V	O	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P																																																								-	1680.47	161.57			105.01	12.96	3.6	469.5	903.18	8333.89	49.73		3.19	12.43	4357.85	3426.21	705.56	661.44			17.11	868.89			95.26		243.91															925	92500			75	0	0	50	100/375	25	25 / 100	100/375 (included in g)	0.3	35/40	15/0	35	35	35			0.3	0/35			35		35															154.22	96.34			25	0.3	0.3	50	203.76	10	0.08		0.3	35.05	15	35	35	35			0.3	35			35		35																80.8	50.48			13.1	0.16	0.23	26.2	106.75	5.24	0.04		0.16	21.85	15	35	35	18.34			0.16	35			32.43		18.02																11.32	0.68	-	-	0.11	2.04	0.84	1.02	8.03	3.64	2.16	-	0.5	0.02	5.45	9.99	2.06	1.01	-	-	2.69	2.53	-	-	0.26	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.72	11.32	0.68	-	-	0.11	2.04	0.84	1.02	8.03	3.64	2.16	-	0.5	0.02	5.45	9.99	2.06	1.01	-	-	2.69	2.53	-	-	0.26	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.72
H3659_033_0	2006											3000											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2205.01	177.69	1266.19		181.59	13.85	4.81	444.71	59.02	9809.69	44.57		1.53	0.63	4460.57	3950.68	748.71	2.56			25.49	873.18			130.98		246.26															280	17500	150		150	0	0	50 / 35	0	10	20-Oct	20 (included in g)	0.3	20/40/30	15/0	30	40 / 30	0			0.3	0/30			30		30															280	175	150		50	0.2	0.2	47.58	0.2	4	0.15		0.3	0.16	15	30	37.5	0.2			0.3	30			30		30																143.04	89.4	76.63		25.54	0.1	0.14	24.3	0.1	2.04	0.08		0.15	0.09	15	30	37.5	0.1			0.15	30			30		17.99																26.28	1.32	8.09	-	0.39	1.41	0.67	0.9	6.03	1.67	3.51	-	0.23	0.06	5.58	9.88	2.34	0.26	-	-	3.91	2.18	-	-	0.33	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.4	26.28	1.32	8.09	-	0.39	1.41	0.67	0.9	6.03	1.67	3.51	-	0.23	0.06	5.58	9.88	2.34	0.26	-	-	3.91	2.18	-	-	0.33	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.4
H3659_050_0	2006											4500											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2136	197	1061	0	155	13.17	6.88	370	68.49	9685	49.18	0	2.48	0.67	4167	3908	851	3.02	0	0	33.88	859	0	0	199	0	246	0	0	0	0											265	175	150	0	150	20	20	50 / 35	20	10	20-Oct	20 (included in g)	20	20/40/30	25/0	35	40 / 30	20	0	0	20	0/35			35		35			0												265	175	150		50	0.2	0.2	48.56	0.2	4	0.15		0.2	0.17	25	35	37.5	0.2			0.2	35			35		35																165.12	109.04	93.46	0	31.15	0.12	0.15	30.26	0.12	2.49	0.1	0	0.12	0.11	25	35	37.5	0.12	0	0	0.12	35	0	0	35	0	17.77	0	0	0	0												29.38	1.79	8.26	-	0.4	1.64	1	0.93	8.53	2.01	4.72	-	0.31	0.07	8.68	11.4	2.66	0.38	-	-	4.22	2.51	-	-	0.58	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.86	29.38	1.79	8.26	-	0.4	1.64	1	0.93	8.53	2.01	4.72	-	0.31	0.07	8.68	11.4	2.66	0.38	-	-	4.22	2.51	-	-	0.58	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.86
H3659_051_0	2006											4500											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2503	170	1743	0	208	13.2	4.64	415	58.39	9528	46.44	0	0.62	0.7	4489	4303	690	4.39	0	0	18.49	990	0	0	46	0	248	0	0	0	0											250	175	150	0	150	20	20	50 / 35	20	10	20-Oct	20 (included in g)	20	20/40/30	Oct-00	25	40 / 30	20	0	0	20	0/25			25		25			0												250	175	150		50	0.2	0.2	47.97	0.2	4	0.15		0.2	0.17	10	25	37.5	0.2			0.2	25			25		25																151.2	105.84	90.72	0	30.24	0.12	0.15	29.01	0.12	2.42	0.09	0	0.12	0.11	10	25	37.5	0.12	0	0	0.12	25	0	0	25	0	17.89	0	0	0	0												31.54	1.5	13.18	-	0.52	1.6	0.7	1	7.06	1.92	4.33	-	0.07	0.07	3.74	8.96	2.16	0.53	-	-	2.24	2.06	-	-	0.1	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.66	31.54	1.5	13.18	-	0.52	1.6	0.7	1	7.06	1.92	4.33	-	0.07	0.07	3.74	8.96	2.16	0.53	-	-	2.24	2.06	-	-	0.1	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.66
H3659_052_0	2006											4500											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2134	160	1198	0	170	12.31	3.44	408	54.61	7747	31.93	0	0.74	0.55	3851	3228	641	1.07	0	0	14.06	584	0	0	60	0	243	0	0	0	0											195	175	75	0	150	20	20	50 / 35	20	10	20-Oct	20 (included in g)	20	20/40/30	May-00	25	40 / 30	20	0	0	20	0/25			25		25			0												195	175	75		50	0.2	0.2	47.62	0.2	4	0.15		0.2	0.16	5	25	37.5	0.2			0.2	25			25		25																138.11	123.94	53.12	0	35.41	0.14	0.17	33.73	0.14	2.83	0.11	0	0.14	0.12	5	25	37.5	0.14	0	0	0.14	25	0	0	25	0	17.91	0	0	0	0												24.56	1.65	5.3	-	0.5	1.74	0.6	1.15	7.74	1.83	3.48	-	0.11	0.06	1.6	6.72	2	0.15	-	-	1.99	1.22	-	-	0.12	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.9	24.56	1.65	5.3	-	0.5	1.74	0.6	1.15	7.74	1.83	3.48	-	0.11	0.06	1.6	6.72	2	0.15	-	-	1.99	1.22	-	-	0.12	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.9
H3659_053_0	2006											4500											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2112	171	1352	0	214	18.37	4.37	507	58.8	10518	47.09	0	0.79	0.72	4577	3830	721	1.39	0	0	26.05	822	0	0	137	0	246	0	0	0	0											250	175	150	0	150	20	20	50 / 35	20	10	20-Oct	20 (included in g)	20	20/40/30	Dec-00	30	40 / 30	20	0	0	20	0/30			30		30			0												250	175	150		50	0.2	0.2	46.92	0.2	4	0.15		0.2	0.17	12	30	37.5	0.2			0.2	30			30		30																157.53	110.27	94.52	0	31.51	0.13	0.16	29.56	0.13	2.52	0.1	0	0.13	0.11	12	30	37.5	0.13	0	0	0.13	30	0	0	30	0	17.78	0	0	0	0												27.72	1.57	10.65	-	0.56	2.32	0.7	1.25	7.41	2.21	4.57	-	0.1	0.08	4.58	9.58	2.25	0.18	-	-	3.28	2.06	-	-	0.34	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.76	27.72	1.57	10.65	-	0.56	2.32	0.7	1.25	7.41	2.21	4.57	-	0.1	0.08	4.58	9.58	2.25	0.18	-	-	3.28	2.06	-	-	0.34	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.76
H3659_054_0	2006											1500											D	D	D	V	P	Coin	Coin	V	V	O	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P																																																								-	1680	162	0	0	105	12.96	3.6	470	903.18	8334	49.73	0	3.19	12.43	4358	3426	706	661.44	0	0	17.11	869	0	0	95	0	244	0	0	0	0											750	750	0	0	75	20	20	50	100/250	25	25 / 100	100/250 (included in g)	20	35/40	Oct-00	25	35	35	0	0	20	0/25			25		25			0												125.05	78.12			25	0.2	0.2	50	156.59	10	0.08		0.2	35.05	10	25	35	35			0.2	25			25		25																64.27	40.15	0	0	12.85	0.1	0.15	25.7	80.48	5.14	0.04	0	0.1	21.57	10	25	35	17.99	0	0	0.1	25	0	0	25	0	18.02	0	0	0	0												9	0.54	-	-	0.11	1.33	0.55	1.01	6.06	3.57	2.12	-	0.33	0.02	3.63	7.14	2.06	0.99	-	-	1.76	1.81	-	-	0.2	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.59	9	0.54	-	-	0.11	1.33	0.55	1.01	6.06	3.57	2.12	-	0.33	0.02	3.63	7.14	2.06	0.99	-	-	1.76	1.81	-	-	0.2	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.59
H3659_055_0	2006											2400											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2205	178	1266	0	182	13.85	4.81	445	59.02	9810	44.57	0	1.53	0.63	4461	3951	749	2.56	0	0	25.49	873	0	0	131	0	246	0	0	0	0											265	175	150	0	150	20	20	50 / 35	20	10	20-Oct	20 (included in g)	20	20/40/30	Oct-00	25	40 / 30	20	0	0	20	0/25			25		25			0												265	175	150		50	0.2	0.2	47.58	0.2	4	0.15		0.2	0.16	10	25	37.5	0.2			0.2	25			25		25																124.36	82.13	70.39	0	23.46	0.09	0.13	22.33	0.09	1.88	0.07	0	0.09	0.08	10	25	37.5	0.09	0	0	0.09	25	0	0	25	0	17.99	0	0	0	0												22.85	1.22	7.43	-	0.36	1.3	0.64	0.83	5.54	1.53	3.22	-	0.14	0.05	3.72	8.23	2.34	0.24	-	-	2.39	1.82	-	-	0.27	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.49	22.85	1.22	7.43	-	0.36	1.3	0.64	0.83	5.54	1.53	3.22	-	0.14	0.05	3.72	8.23	2.34	0.24	-	-	2.39	1.82	-	-	0.27	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.49
H3659_056_0	2006											600											D	D	D	V	P	Coin	Coin	V	V	O	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P																																																								-	2552.46	208.89	1480.15		266.15	21.67	7.55	639.17	1426.3	13539.02	6658.05		2.31	29.25	6100.78	5424.55	1043.19	1212.63			37.35	1197.57			179.42		351.4															25	2500	15		100	0	0	40	15		0/10	15 (included in g)	0.2	4/8/10/15	Feb-00	4	04-Aug	10			0.2	0/4/5			05-Apr		4															25	25	15		33.33	0.2	0.2	40	15		6.2		0.2	9.61	2	4	7	10			0.2	4.5			4.5		4																14.94	14.94	8.96		19.91	0.12	0.15	23.9	8.96		3.7		0.12	6.13	2	4	7	5.97			0.12	4.5			4.5		3.76																3.18	0.26	1.11	-	0.44	2.59	1.13	1.27	1.07	-	2.06	-	0.28	0.01	1.02	1.81	0.61	0.6	-	-	4.46	0.45	-	-	0.07	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.51	3.18	0.26	1.11	-	0.44	2.59	1.13	1.27	1.07	-	2.06	-	0.28	0.01	1.02	1.81	0.61	0.6	-	-	4.46	0.45	-	-	0.07	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.51
H3659_801_0	2006											4800											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2171.71	180.52	996.17		148.44	13.2	7	350.23	87.91	10919.96	57.16		1.31	1.02	4624.57	4621.04	798.94	4.81			27.01	1159.78			238.52		248.43															205	17500	150		150	0	0	50 / 35	0	10	30-Oct	30 (included in g)	0.3	30/40/30	30/0	30	40 / 30	0			0.3	0/30			30		30															205	175	150		50	0.3	0.3	46.59	0.3	4	0.23		0.3	0.26	30	30	37.5	0.3			0.3	30			30		30																125.43	107.07	91.77		30.59	0.18	0.22	28.5	0.18	2.45	0.14		0.18	0.17	30	30	37.5	0.18			0.18	30			30		17.65																22.7	1.61	7.62	-	0.38	2.42	1.51	0.83	16.14	2.23	8.08	-	0.24	0.17	11.56	11.55	2.5	0.88	-	-	4.96	2.9	-	-	0.6	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.23	22.7	1.61	7.62	-	0.38	2.42	1.51	0.83	16.14	2.23	8.08	-	0.24	0.17	11.56	11.55	2.5	0.88	-	-	4.96	2.9	-	-	0.6	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.23
H3659_802_0	2006											4800											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2172	181	996	0	148	13.2	7	350	87.91	10920	57.16	0	1.31	1.02	4625	4621	799	4.81	0	0	27.01	1160	0	0	239	0	248	0	0	0	0											265	175	150	0	150	30	30	50 / 35	20	10	20-Oct	20 (included in g)	30	20/40/30	30/0	30	40 / 30	20	0	0	30	0/30			30		30			0												265	175	150		50	0.3	0.3	46.59	0.2	4	0.15		0.3	0.18	30	30	37.5	0.2			0.3	30			30		30																163.93	108.26	92.79	0	30.93	0.19	0.22	28.82	0.12	2.47	0.1	0	0.19	0.12	30	30	37.5	0.12	0	0	0.19	30	0	0	30	0	17.65	0	0	0	0												29.67	1.63	7.7	-	0.38	2.45	1.52	0.84	10.88	2.25	5.45	-	0.24	0.12	11.56	11.55	2.5	0.6	-	-	5.01	2.9	-	-	0.6	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.2	29.67	1.63	7.7	-	0.38	2.45	1.52	0.84	10.88	2.25	5.45	-	0.24	0.12	11.56	11.55	2.5	0.6	-	-	5.01	2.9	-	-	0.6	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.2
H3660_003_0	2006											1500											D		D		P	Coin	Coin	V	P	P	P			P	P	P	P	P		P	S				V																	0																																										-	1586.55		200.24		143.52	14.71	1.52	274.26	541.67	5015.05	1110.25			869.2	5534.24	3673.34	232.93	477.08		75.68	736.31				680.36																																																										100		75		65	0.2	0.2	47.81	100		68.19			45.14		25	25	22.18		25	50				25																	0	92.68		69.51		60.23	0.19	0.19	44.31	92.68		63.2			41.83		23.17	23.17	20.56		23.17	46.34				23.17																	0	12.25	-	1.16	-	0.72	2.73	0.28	1.01	4.18	-	5.85	-	-	3.03	-	7.09	0.45	0.82	-	0.15	2.84	-	-	-	1.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.88	12.25	-	1.16	-	0.72	2.73	0.28	1.01	4.18	-	5.85	-	-	3.03	-	7.09	0.45	0.82	-	0.15	2.84	-	-	-	1.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.88
H3660_010_0	2006											2500											D		D		P	Coin	Coin	V	P		P			P		P	P	P		P	S				V																	0																																										-	1511		190.71		136.69	14.01	1.45	261.2	515.88		1110.25			827.81	5270.71	3498.41	221.84	454.36		72.08	701.25				647.96																																																										175		100		65	0.2	0.2	47.81	250		64.95			46.11		30	30	26.62		30	50				30																	0	171.05		97.74		63.53	0.2	0.2	46.73	244.36		63.48			45.07		29.32	29.32	26.02		29.32	48.87				29.32																	0	21.54	-	1.55	-	0.72	2.74	0.28	1.02	10.5	-	5.87	-	-	3.11	-	8.55	0.54	0.99	-	0.18	2.86	-	-	-	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.03	21.54	-	1.55	-	0.72	2.74	0.28	1.02	10.5	-	5.87	-	-	3.11	-	8.55	0.54	0.99	-	0.18	2.86	-	-	-	1.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.03
H3660_801_0	2006											2500											D		D		P	Coin	Coin	V	P		P			P	P	P	P	P		P	S				V																	0																																										-	1511		190.71		136.69	13.84	1.43	261.2	515.88		1110.25			827.81	5270.71	3498.41	221.84	454.36		72.08	701.25				647.96																																																										175		100		75	0.2	0.2	47.81	250		64.95			46.11	10	30	30	26.62		30	50				30																	0	171.31		97.89		73.42	0.2	0.2	46.8	244.72		63.57			45.14	9.79	29.37	29.37	26.06		29.37	48.94				29.37																	0	21.57	-	1.56	-	0.84	2.71	0.28	1.02	10.52	-	5.88	-	-	3.11	4.3	8.56	0.54	0.99	-	0.18	2.86	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.5	21.57	-	1.56	-	0.84	2.71	0.28	1.02	10.52	-	5.88	-	-	3.11	4.3	8.56	0.54	0.99	-	0.18	2.86	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.5
H3660_802_0	2006											2500											D		D		P	Coin	Coin	V	P		P			P	P	P	P	P		P	S				V																	0																																										-	1511		190.71		136.69	14.67	1.52	261.2	515.88		1110.25			827.81	5270.71	3498.41	221.84	454.36		72.08	701.25				647.96																																																										175		100		75	0.2	0.2	47.81	250		64.95			46.11	10	30	30	26.62		30	50				30																	0	171.31		97.89		73.42	0.2	0.2	46.8	244.72		63.57			45.14	9.79	29.37	29.37	26.06		29.37	48.94				29.37																	0	21.57	-	1.56	-	0.84	2.87	0.3	1.02	10.52	-	5.88	-	-	3.11	4.3	8.56	0.54	0.99	-	0.18	2.86	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.68	21.57	-	1.56	-	0.84	2.87	0.3	1.02	10.52	-	5.88	-	-	3.11	4.3	8.56	0.54	0.99	-	0.18	2.86	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.68
H3664_001_0	2006																						D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V																																																									-	1515.58	29.62	351.45		151	12.17	1.35	672.56	216.07					448.76	4196.84	3305.48	194.23	367.28							150		150															100 Days 1-5;  for long-term acute care hospital stays there are copays of 50 for days 6-15 and of 25 for days 16-25	100 Days 1-5	20 Days 16-30		75	0	0	50	175					25 Visits 1-3	15	25	25	25							25		25															100	100	20		75	0.15	0.15	50	175					25	15	25	25	25							25		25																100	100	20		75	0.15	0.15	50	175					25	15	25	25	25							25		25																12.63	0.25	0.59	-	0.94	1.83	0.2	2.8	3.15	-	-	-	-	0.93	5.25	6.89	0.4	0.77	-	-	-	-	-	-	0.31	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.25	12.63	0.25	0.59	-	0.94	1.83	0.2	2.8	3.15	-	-	-	-	0.93	5.25	6.89	0.4	0.77	-	-	-	-	-	-	0.31	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.25
H3664_008_0	2006											0											D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V															0																																										-	1515.58	29.62	351.45		151	12.17	1.35	672.56	216.07					448.76	4196.84	3305.48	194.23	367.28							150		150															100 Days 1-5	100 Days 1-5	20 Days 16-30		75	0	0	50	175					25 Visits 1-3	15	25	25	25							25		25															100	100	20		75	0.15	0.15	50	175					25	15	25	25	25							25		25															0	100	100	20		75	0.15	0.15	50	175					25	15	25	25	25							25		25																12.63	0.25	0.59	-	0.94	1.83	0.2	2.8	3.15	-	-	-	-	0.93	5.25	6.89	0.4	0.77	-	-	-	-	-	-	0.31	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.25	12.63	0.25	0.59	-	0.94	1.83	0.2	2.8	3.15	-	-	-	-	0.93	5.25	6.89	0.4	0.77	-	-	-	-	-	-	0.31	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.25
H3664_009_0	2006											0											D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V															0																																										-	1350.38	26.39	313.14		135.9	10.95	1.22	605.31	194.46					395.81	3701.61	2915.43	171.31	323.94							132.3		132.3															150 Days 1-5	150 Days 1-5	30 Days 16-30		75	0	0	50	175					35 Visits 1-3	20	35	35	35							35		35															150	150	30		75	0.2	0.2	50	175					35	20	35	35	35							35		35															0	150	150	30		75	0.2	0.2	50	175					35	20	35	35	35							35		35																16.88	0.33	0.78	-	0.85	2.19	0.24	2.52	2.84	-	-	-	-	1.15	6.17	8.5	0.5	0.94	-	-	-	-	-	-	0.39	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.68	16.88	0.33	0.78	-	0.85	2.19	0.24	2.52	2.84	-	-	-	-	1.15	6.17	8.5	0.5	0.94	-	-	-	-	-	-	0.39	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.68
H3664_011_0	2006											0											D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V															0																																										-	1470.42	28.74	340.97		147.98	11.92	1.32	659.11	211.75					435.39	4030.64	3206.98	188.44	356.33							145.53		145.53															120 Days 1-5	120 Days 1-5	25 Days 16-30		75	0	0	50	175					30 Visits 1-3	15	30	30	30							30		30															120	120	120		75	0.2	0.2	50	175					30	15	30	30	30							30		30															0	120	120	120		75	0.2	0.2	50	175					30	15	30	30	30							30		30																14.7	0.29	3.41	-	0.92	2.38	0.26	2.75	3.09	-	-	-	-	1.09	5.04	8.02	0.47	0.89	-	-	-	-	-	-	0.36	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.04	14.7	0.29	3.41	-	0.92	2.38	0.26	2.75	3.09	-	-	-	-	1.09	5.04	8.02	0.47	0.89	-	-	-	-	-	-	0.36	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.04
H3664_012_0	2006											0											D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V															0																																										-	1629.25	31.84	377.81		162.33	13.08	1.45	723.01	232.28					477.59	4466.49	3517.86	206.71	390.87							161.25		161.25															100 Days 1-5	100 Days 1-5	20 Days 16-30		75	0	0	50	175					25 Visits 1-3	20	30	30	30							30		30															100	100	20		75	0.15	0.15	50	175					25	20	30	30	30							30		30															0	100	100	20		75	0.15	0.15	50	175					25	20	30	30	30							30		30																13.58	0.27	0.63	-	1.01	1.96	0.22	3.01	3.39	-	-	-	-	0.99	7.44	8.79	0.52	0.98	-	-	-	-	-	-	0.4	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.6	13.58	0.27	0.63	-	1.01	1.96	0.22	3.01	3.39	-	-	-	-	0.99	7.44	8.79	0.52	0.98	-	-	-	-	-	-	0.4	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.6
H3664_013_0	2006											0											D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V															0																																										-	1667.14	32.58	386.59		166.1	13.38	1.49	739.82	237.68					488.7	4570.36	3599.67	211.51	399.96							165		165															100 Days 1-5	100 Days 1-5	20 Days 16-30		75	0	0	50	175					25 Visits 1-3	20	30	30	30							30		30															100	100	20		75	0.15	0.15	50	175					25	20	30	30	30							30		30															0	100	100	20		75	0.15	0.15	50	175					25	20	30	30	30							30		30																13.89	0.27	0.64	-	1.04	2.01	0.22	3.08	3.47	-	-	-	-	1.02	7.62	9	0.53	1	-	-	-	-	-	-	0.41	-	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.61	13.89	0.27	0.64	-	1.04	2.01	0.22	3.08	3.47	-	-	-	-	1.02	7.62	9	0.53	1	-	-	-	-	-	-	0.41	-	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.61
H3664_801_0	2006											0											D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V															0																																										-	1350.38	26.39	313.14		135.9	10.95	1.22	605.31	194.46					395.81	3701.61	2915.43	171.31	323.94							132.3		132.3															150 Days 1-5	150 Days 1-5	30 Days 16-30		75	0	0	50	175					35 Visits 1-3	20	35	35	35							35		35															150	150	30		75	0.2	0.2	50	175					35	20	35	35	35							35		35															0	150	150	30		75	0.2	0.2	50	175					35	20	35	35	35							35		35																16.88	0.33	0.78	-	0.85	2.19	0.24	2.52	2.84	-	-	-	-	1.15	6.17	8.5	0.5	0.94	-	-	-	-	-	-	0.39	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.68	16.88	0.33	0.78	-	0.85	2.19	0.24	2.52	2.84	-	-	-	-	1.15	6.17	8.5	0.5	0.94	-	-	-	-	-	-	0.39	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.68
H3664_802_0	2006											0											D	D	D		T	COIN	COIN	V	P					V	V	V	V	V							V		V															0																																										-	1350.38	26.39	313.14		135.9	10.95	1.22	605.31	194.46					395.81	3701.61	2915.43	171.31	323.94							132.3		132.3															150 Days 1-5	150 Days 1-5	30 Days 16-30		75	0	0	50	175					35 Visits 1-3	20	35	35	35							35		35															150	150	30		75	0.2	0.2	50	175					35	20	35	35	35							35		35															0	150	150	30		75	0.2	0.2	50	175					35	20	35	35	35							35		35																16.88	0.33	0.78	-	0.85	2.19	0.24	2.52	2.84	-	-	-	-	1.15	6.17	8.5	0.5	0.94	-	-	-	-	-	-	0.39	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.68	16.88	0.33	0.78	-	0.85	2.19	0.24	2.52	2.84	-	-	-	-	1.15	6.17	8.5	0.5	0.94	-	-	-	-	-	-	0.39	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.68
H3668_005_0	2006																							A	A		T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V	V	Coin	V			V		V																																																									-		4	77		265.25	7.03	4.54	373	356.6	2577	1306		27	1356	4689.33	3947.33	241	284	1576	3633	25.98	667.4			389		167																100 Copay per admit	200 copay per admit		50 Copayment	20	20	50 Copayment	15 Copayment	15 Copayment	15 Copayment		15 Copayment	15 Copayment	15 Copayment	25 Copayment	25 Copayment	15 Copayment	15 Copayment	15/25 copayment	10	25 Copayment			25 Copayment		25 Copaymant																100	200		50	0.2	0.2	50	15	15	15		15	15	15	25	25	15	15	19.15	0.1	25			25		25																	100	200		50	0.2	0.2	50	15	15	15		15	15	15	25	25	15	15	19.15	0.1	25			25		25															0	-	0.03	1.28	-	1.11	1.41	0.92	1.55	0.45	3.22	1.63	-	0.03	1.7	5.86	8.22	0.5	0.36	1.97	5.8	2.6	1.39	-	-	0.81	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.18	-	0.03	1.28	-	1.11	1.41	0.92	1.55	0.45	3.22	1.63	-	0.03	1.7	5.86	8.22	0.5	0.36	1.97	5.8	2.6	1.39	-	-	0.81	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.18
H3668_010_0	2006																						A	A	A		T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V	V	Coin	V			V		V																																																									-		4	76		261	6.91	4.46	367	351	2533	1284		27	1333	4610	3880	237	279	1549	3571	25.54	656			382		164																100 Copay per admit	200 copay per admit		50 Copayment	20	20	50 Copayment	15 Copayment	15 Copayment	15 Copayment		15 Copayment	15 Copayment	15 Copayment	25 Copayment	25 Copayment	15 Copayment	15 Copayment	15/25 copayment	10	25 Copayment			25 Copayment		25 Copaymant																100	200		50	0.2	0.2	50	15	15	15		15	15	15	25	25	15	15	19.15	0.1	25			25		25																	100	200		50	0.2	0.2	50	15	15	15		15	15	15	25	25	15	15	19.15	0.1	25			25		25															0	-	0.03	1.27	-	1.09	1.38	0.9	1.53	0.44	3.17	1.61	-	0.03	1.67	5.76	8.08	0.49	0.35	1.94	5.7	2.55	1.37	-	-	0.8	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.49	-	0.03	1.27	-	1.09	1.38	0.9	1.53	0.44	3.17	1.61	-	0.03	1.67	5.76	8.08	0.49	0.35	1.94	5.7	2.55	1.37	-	-	0.8	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.49
H3668_801_0	2006											Unlimited											Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	252.9	2.54	17.53		5.93	7.03	4.54	388	28.19	12.69	31.88	0.45	0.37	29.7	52.7	118.08	2.18	1.89	23.44	35.09	25.98	7.54																				Medicare Part A Ded/Copay	Medicare Part A Ded/Copay	Medicare Part A Ded/Copay		Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	50 Copay ER/25 Copay Urgent Care	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin	Medicare Part B Ded/Coin																				0.07	0.07	0.17		0.23	0.23	0.23	47.75	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.17		0.23	0.23	0.23	47.75	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	18.35	0.18	2.98	-	1.38	1.64	1.06	1.54	6.57	2.96	7.43	0.11	0.09	6.92	12.22	27.38	0.51	0.44	5.44	8.14	6.05	1.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	113.14	18.35	0.18	2.98	-	1.38	1.64	1.06	1.54	6.57	2.96	7.43	0.11	0.09	6.92	12.22	27.38	0.51	0.44	5.44	8.14	6.05	1.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	113.14
H3672_013_0	2006											N/A											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	P	V	P	O	O	O											N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1849	80.5	1412.1	677.7	250.4	994.5	0	347.1	440.4	7307.9	1666	238.9	163.1	4629.9	4410.7	3432.4	116.6	71.1	0	112.6	1381.9	0	0	0	0	0	0.9	0	0	0	0											100 / days 1-5	100 / days 1-5	0	0	0	20	20	50	100	0	50	0	0	25	15	25	25	25	0	0	20	0	0	0	5	0	15	0	0	0	0											68.27	68.27	0	0	0	26.92	0.2	50	100	0	6.05	0	0	7.8	15	25	25	25	0	0	10.56	0	0	0	0	0	0	0	0	0	0											N/A	68.27	68.27	0	0	0	26.92	0.2	50	100	0	6.05	0	0	7.8	15	25	25	25	0	0	10.56	0	0	0	0	0	0	0	0	0	0											0	10.52	0.46	-	-	-	2.23	-	1.45	3.67	-	0.84	-	-	3.01	5.51	7.15	0.24	0.15	-	-	1.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.45	10.52	0.46	-	-	-	2.23	-	1.45	3.67	-	0.84	-	-	3.01	5.51	7.15	0.24	0.15	-	-	1.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.45
H3672_014_0	2006											N/A											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	P	V	P	O	O	O											N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1603.2	54.8	1401.7	562.7	225.7	976.1	0	347	422.9	6631.5	1574.2	224.7	42.2	4523.7	3899.3	2983.3	111.3	93.9	0	103.4	234.1	0	0	0	0	0	0	0	0	0	0											100 / days 1-5	100 / days 1-5	0	0	0	20	20	50	100	0	50	0	0	25	15	25	25	25	0	0	0.2	0	0	0	5	0	15	0	0	0	0											68.27	68.27	0	0	0	43.29	0.2	50	100	0	3.18	0	0	8.83	15	25	25	25	0	0	8.11	0	0	0	0	0	0	0	0	0	0											N/A	68.27	68.27	0	0	0	43.29	0.2	50	100	0	3.18	0	0	8.83	15	25	25	25	0	0	8.11	0	0	0	0	0	0	0	0	0	0											0	9.12	0.31	-	-	-	3.52	-	1.45	3.52	-	0.42	-	-	3.33	4.87	6.22	0.23	0.2	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.34	9.12	0.31	-	-	-	3.52	-	1.45	3.52	-	0.42	-	-	3.33	4.87	6.22	0.23	0.2	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.34
H3672_804_0	2006											N/A											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	P	V	P	O	O	O											N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1504.7	26.3	1088.4	652.7	168.9	863	0	313.5	418.4	7109	1808.2	320.7	308.8	5308.8	4118.6	3454.1	90.2	115.6	0	108.2	1128.4	0	0	0	0	0	0.4	0	0	0	0											100 / days 1-5	100 / days 1-5	0	0	0	20	20	50	100	0	50	0	0	25	15	25	25	25	0	0	0.2	0	0	0	5	0	15	0	0	0	0											68.27	68.27	0	0	0	31.27	0.2	50	100	0	8.83	0	0	9.41	15	25	25	25	0	0	17.34	0	0	0	0	0	0	0	0	0	0											N/A	68.27	68.27	0	0	0	31.27	0.2	50	100	0	8.83	0	0	9.41	15	25	25	25	0	0	17.34	0	0	0	0	0	0	0	0	0	0											0	8.56	0.15	-	-	-	2.25	-	1.31	3.49	-	1.33	-	-	4.16	5.15	7.2	0.19	0.24	-	-	1.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.65	8.56	0.15	-	-	-	2.25	-	1.31	3.49	-	1.33	-	-	4.16	5.15	7.2	0.19	0.24	-	-	1.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.65
H3706_001_0	2006																						A	A	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin	V	Coin	V			V		V				V																																																					-	294.1	4	478	0	263	12.16	7.95	437	253	0	19.07	0	0.24	234	0	3388.16	169	644	18.59	1076	5.43	531	0	0	0	0	0	0	0	0	0													copay for days 21-100					50 ER 0/25 urgent care			20 rad therapy/specialized								20 rad therapy/specialized																																																																	375	375	105	0	50	0.2	0.2	29.05	200	0	0.09	0	0.2	25	0	25	25	25	0.09	25	0.2	25	0	0	0	0	0	0	0	0	0												9.19	0.13	4.18	-	1.1	2.43	1.59	1.06	4.22	-	1.68	-	0.05	0.49	-	7.06	0.35	1.34	1.62	2.24	1.09	1.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.92	9.19	0.13	4.18	-	1.1	2.43	1.59	1.06	4.22	-	1.68	-	0.05	0.49	-	7.06	0.35	1.34	1.62	2.24	1.09	1.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.92
H3706_803_0	2006																						D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin	V	Coin	V			V		V				V																																																					-	986.7	16.9	478	0	263	12.16	7.95	413	253	0	19.07	0	0.24	234	3657.98	3268.02	172	656	18.21	1098	5.43	540	0	0	0	0	0	0	0	0	0											copay for days 1-5	copay for days 1-5	copay for days 21-100					50 ER 20 urgent care			20 rad therapy/specialized								20 rad therapy/specialized																																																																	100	100	105	0	50	0.2	0.2	38.38	150	0	0.09	0	0.2	20	20	20	20	20	0.09	20	0.2	20	0	0	0	0	0	0	0	0	0												8.22	0.14	4.18	-	1.1	2.43	1.59	1.32	3.16	-	1.68	-	0.05	0.39	6.1	5.45	0.29	1.09	1.6	1.83	1.09	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.61	8.22	0.14	4.18	-	1.1	2.43	1.59	1.32	3.16	-	1.68	-	0.05	0.39	6.1	5.45	0.29	1.09	1.6	1.83	1.09	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.61
H3706_804_0	2006																						D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin	V	Coin	V			V		V				V																																																					-	986.7	16.9	478	0	263	12.16	7.95	413	253	0	19.07	0	0.24	234	3657.98	3268.02	172	656	18.21	1098	5.43	540	0	0	0	0	0	0	0	0	0											copay for days 1-5	copay for days 1-5	copay for days 21-100					50 ER 20 urgent care			20 rad therapy/specialized								20 rad therapy/specialized																																																																	100	100	105	0	50	0.2	0.2	38.38	150	0	0.09	0	0.2	20	20	20	20	20	0.09	20	0.2	20	0	0	0	0	0	0	0	0	0												8.22	0.14	4.18	-	1.1	2.43	1.59	1.32	3.16	-	1.68	-	0.05	0.39	6.1	5.45	0.29	1.09	1.6	1.83	1.09	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.61	8.22	0.14	4.18	-	1.1	2.43	1.59	1.32	3.16	-	1.68	-	0.05	0.39	6.1	5.45	0.29	1.09	1.6	1.83	1.09	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.61
H3706_805_0	2006																						D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin	V	Coin	V			V		V				V																																																					-	986.7	16.9	478	0	263	12.16	7.95	413	253	0	19.07	0	0.24	234	3657.98	3268.02	172	656	18.21	1098	5.43	540	0	0	0	0	0	0	0	0	0											copay for days 1-5	copay for days 1-5	copay for days 21-100					50 ER 20 urgent care			20 rad therapy/specialized								20 rad therapy/specialized																																																																	100	100	105	0	50	0.2	0.2	38.38	150	0	0.09	0	0.2	20	20	20	20	20	0.09	20	0.2	20	0	0	0	0	0	0	0	0	0												8.22	0.14	4.18	-	1.1	2.43	1.59	1.32	3.16	-	1.68	-	0.05	0.39	6.1	5.45	0.29	1.09	1.6	1.83	1.09	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.61	8.22	0.14	4.18	-	1.1	2.43	1.59	1.32	3.16	-	1.68	-	0.05	0.39	6.1	5.45	0.29	1.09	1.6	1.83	1.09	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.61
H3706_806_0	2006																						D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin	V	Coin	V			V		V				V																																																					-	986.7	16.9	478	0	263	12.16	7.95	413	253	0	19.07	0	0.24	234	3657.98	3268.02	172	656	18.21	1098	5.43	540	0	0	0	0	0	0	0	0	0											copay for days 1-5	copay for days 1-5	copay for days 21-100					50 ER 20 urgent care			20 rad therapy/specialized								20 rad therapy/specialized																																																																	100	100	105	0	50	0.2	0.2	38.38	150	0	0.09	0	0.2	20	20	20	20	20	0.09	20	0.2	20	0	0	0	0	0	0	0	0	0												8.22	0.14	4.18	-	1.1	2.43	1.59	1.32	3.16	-	1.68	-	0.05	0.39	6.1	5.45	0.29	1.09	1.6	1.83	1.09	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.61	8.22	0.14	4.18	-	1.1	2.43	1.59	1.32	3.16	-	1.68	-	0.05	0.39	6.1	5.45	0.29	1.09	1.6	1.83	1.09	0.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.61
H3708_001_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	4232.13	421.26	13267	0	1828.16	1292.94	1781.69	710.35	167.68	29062.39	359.79	67.83	31.47	2922.28	1317.94	3332.88	8032.05	105.14	25.8	40412.92	48.29	56.09	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				94.76	57.92	57.88	0	67.27	30.99	30.21	97.19	269.35	4.37	47.97	68.85	636.55	111.73	15.19	19.53	20.11	19.44	0.23	14.08	0.23	13.78	0	0	0	0	0	0	0	0	0												94.76	57.92	57.88	0	67.27	30.99	30.21	97.19	269.35	4.37	47.97	68.85	636.55	111.73	15.19	19.53	20.11	19.44	0.23	14.08	0.23	13.78	0	0	0	0	0	0	0	0	0												33.42	2.03	63.99	-	10.25	3.34	4.49	5.75	3.76	10.58	1.44	0.39	1.67	27.21	1.67	5.43	13.46	0.17	6.01	47.42	11.25	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	253.78	33.42	2.03	63.99	-	10.25	3.34	4.49	5.75	3.76	10.58	1.44	0.39	1.67	27.21	1.67	5.43	13.46	0.17	6.01	47.42	11.25	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	253.78
H3709_001_0	2006											2500											D	D	D		T	Coin	Coin	P	P		V		Coin	Coin			V	Coin		Coin	Coin	V																				2500																																										-	1164.66	20.49	1079.9		284.45	20.86	1.57	306.1	296.93		252.66		0.3	24.83			179.23	1.51		165.05	7.02	582.05																				100 / day up to 5 days.	200 / day up to 5 days.	24 / day		100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 20 copay for Urgent Care	150 copay for Amb. Surg. Svcs and 20 coinsurance for Cardiac Rehabilitation Services and 40 copay for Outpatient Substance Abuse Svcs		100 copay for CT MRI PET and nuclear medicine studies. 0 copay for all other lab plus 0 for Hospital Based physician costs		20 coinsurance and 0 for misc. services	20 coinsurance and 0 for medical/surgical supplies			40 copay	20 coinsurance		20 copay for Office Visits and 20 coinsurance for other services	20 coinsurance	20 copay for Vision Exams and 0 Coinsurance for OP Blood																				100	200	23.83		100	0.2	0.2	41.45	150		100		0.15	0.18			40	0.2		0.09	0.2	20																					63.41	178.99	19.24		95.34	0.19	0.19	39.07	137.27		84.34		0.14	0.17			40	0.2		0.09	0.19	20																				0	6.15	0.31	1.73	-	2.26	3.9	0.29	1	3.4	-	1.78	-	0.04	4.26	-	-	0.6	0.3	-	14.88	1.31	0.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.18	6.15	0.31	1.73	-	2.26	3.9	0.29	1	3.4	-	1.78	-	0.04	4.26	-	-	0.6	0.3	-	14.88	1.31	0.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.18
H3709_003_0	2006											2500											D	D	D		T	Coin	Coin	P	P		V		Coin	Coin			V	Coin		Coin	Coin	V																				2500																																										-	1164.66	20.49	1079.9		284.45	20.86	1.57	306.1	296.93		252.66		0.3	24.83			179.23	1.51		165.05	7.02	582.05																				100 / day up to 5 days.	200 / day up to 5 days.	24 / day		100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 20 copay for Urgent Care	150 copay for Amb. Surg. Svcs and 20 coinsurance for Cardiac Rehabilitation Services and 40 copay for Outpatient Substance Abuse Svcs		100 copay for CT MRI PET and nuclear medicine studies. 0 copay for all other lab plus 0 for Hospital Based physician costs		20 coinsurance and 0 for misc. services	20 coinsurance and 0 for medical/surgical supplies			40 copay	20 coinsurance		20 copay for Office Visits and 20 coinsurance for other services	20 coinsurance	20 copay for Vision Exams and 0 Coinsurance for OP Blood																				100	200	23.83		100	0.2	0.2	41.45	150		100		0.15	0.18			40	0.2		0.09	0.2	20																					63.41	178.99	19.24		95.34	0.19	0.19	39.07	137.27		84.34		0.14	0.17			40	0.2		0.09	0.19	20																				0	6.15	0.31	1.73	-	2.26	3.9	0.29	1	3.4	-	1.78	-	0.04	4.26	-	-	0.6	0.3	-	14.88	1.31	0.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.18	6.15	0.31	1.73	-	2.26	3.9	0.29	1	3.4	-	1.78	-	0.04	4.26	-	-	0.6	0.3	-	14.88	1.31	0.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.18
H3709_801_0	2006											2500											D	D	D		T	Coin	Coin	P	P		V		Coin	Coin			V	Coin		Coin	Coin	V																				0	0	0	0		0	0	0	0	0		0		0	0			0	0		0	0	0																				-	1164.66	20.49	1057.92		284.45	20.86	1.57	306.1	296.93		252.66		0.3	24.83			179.23	1.51		164.08	7.02	569.09																				100 / day up to 5 days.	200 / day up to 5 days.	0/day 1-20; 200/day 21-100		200 copay	20 coinsurance	20 coinsurance	50 copay for ER and 20 copay for Urgent Care	250 copay for Amb. Surg. Svcs and 20 coinsurance for Cardiac Rehabilitation Services and 40 copay for Outpatient Substance Abuse Svcs		150 copay for CT MRI PET and nuclear medicine studies. 0 copay for all other lab plus 0 for Hospital Based physician costs		20 coinsurance and 0 for misc. services	20 coinsurance and 0 for medical/surgical supplies			40 copay	20 coinsurance		40 copay for Office Visits and 20 coinsurance for other services	20 coinsurance	40 copay for Vision Exams and 0 Coinsurance for OP Blood																				100	200	47.67		200	0.2	0.2	41.45	250		150		0.15	0.18			40	0.2		0.17	0.2	40																					76.7	153.39	36.56		153.39	0.15	0.15	31.84	191.74		115.04		0.12	0.14			40	0.2		0.17	0.15	40																				0	7.44	0.26	3.22	-	3.64	3.2	0.24	0.81	4.74	-	2.42	-	0.03	3.49	-	-	0.6	0.3	-	28.59	1.08	1.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.98	7.44	0.26	3.22	-	3.64	3.2	0.24	0.81	4.74	-	2.42	-	0.03	3.49	-	-	0.6	0.3	-	28.59	1.08	1.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.98
H3709_802_0	2006											2500											D	D	D		T	Coin	Coin	P	P		V		Coin	Coin			V	Coin		Coin	Coin	V																				0	0	0	0		0	0	0	0	0		0		0	0			0	0		0	0	0																				-	1164.66	20.49	1057.92		284.45	20.86	1.57	306.1	296.93		252.66		0.3	24.83			179.23	1.51		164.08	7.02	569.09																				100 / day up to 5 days.	200 / day up to 5 days.	0/day 1-20; 200/day 21-100		200 copay	20 coinsurance	20 coinsurance	50 copay for ER and 20 copay for Urgent Care	250 copay for Amb. Surg. Svcs and 20 coinsurance for Cardiac Rehabilitation Services and 40 copay for Outpatient Substance Abuse Svcs		150 copay for CT MRI PET and nuclear medicine studies. 0 copay for all other lab plus 0 for Hospital Based physician costs		20 coinsurance and 0 for misc. services	20 coinsurance and 0 for medical/surgical supplies			40 copay	20 coinsurance		40 copay for Office Visits and 20 coinsurance for other services	20 coinsurance	40 copay for Vision Exams and 0 Coinsurance for OP Blood																				100	200	47.67		200	0.2	0.2	41.45	250		150		0.15	0.18			40	0.2		0.17	0.2	40																					76.7	153.39	36.56		153.39	0.15	0.15	31.84	191.74		115.04		0.12	0.14			40	0.2		0.17	0.15	40																				0	7.44	0.26	3.22	-	3.64	3.2	0.24	0.81	4.74	-	2.42	-	0.03	3.49	-	-	0.6	0.3	-	28.59	1.08	1.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.98	7.44	0.26	3.22	-	3.64	3.2	0.24	0.81	4.74	-	2.42	-	0.03	3.49	-	-	0.6	0.3	-	28.59	1.08	1.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.98
H3749_001_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1576.88	40.39	792.2	2195.59	265.9	15.4	112.65	364	469.84	0	13.02	0	68.34	596.56	5911.62	3694.74	185.28	286.27	3388.91	6913.33	23.71	0	0	0	91.2	254.38	0	0	0	0	271.29											No Change	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	5	25	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											17.42	109.69	49	0	75	0.2	23.3	49.12	100	0	0.2	0	0	89.09	5	25	30	30	3.56	0	0.2	0	0	0	25	20	0	0	0	0	0											0	17.42	109.69	49	0	75	0.2	23.3	49.12	100	0	0.2	0	0	89.09	5	25	30	30	3.56	0	0.2	0	0	0	25	20	0	0	0	0	0												2.29	0.37	3.23	-	1.66	3.08	0.22	1.49	3.92	-	2.6	-	-	4.43	2.46	7.7	0.46	0.72	1	-	4.74	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.99	2.29	0.37	3.23	-	1.66	3.08	0.22	1.49	3.92	-	2.6	-	-	4.43	2.46	7.7	0.46	0.72	1	-	4.74	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.99
H3749_004_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1564.88	40.08	904.17	2214.58	268.2	17.58	113.57	361.63	343.28	0	14.87	0	68.9	617.11	5217.39	3640.6	186.88	288.74	3152.32	6445.33	24.15	0	0	0	91.99	256.58	0	0	0	0	0											600 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											104.53	109.69	49	0	75	0.2	26.39	49.12	200	0	0.2	0	0	174.18	15	30	30	30	4.36	0	0.2	0	0	0	25	20	0	0	0	0	0											0	104.53	109.69	49	0	75	0.2	26.39	49.12	200	0	0.2	0	0	174.18	15	30	30	30	4.36	0	0.2	0	0	0	25	20	0	0	0	0	0												13.63	0.37	3.69	-	1.68	3.52	0.25	1.48	5.72	-	2.97	-	-	8.96	6.52	9.1	0.47	0.72	1.15	-	4.83	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.67	13.63	0.37	3.69	-	1.68	3.52	0.25	1.48	5.72	-	2.97	-	-	8.96	6.52	9.1	0.47	0.72	1.15	-	4.83	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.67
H3749_006_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1734.57	44.43	871.42	2415.15	292.49	17.93	123.92	400.4	516.83	0	15.16	0	75.17	656.22	6502.78	4694	203.8	314.89	4046.64	8276.71	24.15	0	0	0	100.32	279.82	183.51	39.7	0	0	298.42											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	24.66	49.12	50	0	0.2	0	0	46.88	5	10	30	30	3.47	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	24.66	49.12	50	0	0.2	0	0	46.88	5	10	30	30	3.47	0	0.2	0	0	0	25	20	25	0	0	0	0												1.26	0.41	3.56	-	1.83	3.59	0.25	1.64	2.15	-	3.03	-	-	2.56	2.71	3.91	0.51	0.79	1.17	-	4.83	-	-	-	0.21	0.47	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.25	1.26	0.41	3.56	-	1.83	3.59	0.25	1.64	2.15	-	3.03	-	-	2.56	2.71	3.91	0.51	0.79	1.17	-	4.83	-	-	-	0.21	0.47	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.25
H3749_007_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1576.88	40.39	792.2	2195.59	265.9	16.23	112.65	364	469.84	0	13.73	0	68.34	596.56	5911.62	4267.27	185.28	286.27	3693.08	7524.28	24.15	0	0	0	91.2	254.38	0	0	0	0	271.29											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	24.56	49.12	50	0	0.2	0	0	46.88	5	10	30	30	3.44	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	24.56	49.12	50	0	0.2	0	0	46.88	5	10	30	30	3.44	0	0.2	0	0	0	25	20	0	0	0	0	0												1.14	0.37	3.23	-	1.66	3.25	0.23	1.49	1.96	-	2.75	-	-	2.33	2.46	3.56	0.46	0.72	1.06	-	4.83	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.11	1.14	0.37	3.23	-	1.66	3.25	0.23	1.49	1.96	-	2.75	-	-	2.33	2.46	3.56	0.46	0.72	1.06	-	4.83	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.11
H3749_801_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.34	0.03	0.2	0.56		0.52		0.04	0.43	1.22	2.34	0.14	0.04	0.49	0.25	0.85	0.21																				7.95	1575.01	40.34	809.69	2125.11	12.27	14.54	1.3	12.12	33.98	0	22.43	0	1.67	18.26	52.23	100.47	2.48	1.63	20.99	10.77	36.46	8.85	0	0	0	0	0	0	0	0	262.58											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.08	0.37	3.78	-	2.45	2.91	0.26	2.42	6.8	-	4.49	-	0.33	3.65	10.45	20.09	1.24	0.33	4.2	2.15	7.29	1.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.06	14.08	0.37	3.78	-	2.74	3.25	0.29	2.62	7.36	-	5.01	-	0.37	4.08	11.66	22.44	1.38	0.36	4.69	2.41	8.14	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.01
H3749_802_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.34	0.03	0.2	0.56		0.52		0.04	0.43	1.22	2.34	0.14	0.04	0.49	0.25	0.85	0.21																				7.95	1575.01	40.34	809.69	2125.11	12.27	14.54	1.3	12.12	33.98	0	22.43	0	1.67	18.26	52.23	100.47	2.48	1.63	20.99	10.77	36.46	8.85	0	0	0	0	0	0	0	0	262.58											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.08	0.37	3.78	-	2.45	2.91	0.26	2.42	6.8	-	4.49	-	0.33	3.65	10.45	20.09	1.24	0.33	4.2	2.15	7.29	1.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.06	14.08	0.37	3.78	-	2.74	3.25	0.29	2.62	7.36	-	5.01	-	0.37	4.08	11.66	22.44	1.38	0.36	4.69	2.41	8.14	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.01
H3749_803_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.34	0.03	0.2	0.56		0.52		0.04	0.43	1.22	2.34	0.14	0.04	0.49	0.25	0.85	0.21																				7.95	1575.01	40.34	809.69	2125.11	12.27	14.54	1.3	12.12	33.98	0	22.43	0	1.67	18.26	52.23	100.47	2.48	1.63	20.99	10.77	36.46	8.85	0	0	0	0	0	0	0	0	262.58											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.08	0.37	3.78	-	2.45	2.91	0.26	2.42	6.8	-	4.49	-	0.33	3.65	10.45	20.09	1.24	0.33	4.2	2.15	7.29	1.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.06	14.08	0.37	3.78	-	2.74	3.25	0.29	2.62	7.36	-	5.01	-	0.37	4.08	11.66	22.44	1.38	0.36	4.69	2.41	8.14	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.01
H3749_804_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.34	0.03	0.2	0.56		0.52		0.04	0.43	1.22	2.34	0.14	0.04	0.49	0.25	0.85	0.21																				7.95	1575.01	40.34	809.69	2125.11	12.27	14.54	1.3	12.12	33.98	0	22.43	0	1.67	18.26	52.23	100.47	2.48	1.63	20.99	10.77	36.46	8.85	0	0	0	0	0	0	0	0	262.58											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.08	0.37	3.78	-	2.45	2.91	0.26	2.42	6.8	-	4.49	-	0.33	3.65	10.45	20.09	1.24	0.33	4.2	2.15	7.29	1.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.06	14.08	0.37	3.78	-	2.74	3.25	0.29	2.62	7.36	-	5.01	-	0.37	4.08	11.66	22.44	1.38	0.36	4.69	2.41	8.14	1.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	97.01
H3755_001_0	2006																						D	D	D		T	P		V	V	V	P			V	V	V	V	V	P	V		V			V	P	V																																																									-	855.3	31.1	16.9	0	68.3	32.4	0	270.5	223.3	43.9	270.9	0	0	110.1	4810.4	4139.6	127.7	108.1	183.7	182.3	0	582.7	0	0	610.4	107.5	66.71	0	0	0	0											100 1st 5 Days	100 1st 5 Days				50/Wheelchair 250/motorized scooter					100 per CT/MRI						Group Session 15 Individual 25		100 per CT/MRI																																																																	100	100	50		50	56	0	50	100	100	100	0	0	100	20	30	24	20	100	30	0	30	0	0	20	25	20	0	0	0	0												7.13	0.26	0.07	-	0.28	0.15	-	1.13	1.86	0.37	2.26	-	-	0.92	8.02	10.35	0.26	0.18	1.53	0.46	-	1.46	-	-	1.02	0.22	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.02	7.13	0.26	0.07	-	0.28	0.15	-	1.13	1.86	0.37	2.26	-	-	0.92	8.02	10.35	0.26	0.18	1.53	0.46	-	1.46	-	-	1.02	0.22	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.02
H3755_002_0	2006																						D	D	D		T	P		V	V	V	P			V	V	V	V	V	P	V		V			V	P	V																																																									-	855.3	31.1	16.9	0	68.3	32.4	0	270.5	223.3	43.9	270.9	0	0	110.1	4810.4	4139.6	127.7	108.1	183.7	182.3	0	582.7	0	0	610.4	107.5	66.71	0	0	0	0											100 1st 5 Days	100 1st 5 Days				50/Wheelchair 250/motorized scooter					100 per CT/MRI						Group Session 15 Individual 25		100 per CT/MRI																																																																	100	100	50		50	56	0	50	100	100	100	0	0	100	20	30	24	20	100	30	0	30	0	0	20	25	20	0	0	0	0												7.13	0.26	0.07	-	0.28	0.15	-	1.13	1.86	0.37	2.26	-	-	0.92	8.02	10.35	0.26	0.18	1.53	0.46	-	1.46	-	-	1.02	0.22	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.02	7.13	0.26	0.07	-	0.28	0.15	-	1.13	1.86	0.37	2.26	-	-	0.92	8.02	10.35	0.26	0.18	1.53	0.46	-	1.46	-	-	1.02	0.22	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.02
H3755_801_0	2006																						D	D	D		T	P		V	V	V	P			V	V	V	V	V	P	V		V			V	P	V																																																									-	855.3	31.1	16.9	0	68.3	32.4	0	270.5	223.3	43.9	270.9	0	0	110.1	4810.4	4139.6	127.7	108.1	183.7	182.3	0	582.7	0	0	610.4	107.5	66.71	0	0	0	0											100 1st 5 Days	100 1st 5 Days				50/Wheelchair 250/motorized scooter					100 per CT/MRI						Group Session 15 Individual 25		100 per CT/MRI																																																																	100	100	50		50	56	0	50	100	100	100	0	0	100	20	30	24	20	100	30	0	30	0	0	20	25	20	0	0	0	0												7.13	0.26	0.07	-	0.28	0.15	-	1.13	1.86	0.37	2.26	-	-	0.92	8.02	10.35	0.26	0.18	1.53	0.46	-	1.46	-	-	1.02	0.22	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.02	7.13	0.26	0.07	-	0.28	0.15	-	1.13	1.86	0.37	2.26	-	-	0.92	8.02	10.35	0.26	0.18	1.53	0.46	-	1.46	-	-	1.02	0.22	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.02
H3755_802_0	2006																						D	D	D		T	P		V	V	V	P			V	V	V	V	V	P	V		V			V	P	V																																																									-	855.3	31.1	16.9	0	68.3	32.4	0	270.5	223.3	43.9	270.9	0	0	110.1	4810.4	4139.6	127.7	108.1	183.7	182.3	0	582.7	0	0	610.4	107.5	66.71	0	0	0	0											100 1st 5 Days	100 1st 5 Days				50/Wheelchair 250/motorized scooter					100 per CT/MRI						Group Session 15 Individual 25		100 per CT/MRI																																																																	100	100	50		50	56	0	50	100	100	100	0	0	100	20	30	24	20	100	30	0	30	0	0	20	25	20	0	0	0	0												7.13	0.26	0.07	-	0.28	0.15	-	1.13	1.86	0.37	2.26	-	-	0.92	8.02	10.35	0.26	0.18	1.53	0.46	-	1.46	-	-	1.02	0.22	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.02	7.13	0.26	0.07	-	0.28	0.15	-	1.13	1.86	0.37	2.26	-	-	0.92	8.02	10.35	0.26	0.18	1.53	0.46	-	1.46	-	-	1.02	0.22	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.02
H3805_001_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1179.97	30.22	1021.25	2145.51	259.84	16.88	112.01	341.14	390.87	0	14.27	0	67.76	595.93	5423.63	3799.47	184.15	284.52	3345.14	6828.31	40.13	0	0	0	89.12	248.58	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	25.69	49.12	100	0	0.2	0	0	89.17	10	20	30	30	3.95	0	0.2	0	0	0	25	20	0	0	0	0	0											1500	69.69	109.69	49	0	75	0.2	25.69	49.12	100	0	0.18	0	0	89.17	10	20	30	30	3.95	0	0.18	0	0	0	25	20	0	0	0	0	0												6.85	0.28	4.17	-	1.62	3.38	0.24	1.4	3.26	-	2.57	-	-	4.43	4.52	6.33	0.46	0.71	1.1	-	7.22	-	-	-	0.19	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.14	6.85	0.28	4.17	-	1.62	3.38	0.24	1.4	3.26	-	2.57	-	-	4.43	4.52	6.33	0.46	0.71	1.1	-	7.22	-	-	-	0.19	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.14
H3805_007_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1210.34	31	949.73	1438.35	174.2	13.88	111.77	244.32	308.88	0	11.74	0	67.61	578.29	5280.59	3684.71	189.14	292.24	3193.26	6523.4	40.39	0	0	0	91.54	255.32	0	0	0	0	272.29											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	21.18	49.12	200	0	0.2	0	0	172.97	15	30	30	30	3.4	0	0.2	0	0	0	25	20	0	0	0	0	0											1500	69.69	109.69	49	0	75	0.2	21.18	49.12	200	0	0.18	0	0	172.97	15	30	30	30	3.4	0	0.18	0	0	0	25	20	0	0	0	0	0												7.03	0.28	3.88	-	1.09	2.78	0.2	1	5.15	-	2.11	-	-	8.34	6.6	9.21	0.47	0.73	0.91	-	7.27	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.66	7.03	0.28	3.88	-	1.09	2.78	0.2	1	5.15	-	2.11	-	-	8.34	6.6	9.21	0.47	0.73	0.91	-	7.27	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.66
H3805_010_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1210.34	31	949.73	1438.35	174.2	14.19	111.77	244.32	308.88	0	12	0	67.61	578.29	5280.59	3684.71	189.14	292.24	3193.26	6523.4	40.81	0	0	0	91.54	255.32	0	0	0	0	272.29											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	21.64	49.12	200	0	0.2	0	0	172.97	15	30	30	30	3.48	0	0.2	0	0	0	25	20	0	0	0	0	0											1500	69.69	109.69	49	0	75	0.2	21.64	49.12	200	0	0.18	0	0	172.97	15	30	30	30	3.48	0	0.18	0	0	0	25	20	0	0	0	0	0												7.03	0.28	3.88	-	1.09	2.84	0.2	1	5.15	-	2.16	-	-	8.34	6.6	9.21	0.47	0.73	0.93	-	7.35	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.86	7.03	0.28	3.88	-	1.09	2.84	0.2	1	5.15	-	2.16	-	-	8.34	6.6	9.21	0.47	0.73	0.93	-	7.35	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.86
H3805_801_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.28	0.34	0.03	0.2	0.57		0.53		0.04	0.43	1.22	2.35	0.14	0.04	0.49	0.25	1.44	0.21																				8.57	1197.55	30.67	979.85	1691.68	12.16	14.67	1.31	11.98	34.25	0	22.7	0	1.69	18.48	52.37	100.75	2.48	1.63	21.05	10.8	61.69	9.04	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	10.71	0.28	4.57	-	2.43	2.93	0.26	2.4	6.85	-	4.54	-	0.34	3.7	10.47	20.15	1.24	0.33	4.21	2.16	12.34	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.72	10.71	0.28	4.57	-	2.71	3.28	0.29	2.59	7.42	-	5.07	-	0.38	4.13	11.7	22.5	1.39	0.36	4.7	2.41	13.78	2.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	100.28
H3805_802_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.28	0.34	0.03	0.2	0.57		0.53		0.04	0.43	1.22	2.35	0.14	0.04	0.49	0.25	1.44	0.21																				8.57	1197.55	30.67	979.85	1691.68	12.16	14.67	1.31	11.98	34.25	0	22.7	0	1.69	18.48	52.37	100.75	2.48	1.63	21.05	10.8	61.69	9.04	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	10.71	0.28	4.57	-	2.43	2.93	0.26	2.4	6.85	-	4.54	-	0.34	3.7	10.47	20.15	1.24	0.33	4.21	2.16	12.34	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.72	10.71	0.28	4.57	-	2.71	3.28	0.29	2.59	7.42	-	5.07	-	0.38	4.13	11.7	22.5	1.39	0.36	4.7	2.41	13.78	2.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	100.28
H3805_803_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.28	0.34	0.03	0.2	0.57		0.53		0.04	0.43	1.22	2.35	0.14	0.04	0.49	0.25	1.44	0.21																				8.57	1197.55	30.67	979.85	1691.68	12.16	14.67	1.31	11.98	34.25	0	22.7	0	1.69	18.48	52.37	100.75	2.48	1.63	21.05	10.8	61.69	9.04	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	10.71	0.28	4.57	-	2.43	2.93	0.26	2.4	6.85	-	4.54	-	0.34	3.7	10.47	20.15	1.24	0.33	4.21	2.16	12.34	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.72	10.71	0.28	4.57	-	2.71	3.28	0.29	2.59	7.42	-	5.07	-	0.38	4.13	11.7	22.5	1.39	0.36	4.7	2.41	13.78	2.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	100.28
H3805_804_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.28	0.34	0.03	0.2	0.57		0.53		0.04	0.43	1.22	2.35	0.14	0.04	0.49	0.25	1.44	0.21																				8.57	1197.55	30.67	979.85	1691.68	12.16	14.67	1.31	11.98	34.25	0	22.7	0	1.69	18.48	52.37	100.75	2.48	1.63	21.05	10.8	61.69	9.04	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	10.71	0.28	4.57	-	2.43	2.93	0.26	2.4	6.85	-	4.54	-	0.34	3.7	10.47	20.15	1.24	0.33	4.21	2.16	12.34	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.72	10.71	0.28	4.57	-	2.71	3.28	0.29	2.59	7.42	-	5.07	-	0.38	4.13	11.7	22.5	1.39	0.36	4.7	2.41	13.78	2.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	100.28
H3810_001_0	2006											0											D	D			T	Coin	Coin	V	V				Coin	V	V	V	V	V		V	Coin	V			V		V				V											N/A																																										-	262.6	3.8	0	0	299	12.76	8.24	499	331	0	0	0	0.25	313	4322.26	3888.74	221	830	0	1538	5.61	630	0	0	367	0	157	0	0	0	524											100 per admit	100 per admit			50 per trip	20 Coinsurance	20 Coinsurance	50 per visit	50 per visit				20 Coinsurance	15 per visit	15 per visit	15 per visit	15 per visit	15 per visit		15 per visit	20 Coinsurance	15 per visit			15 per visit		15 per visit				15 per visit											100	100	0	0	50	0.2	0.2	41.28	50	0	0	0	0.2	15	15	15	15	15	0	15	0.2	15	0	0	15	0	15	0	0	0	15											N/A	100	100	0	0	50	0.2	0.2	41.28	50	0	0	0	0.2	15	15	15	15	15	0	15	0.2	15	0	0	15	0	15	0	0	0	15											0	2.19	0.03	-	-	1.25	2.55	1.64	1.72	1.38	-	-	-	0.05	0.39	5.4	4.86	0.28	1.04	-	1.92	1.12	0.79	-	-	0.46	-	0.2	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	27.91	2.19	0.03	-	-	1.25	2.55	1.64	1.72	1.38	-	-	-	0.05	0.39	5.4	4.86	0.28	1.04	-	1.92	1.12	0.79	-	-	0.46	-	0.2	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	27.91
H3810_002_0	2006											0											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A					0.34	0.6	0.39	0.23	0.93	0.04	0.98	0	0.01	0.94	1.78	4.85	0.08	0.08	1.07	1.05	0.27	0.21																				13.85	295.4	3.14	37.04		10.44	18.29	11.8	7.11	28.05	1.2	29.79	0	0.37	28.6	53.83	147.04	2.3	2.42	32.47	31.68	8.05	6.3																				Medicare CS	Medicare CS	Medicare CS		20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)																																																													N/A	0.08	0.08	0.12		0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																					22.21	0.24	4.56	-	2.09	3.66	2.36	1.42	5.61	0.24	5.96	-	0.07	5.72	10.77	29.41	0.46	0.48	6.49	6.34	1.61	1.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	110.96	22.21	0.24	4.56	-	2.43	4.26	2.75	1.66	6.54	0.28	6.94	-	0.09	6.66	12.54	34.26	0.54	0.56	7.57	7.38	1.88	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	124.81
H3810_003_0	2006											0											D	D			T	Coin	Coin	V	V				Coin	V	V	V	V	V		V	Coin	V			V		V				V											N/A																																										-	262.6	3.8	0	0	299	12.76	8.24	499	331	0	0	0	0.25	313	4322.26	3888.74	221	830	0	1538	5.61	630	0	0	367	0	157	0	0	0	524											100 per admit	100 per admit			50 per trip	20 Coinsurance	20 Coinsurance	50 per visit	50 per visit				20 Coinsurance	15 per visit	15 per visit	15 per visit	15 per visit	15 per visit		15 per visit	20 Coinsurance	15 per visit			15 per visit		15 per visit				15 per visit											100	100	0	0	50	0.2	0.2	41.28	50	0	0	0	0.2	15	15	15	15	15	0	15	0.2	15	0	0	15	0	15	0	0	0	15											N/A	100	100	0	0	50	0.2	0.2	41.28	50	0	0	0	0.2	15	15	15	15	15	0	15	0.2	15	0	0	15	0	15	0	0	0	15											0	2.19	0.03	-	-	1.25	2.55	1.64	1.72	1.38	-	-	-	0.05	0.39	5.4	4.86	0.28	1.04	-	1.92	1.12	0.79	-	-	0.46	-	0.2	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	27.91	2.19	0.03	-	-	1.25	2.55	1.64	1.72	1.38	-	-	-	0.05	0.39	5.4	4.86	0.28	1.04	-	1.92	1.12	0.79	-	-	0.46	-	0.2	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	27.91
H3811_001_0	2006																																																																																																									-	1022.98	21.57	639.54	936.98	194.55	41016.79	213.42	270.48	271.65	0	900.41	0	5053.77	3291.42	0	0	717.18	0	3530.63	29261.29	0	985.18	0	296.54	355.94	306.87	157.44	0	0	0	170.1																																																																																														31.49	21.65	37.61	0	50	1.14	15.34	50	30	0	0	0	0	2.3	0	0	5.54	0	0	5.14	0	7.73	0	25	15	0	0	0	0	0	0												2.68	0.04	2	-	0.81	3.91	0.27	1.13	0.68	-	-	-	-	0.63	-	-	0.33	-	-	12.53	-	0.63	-	0.62	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.72	2.68	0.04	2	-	0.81	3.91	0.27	1.13	0.68	-	-	-	-	0.63	-	-	0.33	-	-	12.53	-	0.63	-	0.62	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.72
H3811_002_0	2006																																																																																																									-	1022.98	21.57	639.54	936.98	194.55	41016.79	213.42	270.48	271.65	0	900.41	0	5053.77	3291.42	0	0	717.18	0	3530.63	29261.29	0	985.18	0	296.54	355.94	306.87	157.44	0	0	0	170.1																																																																																														31.49	21.65	37.61	0	50	1.14	15.34	50	30	0	0	0	0	2.3	0	0	5.54	0	0	5.14	0	7.73	0	25	15	0	0	0	0	0	0												2.68	0.04	2	-	0.81	3.91	0.27	1.13	0.68	-	-	-	-	0.63	-	-	0.33	-	-	12.53	-	0.63	-	0.62	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.72	2.68	0.04	2	-	0.81	3.91	0.27	1.13	0.68	-	-	-	-	0.63	-	-	0.33	-	-	12.53	-	0.63	-	0.62	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.72
H3811_003_0	2006																											Coin	Coin																																																																													-	1581.66	33.39	988.82	1448.67	253.1	26.18	1.83	351.95	353.54	0	1171.51	0	6575.36	4282.09	0	0	933.14	0	4593.72	38071.21	0	886.42	0	0	463.12	399.33	0	0	0	0	967.88																																																																																														31.49	21.65	37.61	0	50	0.2	0.2	50	30	0	0	0	0	2.3	0	0	5.54	0	0	5.14	0	0.03	0	0	15	0	0	0	0	0	19.15												4.15	0.06	3.1	-	1.05	5.24	0.37	1.47	0.88	-	-	-	-	0.82	-	-	0.43	-	-	16.3	-	0	-	-	0.58	-	-	-	-	-	1.54	-	-	-	-	-	-	-	-	-	-	35.99	4.15	0.06	3.1	-	1.05	5.24	0.37	1.47	0.88	-	-	-	-	0.82	-	-	0.43	-	-	16.3	-	0	-	-	0.58	-	-	-	-	-	1.54	-	-	-	-	-	-	-	-	-	-	35.99
H3812_001_0	2006											3000											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	885.26	38.32	491.19		101.91	9.64	12.8	288.2	36.71		17.62	1.91	0.01	17.21	3698.12	3680.01	122.33	4.1	16.37	240.73	16.37				117.8		210.9															275	275	125		150	30	30	50	30		0/30	30	30	30/40/30	Oct-00	25	40/30	30	0/30	0/25	30				25		25															275	275	125		150	0.3	0.3	50	0.3		0.25	0.3	0.3	0.3	10	23.13	37.5	0.3	0.16	0.4	0.3				25		25																179.62	172.49	78.4		94.09	0.19	0.19	31.36	0.19		0.16	0.19	0.19	0.19	10	23.13	37.5	0.19	0.1	0.4	0.19				25		25																13.25	0.55	3.21	-	0.8	1.81	2.41	0.75	6.91	-	2.78	0.36	0	3.22	3.08	7.09	0.38	0.79	1.65	0.01	3.08	-	-	-	0.25	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.83	13.25	0.55	3.21	-	0.8	1.81	2.41	0.75	6.91	-	2.78	0.36	0	3.22	3.08	7.09	0.38	0.79	1.65	0.01	3.08	-	-	-	0.25	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.83
H3812_003_0	2006											2400											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	885.26	38.32	491.19	0	101.91	9.64	12.8	288.2	36.71	0	17.62	1.91	0.01	17.21	3698.13	3680.02	122.33	4.1	16.37	240.73	16.37	0	0	0	117.8	0	210.9	0	0	0	0											225	225	75	0	150	20	20	50	20	0	0/20	20	20	20/40/30	Aug-00	20	40/30	20	0/20	0/20	20	0			20		20															225	225	75	0	150	0.2	0.2	50	0.2	0	0.17	0.2	0.2	0.2	8	18.75	37.5	0.2	0.11	0.55	0.2	0	0	0	20	0	20	0	0	0	0												152.24	146.8	48.93	0	97.86	0.13	0.13	32.62	0.13	0	0.11	0.13	0.13	0.13	8	18.75	37.5	0.13	0.07	0.55	0.13	0	0	0	20	0	20	0	0	0	0												11.23	0.47	2	-	0.83	1.26	1.67	0.78	4.79	-	1.93	0.25	0	2.23	2.47	5.75	0.38	0.54	1.14	0.01	2.14	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.43	11.23	0.47	2	-	0.83	1.26	1.67	0.78	4.79	-	1.93	0.25	0	2.23	2.47	5.75	0.38	0.54	1.14	0.01	2.14	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.43
H3812_004_0	2006											600											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1107.9	50.09	516.99		142.38	13.47	17.88	491.85	62.7		32.01	3.26	0.02	29.41	7474.49	4901.27	180.64	5.44	23.98	319.92	21.75				117.8		311.42															25	25	15		100	20	20	40	15		0/10	15	20	15/10/8/4	Feb-00	4	04-Aug	10	0/10	0/4	20				4.00/5.00		4															25	25	15		100	0.2	0.2	40	0.01		0.02	0.04	0.2	0.05	1.39	3.75	7	0.09	0.08	0.38	0.2				4		4																17.3	16.72	10.03		66.89	0.13	0.13	26.76	0.01		0.01	0.03	0.13	0.04	1.39	3.75	7	0.06	0.05	0.38	0.13				4		4																1.6	0.07	0.43	-	0.79	1.8	2.39	1.1	0.44	-	0.39	0.09	0	1.05	0.87	1.53	0.11	0.33	1.21	0.01	2.91	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.25	1.6	0.07	0.43	-	0.79	1.8	2.39	1.1	0.44	-	0.39	0.09	0	1.05	0.87	1.53	0.11	0.33	1.21	0.01	2.91	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.25
H3812_005_0	2006	OP Facility - Emergency	OP Facility - Other									1100		Observation									D	D	D	P	P	Coin	Coin	V	Coin	V	V	V	Coin	Coin	P	Coin	P	Coin		Coin	Coin	Coin	P		P	P	Coin					V	Coin																																																			-	2344.16	166.66			1694.46	16.16	6.09	170.06	9.8	2917.72	151.51		0.14	6.37		104.85	1040.53	0.02		9.5	3.9	6.27					1.17					94.24	1.61									75/day	75/day			50/trip	20	20	40	20	0/10	0/10	40	20	20		20	40/30	20		20	20	20					20					40	20									75	75			16.67	0.2	0.2	40	0.2			40	0.2	0.2		0.2	35	0.2		0.2	0.2	0.2					0.2					40	0.2										55.28	55.28			12.28	0.15	0.15	29.48	0.15			29.48	0.15	0.15		0.15	25.8	0.15		0.15	0.15	0.15					0.15					29.48	0.15										10.8	0.77	-	-	1.73	2.38	0.9	0.42	1.44	-	-	-	0.02	0.94	-	15.46	2.24	0	-	1.4	0.57	0.92	-	-	-	-	0.17	-	-	-	-	0.23	0.24	-	-	-	-	-	-	-	-	40.64	10.8	0.77	-	-	1.73	2.38	0.9	0.42	1.44	-	-	-	0.02	0.94	-	15.46	2.24	0	-	1.4	0.57	0.92	-	-	-	-	0.17	-	-	-	-	0.23	0.24	-	-	-	-	-	-	-	-	40.64
H3812_801_0	2006											4100											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	933.3	35.55	509.29		104.13	9.55	13.2	296.63	39.87		21.73	2.09	0.01	18.17	3958.57	3981.23	121.41	4.44	17.69	260.56	17.87				126.64		226.72															225	175	125		150	30	30	50	30	20	20/30	30	30	30/40/30	35/0	35	40/30	30	0/30	0/35	30				35		35															225	175	125		150	0.3	0.3	50	0.3		0.24	0.3	0.3	0.3	35	32.83	10.5	0.3	0.29	0.55	0.3				35		35																161	121.43	86.73		104.08	0.21	0.21	34.69	0.21		0.17	0.21	0.21	0.21	35	32.83	10.5	0.21	0.2	0.55	0.21				35		35																12.52	0.36	3.68	-	0.9	1.99	2.75	0.86	8.3	-	3.6	0.44	0	3.76	11.55	10.89	0.11	0.94	3.55	0.01	3.72	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.95	12.52	0.36	3.68	-	0.9	1.99	2.75	0.86	8.3	-	3.6	0.44	0	3.76	11.55	10.89	0.11	0.94	3.55	0.01	3.72	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.95
H3813_001_0	2006											2960											A	A	D		T	O	O	V	P	P	P	V	P	P	V	V	V	V	P	P	S	V					V															2960																																										-	290.25	2.9	800.52		246.1	34563.62	11760.94	395.82	355.95	58.97	1120.47	17.45	956.57	257.95	5381.35	7986.53	162.01	584.97	1361.99	2487.07	191.31	559.4					80.41																	0 for 1st 20 days 50 21-100th			10 coinsurance	Supplies 10 coins Equipment 10 copay	50 ER copay 20 Primary Care and 35 Specialist copay	400 copay	O/P Diag 100 & O/P Therapy 35	O/P Diag 100 O/P Therapy 35 O/P X-Ray 10		10 coinsurance	10 coinsurance 20 Physical Therapy and 30 O/P Psych copays	20 Office and Hospital Outpatient 25 Inpatient Hospital 35 Urgent Care and 0 and 10 Immunizations	20 O/P Surgery Chiro and Podiatrist visits 35 Specialist visit and 35 Consults				10 coinsurance	10 coinsurance																					400	400	25		50	0.47	0.66	46.13	360	20.77	20.77	50	3.74	8.01	23.93	24.07	30	20	10	3.74	3.74	20					20															2960	400	400	25		50	0.47	0.66	46.13	360	20.77	20.77	50	3.74	8.01	23.93	24.07	30	20	10	3.74	3.74	20					20															0	9.67	0.1	1.67	-	1.03	1.35	0.65	1.52	10.68	0.1	1.94	0.07	0.3	0.17	10.73	16.02	0.41	0.97	1.13	0.78	0.06	0.93	-	-	-	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.42	9.67	0.1	1.67	-	1.03	1.35	0.65	1.52	10.68	0.1	1.94	0.07	0.3	0.17	10.73	16.02	0.41	0.97	1.13	0.78	0.06	0.93	-	-	-	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.42
H3813_002_0	2006											2960											A	A	D		T	O	O	V	P	P	P	V	P	P	V	V	V	V	P	P	S	V					V															2960																																										-	290.25	2.9	800.52		246.1	34563.62	11760.94	395.82	355.95	58.97	1120.47	17.45	956.57	257.95	5381.35	7986.53	162.01	584.97	1361.99	2487.07	191.31	559.4					80.41																	0 for 1st 20 days 50 21-100th			10 coinsurance	Supplies 10 coins Equipment 10 copay	50 ER copay 20 Primary Care and 35 Specialist copay	400 copay	O/P Diag 100 & O/P Therapy 35	O/P Diag 100 O/P Therapy 35 O/P X-Ray 10		10 coinsurance	10 coinsurance 20 Physical Therapy and 30 O/P Psych copays	20 Office and Hospital Outpatient 25 Inpatient Hospital 35 Urgent Care and 0 and 10 Immunizations	20 O/P Surgery Chiro and Podiatrist visits 35 Specialist visit and 35 Consults				10 coinsurance	10 coinsurance																					400	400	25		50	0.47	0.66	46.13	360	20.77	20.77	50	3.74	8.01	23.93	24.07	30	20	10	3.74	3.74	20					20															2960	400	400	25		50	0.47	0.66	46.13	360	20.77	20.77	50	3.74	8.01	23.93	24.07	30	20	10	3.74	3.74	20					20															0	9.67	0.1	1.67	-	1.03	1.35	0.65	1.52	10.68	0.1	1.94	0.07	0.3	0.17	10.73	16.02	0.41	0.97	1.13	0.78	0.06	0.93	-	-	-	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.42	9.67	0.1	1.67	-	1.03	1.35	0.65	1.52	10.68	0.1	1.94	0.07	0.3	0.17	10.73	16.02	0.41	0.97	1.13	0.78	0.06	0.93	-	-	-	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.42
H3813_801_0	2006											1000											A	A	D		T	O	O	V	P	P	P	V	P	P	V	V	V	V	P	P	S	V					V															1000																																										-	298.95	2.99	800.52		246.1	34563.62	11760.94	398.39	364.85	58.97	1120.47	17.45	956.57	260.61	4568.44	7261.2	168.49	608.36	1361.99	2487.07	191.31	581.77					83.62																	0 for 1st 20 days 40 21-100th			10 coinsurance	Supplies 10 coins Equipment 10 copay	50 ER copay 15 Primary Care and Specialist copay	400 copay but some surgeries less than 400	O/P Diag 100 & O/P Therapy 35	O/P Diag 100 O/P Therapy 35 O/P X-Ray 10		10 coinsurance	10 coinsurance 15 Physical Therapy and O/P Psych copays	15 Office and Hospital Outpatient 25 Inpatient Hospital 10 diabetes monitoring 35 Urgent Care and 0 and 10 Immunizations	15 O/P Surgery PCP specialist Chiro and Podiatrist visits 25 inpatient visits				10 coinsurance	10 coinsurance																					250	250	20		50	0.47	0.66	44.15	200	20.77	20.77	50	3.74	6.74	14.06	15.06	15	15	10	3.74	3.74	15					15															1000	134.46	134.46	10.76		26.89	0.25	0.36	23.74	107.57	11.17	11.17	26.89	2.01	3.62	7.56	8.1	8.07	8.07	5.38	2.01	2.01	8.07					8.07															0	3.35	0.03	0.72	-	0.55	0.72	0.35	0.79	3.27	0.05	1.04	0.04	0.16	0.08	2.88	4.9	0.11	0.41	0.61	0.42	0.03	0.39	-	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.97	3.35	0.03	0.72	-	0.55	0.72	0.35	0.79	3.27	0.05	1.04	0.04	0.16	0.08	2.88	4.9	0.11	0.41	0.61	0.42	0.03	0.39	-	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.97
H3813_802_0	2006											2960											A	A	D		T	O	O	V	P	P	P	V	P	P	V	V	V	V	P	P	S	V					V															2960																																										-	290.25	2.9	800.52		246.1	34563.62	11760.94	395.82	355.95	58.97	1120.47	17.45	956.57	257.95	5381.35	7986.53	162.01	584.97	1361.99	2487.07	191.31	559.4					80.41																	0 for 1st 20 days 50 21-100th			10 coinsurance	Supplies 10 coins Equipment 10 copay	50 ER copay 20 Primary Care and 35 Specialist copay	400 copay	O/P Diag 100 & O/P Therapy 35	O/P Diag 100 O/P Therapy 35 O/P X-Ray 10		10 coinsurance	10 coinsurance 20 Physical Therapy and 30 O/P Psych copays	20 Office and Hospital Outpatient 25 Inpatient Hospital 35 Urgent Care and 0 and 10 Immunizations	20 O/P Surgery Chiro and Podiatrist visits 35 Specialist visit and 35 Consults				10 coinsurance	10 coinsurance																					400	400	25		50	0.47	0.66	46.13	360	20.77	20.77	50	3.74	8.01	23.93	24.07	30	20	10	3.74	3.74	20					20															2960	400	400	25		50	0.47	0.66	46.13	360	20.77	20.77	50	3.74	8.01	23.93	24.07	30	20	10	3.74	3.74	20					20															0	9.67	0.1	1.67	-	1.03	1.35	0.65	1.52	10.68	0.1	1.94	0.07	0.3	0.17	10.73	16.02	0.41	0.97	1.13	0.78	0.06	0.93	-	-	-	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.42	9.67	0.1	1.67	-	1.03	1.35	0.65	1.52	10.68	0.1	1.94	0.07	0.3	0.17	10.73	16.02	0.41	0.97	1.13	0.78	0.06	0.93	-	-	-	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.42
H3814_001_0	2006											1200											D		D		T			V	V											V							V				V											N/A																																										-	1340.05		863.3		255.8			404.4	412.5											11619.56							157.16				41.5											100 per day up 5 days																			All office visits																						100		25		50			50	200											15							15				15											N/A	62.73		24.75		21.43			43.07	198											14.85							14.85				14.85												7	-	1.78	-	0.46	-	-	1.45	6.81	-	-	-	-	-	-	-	-	-	-	14.38	-	-	-	-	-	-	0.19	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	32.13	7	-	1.78	-	0.46	-	-	1.45	6.81	-	-	-	-	-	-	-	-	-	-	14.38	-	-	-	-	-	-	0.19	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	32.13
H3814_004_0	2006											1200											D		D		T			V	V											V							V				V											N/A																																										-	1375.34		904.1		254.5			402.3	432											12168.9							164.59				43.5											100 per day up 5 days																			All office visits																						100		25		50			50	200											15							15				15											N/A	62.73		24.75		21.43			43.07	198											14.85							14.85				14.85												7.19	-	1.86	-	0.45	-	-	1.44	7.13	-	-	-	-	-	-	-	-	-	-	15.06	-	-	-	-	-	-	0.2	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	33.4	7.19	-	1.86	-	0.45	-	-	1.44	7.13	-	-	-	-	-	-	-	-	-	-	15.06	-	-	-	-	-	-	0.2	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	33.4
H3814_005_0	2006											1200											D		D		T			V	V											V							V				V											N/A																																										-	1327.92		855.5		256.1			404.8	408.8											11991.27							157.31				239.1											100 per day up 5 days																			All office visits																						100		25		50			50	100											15							15				15											N/A	62.73		24.75		21.43			43.07	99											14.85							14.85				14.85											0	6.94	-	1.76	-	0.46	-	-	1.45	3.37	-	-	-	-	-	-	-	-	-	-	14.84	-	-	-	-	-	-	0.19	-	-	-	0.3	-	-	-	-	-	-	-	-	-	-	29.32	6.94	-	1.76	-	0.46	-	-	1.45	3.37	-	-	-	-	-	-	-	-	-	-	14.84	-	-	-	-	-	-	0.19	-	-	-	0.3	-	-	-	-	-	-	-	-	-	-	29.32
H3814_006_0	2006	Other Non-Covered (Travel Benefit)										1200											D		D		T			V	V											V							V				V											N/A																																										-	1363.9		896.6		254.9			403	428.4											12567.45							164.87				241.1											100 per day up 5 days																			All office visits																						100		25		50			50	100											15							15				15											N/A	62.73		24.75		21.43			43.07	99											14.85							14.85				14.85											0	7.13	-	1.85	-	0.46	-	-	1.45	3.53	-	-	-	-	-	-	-	-	-	-	15.55	-	-	-	-	-	-	0.2	-	-	-	0.3	-	-	-	-	-	-	-	-	-	-	30.47	7.13	-	1.85	-	0.46	-	-	1.45	3.53	-	-	-	-	-	-	-	-	-	-	15.55	-	-	-	-	-	-	0.2	-	-	-	0.3	-	-	-	-	-	-	-	-	-	-	30.47
H3814_007_0	2006											N/A											D		D		T			V	V											V																						N/A																																										-	1804.04		1162.2		344.4			544.4	555.4											15642.64																						100 per day up 5 days																			All office visits																						100		25		50			50	200											15																						N/A	63.36		25		21.65			43.5	200											15																						0	9.53	-	2.42	-	0.62	-	-	1.97	9.26	-	-	-	-	-	-	-	-	-	-	19.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.35	9.53	-	2.42	-	0.62	-	-	1.97	9.26	-	-	-	-	-	-	-	-	-	-	19.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.35
H3815_001_0	2006											Unlimited											D	Ded	D	P	T	O	Coin	V	P	P	P	P	V	V	V	P	V	P	P	V	O	P	P	P	P	P	P	P	P	P	P											n/a	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	3.56	9.3	0	0	193.68	866.54	0.11	234.21	0	0	0	0	22.9	1	42.4	0	201.34	0	0	928.9	0	0	0	0	0	0	0	0	0	0	0											456 / reserve day	150 deductible					10 prosthetics / 0 supplies																																			456	150	0	0	50	12.08	1	50	0	0	0	0	25	30	25	0	30	0	0	5	0	0	0	0	0	0	0	0	0	0	0											n/a	456	150	0	0	50	12.08	1	50	0	0	0	0	25	30	25	0	30	0	0	5	0	0	0	0	0	0	0	0	0	0	0												0.14	0.12	-	-	0.81	0.87	0.11	0.98	-	-	-	-	0.05	0	0.09	-	0.5	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.05	0.14	0.12	-	-	0.81	0.87	0.11	0.98	-	-	-	-	0.05	0	0.09	-	0.5	-	-	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.05
H3817_001_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	563.94	9.36	0	0	244.8	11.61	7.52	536.4	0	0	0	0	0	0	4584.36	4086.24	225.9	933.3	0	1555.2	6.79	669.6	0	0	391.5	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	33.39	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												4.7	0.08	-	-	1.02	1.29	-	1.49	-	-	-	-	-	-	1.91	1.7	0.09	0.35	-	0.65	0.75	0.28	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.48	4.7	0.08	-	-	1.02	1.29	-	1.49	-	-	-	-	-	-	1.91	1.7	0.09	0.35	-	0.65	0.75	0.28	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.48
H3817_002_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	563.94	9.36	0	0	244.8	11.61	7.52	536.4	0	0	0	0	0	0	4584.36	4086.24	225.9	933.3	0	1555.2	6.79	669.6	0	0	391.5	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	33.39	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												4.7	0.08	-	-	1.02	1.29	-	1.49	-	-	-	-	-	-	1.91	1.7	0.09	0.35	-	0.65	0.75	0.28	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.48	4.7	0.08	-	-	1.02	1.29	-	1.49	-	-	-	-	-	-	1.91	1.7	0.09	0.35	-	0.65	0.75	0.28	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.48
H3818_001_0	2006											1500											A					Coin	Coin	V		Coin	Coin				V	V	V	V	Coin		Coin			V	V		V																																																									-	1320.77					9.9	15.67	314.17		19.67	20.18				3495.14	4259.72	203.67	1002.39	22.53		18.96			1550.95	124		222															200					0	0	50		0	0.1				20/25	20/25	20	20	10		20			12/35/40/8	25		20															42.86					0.2	0.2	49.98		0.1	0.1				20	20.61	20	20	0.1		0.2			20.44	25		20																20.05					0.09	0.09	23.28		0.05	0.05				9.53	9.78	9.3	9.3	0.05		0.09			20.44	25		20																2.21	-	-	-	-	0.92	1.46	0.61	-	0.91	0.94	-	-	-	2.77	3.47	0.16	0.78	1.05	-	1.76	-	-	2.64	0.26	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.31	2.21	-	-	-	-	0.92	1.46	0.61	-	0.91	0.94	-	-	-	2.77	3.47	0.16	0.78	1.05	-	1.76	-	-	2.64	0.26	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.31
H3818_002_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	328.67	32.78	39.74		15.38	26.44	26.11	948	27.19	19.77	15.67	3.43	0.67	36.46	21.28	23.59	9.35	5.47	18.74	83.78	15.44	0.19																				mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin		mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.07	0.07	0.13		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.13		0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				110	24.38	2.43	5.06	-	3.58	6.16	6.08	3.95	6.34	4.61	3.65	0.8	0.16	8.49	4.96	5.5	2.18	1.28	4.37	19.52	3.6	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.13	24.38	2.43	5.06	-	3.58	6.16	6.08	3.95	6.34	4.61	3.65	0.8	0.16	8.49	4.96	5.5	2.18	1.28	4.37	19.52	3.6	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	117.13
H3856_007_0	2006											1500											D	D			T	Coin	Coin	P	P						V	V	V								V																	none																																										-	817.04	10.61			249.36	11.48	0.18	441.06	412.19						7818.1	9426.58	326.17	3737.34							188.7																	100 for 1st 8 days	100 for 1st 8 days															20-25																									100	100			50	0.2	0.2	50	50						20	20	22.5	20							20																	none	100	100			50	0.2	0.2	50	50						20	20	22.5	20							20																	0	6.81	0.09	-	-	1.04	2.3	0.04	1.84	1.72	-	-	-	-	-	13.03	15.71	0.61	6.23	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.72	6.81	0.09	-	-	1.04	2.3	0.04	1.84	1.72	-	-	-	-	-	13.03	15.71	0.61	6.23	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.72
H3856_010_0	2006											1500											D	D			T	Coin	Coin	P	P						V	V	V								V																	none																																										-	817.04	10.61			249.36	11.48	0.18	441.06	412.19						7818.1	9426.58	326.17	3737.34							188.7																	100 for 1st 8 days	100 for 1st 8 days															20-25																									100	100			50	0.2	0.2	50	50						20	20	22.5	20							20																	none	100	100			50	0.2	0.2	50	50						20	20	22.5	20							20																	0	6.81	0.09	-	-	1.04	2.3	0.04	1.84	1.72	-	-	-	-	-	13.03	15.71	0.61	6.23	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.72	6.81	0.09	-	-	1.04	2.3	0.04	1.84	1.72	-	-	-	-	-	13.03	15.71	0.61	6.23	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.72
H3856_014_0	2006											1500											D	D			T	Coin	Coin	P	P						V	V	V								V																	none																																										-	817.04	10.61			249.36	11.48	0.18	441.06	412.19						7818.1	9426.58	326.17	3737.34							188.7																	100 for 1st 8 days	100 for 1st 8 days															20-25																									100	100			50	0.2	0.2	50	50						20	20	22.5	20							20																	none	100	100			50	0.2	0.2	50	50						20	20	22.5	20							20																	0	6.81	0.09	-	-	1.04	2.3	0.04	1.84	1.72	-	-	-	-	-	13.03	15.71	0.61	6.23	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.72	6.81	0.09	-	-	1.04	2.3	0.04	1.84	1.72	-	-	-	-	-	13.03	15.71	0.61	6.23	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.72
H3856_016_0	2006											1500											D	D			T	Coin	Coin	P	P						V	V	V								V																	none																																										-	817.04	10.61			249.36	11.48	0.18	441.06	412.19						7818.1	9426.58	326.17	3737.34							188.7																	100 for 1st 8 days	100 for 1st 8 days															20-25																									100	100			50	0.2	0.2	50	50						20	20	22.5	20							20																	none	100	100			50	0.2	0.2	50	50						20	20	22.5	20							20																	0	6.81	0.09	-	-	1.04	2.3	0.04	1.84	1.72	-	-	-	-	-	13.03	15.71	0.61	6.23	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.72	6.81	0.09	-	-	1.04	2.3	0.04	1.84	1.72	-	-	-	-	-	13.03	15.71	0.61	6.23	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.72
H3864_001_0	2006											0															T	Coin	Coin	V							V	V	V	V									V				V											0																																										-					125.39	9.86	3.18	269.5							3751.75	4213.91	201.94	1363.33									16.02				88.9															Copay waived if admitted	20 coins up to 500 max	20 coins up to 500 max	Copay waived if admitted																																						50	0.2	0.2	50							10	10	10	10									10				10											0					18.89	0.17	0.17	47.9							10	10	10	10									10				10											0	-	-	-	-	0.2	1.68	0.54	1.08	-	-	-	-	-	-	3.13	3.51	0.17	1.14	-	-	-	-	-	-	-	-	0.01	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	11.52	-	-	-	-	0.2	1.68	0.54	1.08	-	-	-	-	-	-	3.13	3.51	0.17	1.14	-	-	-	-	-	-	-	-	0.01	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	11.52
H3864_002_0	2006											1200											D		D		T	Coin	Coin	V	V						V	V	V	V									V				V											NA																																										-	1078.63		345.89		269.49	24.43	3.79	538.21	212.61						3501.84	3625.64	599.33	718.95									14.38				80.11											100 per day to 5 days				copay waived if admitted	20 up to 500 max	20 up to 500 max	copay waived if admitted																																		100		25		50	0.2	0.2	50	200						15	15	15	15									15				15											NA	84.67		24.5		21.2	0.14	0.14	42.7	196						14.7	14.7	14.7	14.7									14.7				14.7											0	7.61	-	0.71	-	0.48	3.53	0.55	1.92	3.47	-	-	-	-	-	4.29	4.44	0.73	0.88	-	-	-	-	-	-	-	-	0.02	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	28.72	7.61	-	0.71	-	0.48	3.53	0.55	1.92	3.47	-	-	-	-	-	4.29	4.44	0.73	0.88	-	-	-	-	-	-	-	-	0.02	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	28.72
H3864_006_0	2006											1200											D		D		T	Coin	Coin	V	V						V	V	V	V									V				V											NA																																										-	1078.63		345.89		269.49	24.43	3.79	538.21	212.61						3501.84	3625.64	599.33	718.95									14.38				80.11											100 per day to 5 days				copay waived if admitted	20 up to 500 max	20 up to 500 max	copay waived if admitted																																		100		25		50	0.2	0.2	50	200						15	15	15	15									15				15											NA	84.67		24.5		21.2	0.14	0.14	42.7	196						14.7	14.7	14.7	14.7									14.7				14.7											0	7.61	-	0.71	-	0.48	3.53	0.55	1.92	3.47	-	-	-	-	-	4.29	4.44	0.73	0.88	-	-	-	-	-	-	-	-	0.02	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	28.72	7.61	-	0.71	-	0.48	3.53	0.55	1.92	3.47	-	-	-	-	-	4.29	4.44	0.73	0.88	-	-	-	-	-	-	-	-	0.02	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	28.72
H3864_007_0	2006											0											A				T	Coin	Coin	V							V	V	V	V									V				V											0																																										-	256.07				119.12	9.86	3.18	256.03							3564.16	4003.21	191.84	1295.16									15.22				84.46															Copay waived if admitted	20 coins up to 500 max	20 coins up to 500 max	Copay waived if admitted																																		100				50	0.2	0.2	50							10	15	15	15									15				15											0	100				18.89	0.17	0.17	47.9							10	15	15	15									15				15											0	2.13	-	-	-	0.19	1.68	0.54	1.02	-	-	-	-	-	-	2.97	5	0.24	1.62	-	-	-	-	-	-	-	-	0.02	-	-	-	0.11	-	-	-	-	-	-	-	-	-	-	15.52	2.13	-	-	-	0.19	1.68	0.54	1.02	-	-	-	-	-	-	2.97	5	0.24	1.62	-	-	-	-	-	-	-	-	0.02	-	-	-	0.11	-	-	-	-	-	-	-	-	-	-	15.52
H3864_801_0	2006											0															T			V							V	V	V	V									V				V											0																																										-					65.93			188.38							3239.93	4172.3	77.39	1536.74									19.65				117.93															Copay waived if admitted			Copay waived if admitted																																						50			50							10	10	10	10									10				10											0					20.54			46.77							10	10	10	10									10				10											0	-	-	-	-	0.11	-	-	0.73	-	-	-	-	-	-	2.7	3.48	0.06	1.28	-	-	-	-	-	-	-	-	0.02	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	8.48	-	-	-	-	0.11	-	-	0.73	-	-	-	-	-	-	2.7	3.48	0.06	1.28	-	-	-	-	-	-	-	-	0.02	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	8.48
H3907_002_0	2006																						A				T	Coin		V	V						V									Coin	V		V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	333.7				282.49	23.71		524.43	683.52						11018.8						947.11			5	300		25															100 per admit				50	0		50	25						0 pcp/25 spec									0.2	25		25															95				47.5	0.15		47.5	23.75						5.7						10			0.2	23.75		23.75																95				47.5	0.15		47.5	23.75						5.7						10			0.2	23.75		23.75																2.64	-	-	-	1.12	3.56	-	2.08	1.35	-	-	-	-	-	5.23	-	-	-	-	-	0.79	-	-	1	0.59	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.41	2.64	-	-	-	1.12	3.56	-	2.08	1.35	-	-	-	-	-	5.23	-	-	-	-	-	0.79	-	-	1	0.59	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.41
H3907_006_0	2006																						A				T	Coin		V	V						V						S			Coin	V		V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1211.56				306.08	25.69		568.22	740.6						11938.97						1026.2			5.06	325.44		36.25															100 per day max 5 days				50	0		50	25						0 pcp/25 spec									0.2	25		25															95				47.5	0.15		47.5	23.75						4.75						9.5			0.2	23.75		23.75																95				47.5	0.15		47.5	23.75						4.75						9.5			0.2	23.75		23.75																9.59	-	-	-	1.21	3.85	-	2.25	1.47	-	-	-	-	-	4.73	-	-	-	-	-	0.81	-	-	1.01	0.64	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.64	9.59	-	-	-	1.21	3.85	-	2.25	1.47	-	-	-	-	-	4.73	-	-	-	-	-	0.81	-	-	1.01	0.64	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.64
H3907_020_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	3510.59	1082.8	2547.83	0	594.03	1821.15	1902.25	837.92	323.53	10213.59	1077.48	37.08	3.64	2149.51	3704.06	4661.31	1781.71	521.31	20	20484.65	20.24	29.76	0	0	0	0	0	0	0	0	0											Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing											123.87	53.48	59.26	0	103.22	27.03	32.51	79.27	274.11	6.61	66.28	77.71	704.84	59.05	13.94	17.77	15.44	17.99	0.23	16.6	0.23	19.21	0	0	0	0	0	0	0	0	0												123.87	53.48	59.26	0	103.22	27.03	32.51	79.27	274.11	6.61	66.28	77.71	704.84	59.05	13.94	17.77	15.44	17.99	0.23	16.6	0.23	19.21	0	0	0	0	0	0	0	0	0											123	36.24	4.83	12.58	-	5.11	4.1	5.15	5.54	7.39	5.62	5.95	0.24	0.21	10.58	4.3	6.9	2.29	0.78	4.66	28.34	4.72	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	155.59	36.24	4.83	12.58	-	5.11	4.1	5.15	5.54	7.39	5.62	5.95	0.24	0.21	10.58	4.3	6.9	2.29	0.78	4.66	28.34	4.72	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	155.59
H3907_801_0	2006																						A		D	V	T	Coin		V	V						V						Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	379.72		1173.02	1094.21	289.6	22		502.96	868.79						12578.9						10.98																					500 per stay		50 per day for 100 days	25	100	20		50	100						PCP - 30 Spec.-50						20																					475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						15.03	-	4.63	2.17	2.29	4.18	-	1.99	6.88	-	-	-	-	-	33.86	-	-	-	-	-	2.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.11	15.03	-	4.63	2.17	2.29	4.18	-	1.99	6.88	-	-	-	-	-	33.86	-	-	-	-	-	2.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.11
H3907_802_0	2006																						A		D	V	T	Coin		V	V						V						Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	379.72		1173.02	1094.21	289.6	22		502.96	868.79						12578.9						10.98																					500 per stay		50 per day for 100 days	25	100	20		50	100						PCP - 30 Spec.-50						20																					475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						15.03	-	4.63	2.17	2.29	4.18	-	1.99	6.88	-	-	-	-	-	33.86	-	-	-	-	-	2.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.11	15.03	-	4.63	2.17	2.29	4.18	-	1.99	6.88	-	-	-	-	-	33.86	-	-	-	-	-	2.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.11
H3907_803_0	2006																						A		D	V	T	Coin		V	V						V						Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	379.72		1173.02	1094.21	289.6	22		502.96	868.79						12578.9						10.98																					500 per stay		50 per day for 100 days	25	100	20		50	100						PCP - 30 Spec.-50						20																					475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						15.03	-	4.63	2.17	2.29	4.18	-	1.99	6.88	-	-	-	-	-	33.86	-	-	-	-	-	2.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.11	15.03	-	4.63	2.17	2.29	4.18	-	1.99	6.88	-	-	-	-	-	33.86	-	-	-	-	-	2.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.11
H3909_001_0	2006											N/A											D	D	D		T	Coin	Coin	V	V						V	V	V	V	V		S																					N/A																																										-	1213.33	5.2	1025.04		120.79	15.25	1.16	208.71	381.97						4744.92	6672.71	358.66	1835.23	326.26		5.32																					1st 10 days	1st 10 days																																								100	100	25		100	0	0	40	150						20	35	35	35	35		50																					N/A	100	100	25		100	0.2	0.2	40	150						20	35	35	35	35		50																						10.11	0.04	2.14	-	1.01	3.05	0.23	0.7	4.77	-	-	-	-	-	7.91	19.46	1.05	5.35	0.95	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.79	10.11	0.04	2.14	-	1.01	3.05	0.23	0.7	4.77	-	-	-	-	-	7.91	19.46	1.05	5.35	0.95	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.79
H3909_003_0	2006																						D	D	Coin		Coin			Coin	Coin	Coin	Coin	Coin		Coin	V	V	Coin	Coin	Coin	Coin	S																																																															-	1213.86	5.2	28.46		7.2			4.02	36.65	49.99	18.76	0.79		8.42	11868.91	7575.9	7.09	1.98	43.08	142.29	5.32																					1st 5 days 1000/200	1st 5 days 1000/200	10 coinsurance		10 coinsurance			10 coinsurance	10 coinsurance	10 coinsurance	10 coinsurance	10 coinsurance		10 coinsurance			10 coinsurance	10 coinsurance	10 coinsurance	10 coinsurance																						154.87	154.87	0.09		0.09			0.09	0.09	0.09	0.09	0.09		0.09	10	20	0.09	0.09	0.09	0.09	50																						154.87	154.87	0.09		0.09			0.09	0.09	0.09	0.09	0.09		0.09	10	20	0.09	0.09	0.09	0.09	50																						15.67	0.07	2.68	-	0.68	-	-	0.38	3.45	4.71	1.77	0.07	-	0.79	9.89	12.63	0.67	0.19	4.06	13.4	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.12	15.67	0.07	2.68	-	0.68	-	-	0.38	3.45	4.71	1.77	0.07	-	0.79	9.89	12.63	0.67	0.19	4.06	13.4	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.12
H3909_004_0	2006																						D	D	D		T	Coin	Coin	V	v						V	V	V	V	V		O																																																															-	1418.47	23.66	972.6		105.2	20.18	1.2	252.8	517						5144.13	7211.01	179.94	1518.49	148.33		9.5																					100/day 10 day annual max	100/day 10 day annual max																																								100	100	25		100			40	150						20	35	35	35	35		50																						100	100	25		100	0.2	0.2	40	150						20	35	35	35	35		50																						11.82	0.2	2.03	-	0.88	4.04	0.24	0.84	6.46	-	-	-	-	-	8.57	21.03	0.52	4.43	0.43	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.53	11.82	0.2	2.03	-	0.88	4.04	0.24	0.84	6.46	-	-	-	-	-	8.57	21.03	0.52	4.43	0.43	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.53
H3909_005_0	2006																						D	D	Coin		Coin			Coin	Coin	Coin	Coin	Coin		Coin	V	V	Coin	Coin	Coin	Coin	S																																																															-	1213.86	5.2	28.46		7.2			4.02	36.65	49.99	18.76	0.79		8.42	11868.91	7575.9	7.09	1.98	43.08	142.29	5.32																					1st 5 days 1000/200	1st 5 days 1000/200	10 coinsurance		10 coinsurance			10 coinsurance	10 coinsurance	10 coinsurance	10 coinsurance	10 coinsurance		10 coinsurance			10 coinsurance	10 coinsurance	10 coinsurance	10 coinsurance																						154.87	154.87	0.09		0.09			0.09	0.09	0.09	0.09	0.09		0.09	10	20	0.09	0.09	0.09	0.09	50																						154.87	154.87	0.09		0.09			0.09	0.09	0.09	0.09	0.09		0.09	10	20	0.09	0.09	0.09	0.09	50																						15.67	0.07	2.68	-	0.68	-	-	0.38	3.45	4.71	1.77	0.07	-	0.79	9.89	12.63	0.67	0.19	4.06	13.4	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.12	15.67	0.07	2.68	-	0.68	-	-	0.38	3.45	4.71	1.77	0.07	-	0.79	9.89	12.63	0.67	0.19	4.06	13.4	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.12
H3909_006_0	2006																						D	D	Coin		Coin			Coin	Coin	Coin	Coin	Coin		Coin	V	V	Coin	Coin	Coin	Coin	S																																																															-	1213.86	5.2	28.46		7.2			4.02	36.65	49.99	18.76	0.79		8.42	11868.91	7575.9	7.09	1.98	43.08	142.29	5.32																					1st 5 days 1000/200	1st 5 days 1000/200	10 coinsurance		10 coinsurance			10 coinsurance	10 coinsurance	10 coinsurance	10 coinsurance	10 coinsurance		10 coinsurance			10 coinsurance	10 coinsurance	10 coinsurance	10 coinsurance																						154.87	154.87	0.09		0.09			0.09	0.09	0.09	0.09	0.09		0.09	10	20	0.09	0.09	0.09	0.09	50																						154.87	154.87	0.09		0.09			0.09	0.09	0.09	0.09	0.09		0.09	10	20	0.09	0.09	0.09	0.09	50																						15.67	0.07	2.68	-	0.68	-	-	0.38	3.45	4.71	1.77	0.07	-	0.79	9.89	12.63	0.67	0.19	4.06	13.4	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.12	15.67	0.07	2.68	-	0.68	-	-	0.38	3.45	4.71	1.77	0.07	-	0.79	9.89	12.63	0.67	0.19	4.06	13.4	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.12
H3909_007_0	2006											N/A											D	D	D		T	Coin	Coin	V	V						V	V	V	V	V		S																					N/A																																										-	1213.33	5.2	1025.04		120.79	15.25	1.16	208.71	381.97						4744.92	6672.71	358.66	1835.23	326.26		5.32																					1st 10 days	1st 10 days																																								100	100	25		100	0	0	40	150						20	35	35	35	35		50																					N/A	100	100	25		100	0.2	0.2	40	150						20	35	35	35	35		50																						10.11	0.04	2.14	-	1.01	3.05	0.23	0.7	4.77	-	-	-	-	-	7.91	19.46	1.05	5.35	0.95	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.79	10.11	0.04	2.14	-	1.01	3.05	0.23	0.7	4.77	-	-	-	-	-	7.91	19.46	1.05	5.35	0.95	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.79
H3909_008_0	2006											N/A											D	D	D		T	Coin	Coin	V	V						V	V	V	V	V		S																					N/A																																										-	1213.33	5.2	1025.04		120.79	15.25	1.16	208.71	381.97						4744.92	6672.71	358.66	1835.23	326.26		5.32																					1st 10 days	1st 10 days																																								100	100	25		100	0	0	40	150						20	35	35	35	35		50																					N/A	100	100	25		100	0.2	0.2	40	150						20	35	35	35	35		50																						10.11	0.04	2.14	-	1.01	3.05	0.23	0.7	4.77	-	-	-	-	-	7.91	19.46	1.05	5.35	0.95	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.79	10.11	0.04	2.14	-	1.01	3.05	0.23	0.7	4.77	-	-	-	-	-	7.91	19.46	1.05	5.35	0.95	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.79
H3909_801_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin		Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	S	Coin																				N/A																																										-	266.14	1.14	14.17		4.65	13.33	1.02	4.07	42.3		20.47	0			90.94	142.74	2.89	46.52	2.67	0	4.91	2.86																				Part A/B	Part A/B	Part A/B		Part A/B	Part A/B	Part A/B	Part A/B	Part A/B		Part A/B	Part A/B			Part A/B	Part A/B	Part A/B	Part A/B	Part A/B	Part A/B	50 HCI	Part A/B																				0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	50	0.2																				N/A	0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	50	0.2																					16.77	0.07	2.3	-	0.93	2.67	0.2	0.81	8.46	-	4.09	-	-	-	18.19	28.55	0.58	9.3	0.53	-	0.02	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.05	16.77	0.07	2.3	-	0.93	2.67	0.2	0.81	8.46	-	4.09	-	-	-	18.19	28.55	0.58	9.3	0.53	-	0.02	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.05
H3909_802_0	2006											N/A											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin		Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	S	Coin																				N/A																																										-	266.14	1.14	14.17		4.65	13.33	1.02	4.07	42.3		20.47	0			90.94	142.74	2.89	46.52	2.67	0	4.91	2.86																				Part A/B	Part A/B	Part A/B		Part A/B	Part A/B	Part A/B	Part A/B	Part A/B		Part A/B	Part A/B			Part A/B	Part A/B	Part A/B	Part A/B	Part A/B	Part A/B	50 HCI	Part A/B																				0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	50	0.2																				N/A	0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	50	0.2																					16.77	0.07	2.3	-	0.93	2.67	0.2	0.81	8.46	-	4.09	-	-	-	18.19	28.55	0.58	9.3	0.53	-	0.02	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.05	16.77	0.07	2.3	-	0.93	2.67	0.2	0.81	8.46	-	4.09	-	-	-	18.19	28.55	0.58	9.3	0.53	-	0.02	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.05
H3912_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional	Professional					1750		Other	PCP	Specialist excl. MH	Specialist excl. MH	Specialist excl. MH					D	D	D	P	P	Coin	Coin	V	V	V	V	V	Coin	V	P	P	V	P		P	S	V	P		P	P	P					V	Coin	P	P	P	P																																															-	1654.75	302.16			2639.08	31.8	4.11	179.29	115.05	4665.12	185.28	32.28	0.08	217.83	105.34	1.68	23.82	8.46		1417.46					13.68							100.27	0.09	1.58	27864.51	120.66	261.68					125/day	125/day			100/trip	0	0	35	25	0/10 SNF/Non-SNF	0/10 SNF/Non-SNF	25	0.2	25	0/25 SNF/Non-SNF	25	50	0/10 SNF/Non-SNF		0/25 SNF/Non-SNF					25							25	20	25	25	0/25 SNF/Non-SNF	0/25 SNF/Non-SNF					125	125			100	0.2	0.2	35	25	0.2	0.2	25	0.2	25	0.5	25	0.5	0.2		0.5					25							25	0.2	25	25	0.5	0.5						84.73	84.73			67.78	0.14	0.14	23.72	16.95	0.14	0.14	16.95	0.14	16.95	0.34	16.95	0.34	0.14		0.34					25							16.95	0.14	25	16.95	0.34	0.5						11.68	2.13	-	-	14.91	4.31	0.56	0.35	0.16	0.05	0	0.05	0.01	0.31	0	0	0	0	-	0.04	-	-	-	-	0.03	-	-	-	-	-	-	0.14	0.01	0	39.35	0	0.01	-	-	-	-	74.12	11.68	2.13	-	-	14.91	4.31	0.56	0.35	0.16	0.05	0	0.05	0.01	0.31	0	0	0	0	-	0.04	-	-	-	-	0.03	-	-	-	-	-	-	0.14	0.01	0	39.35	0	0.01	-	-	-	-	74.12
H3912_004_0	2006	OP Facility - Emergency	OP Facility - Other									800		Other									D	D	D	P	P	Coin	Coin	V	V	V	V	V	Coin	V	P	P	Coin	P		P	S	P	P		P	P	P					V	Coin																																																			-	2405.68	171.04			1738.94	17.02	6.41	174.52	100.16	2994.3	155.49	24.34	0.15	221.06		21121.71	7.07	5.51		1944.73		1175.9			22.95							96.71	0									125/day	125/day			100/trip	20	20	35	25	0/10 SNF/Non-SNF	0/10 SNF/Non-SNF	25	20	25		0/25 SNF/Non-SNF	0/50 SNF/Non-SNF	0/10 SNF/Non-SNF		0/25 SNF/Non-SNF		0/25 SNF/Non-SNF			0/25 SNF/Non-SNF							25	20									125	125			100	0.2	0.2	35	25	0.2	0.2	25	0.2	25		0.5	0.01	0.2		0.5		0.5			0.5							25	0.21										85.71	85.71			68.57	0.14	0.14	24	17.14	0.14	0.14	17.14	0.14	17.14		0.34	0.01	0.14		0.34		0.34			0.34							17.14	0.14										17.18	1.22	-	-	9.94	2.33	0.88	0.35	0.14	0.03	0	0.03	0.02	0.32	-	0.6	0.05	0	-	0.06	-	0.03	-	-	0	-	-	-	-	-	-	0.14	0	-	-	-	-	-	-	-	-	33.33	17.18	1.22	-	-	9.94	2.33	0.88	0.35	0.14	0.03	0	0.03	0.02	0.32	-	0.6	0.05	0	-	0.06	-	0.03	-	-	0	-	-	-	-	-	-	0.14	0	-	-	-	-	-	-	-	-	33.33
H3912_005_0	2006											1250	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		P			T	V	V	P	V	P																																																								-	2206.61	506.74	855.75		281.78	25.27	22.25	786.13	315.26	1597.14	785.89	53.83	2.47	2045.11		3542.86	1018.72	646.07		797.05																						75/day	75/day	114 days 21-62		100	20	20	35	25	10	10	50	20	50		25	35 indiv/25 group	10		25																						75	75	60.08		100	0.2	0.2	35	25	10	10	50	0.2	46.38		25	32.5	13.58		25																							40.2	40.2	32.2		53.6	0.11	0.11	18.76	13.4	5.36	5.36	26.8	0.11	24.86		13.4	17.42	7.28		13.4																							7.39	1.7	2.3	-	1.26	2.71	2.39	1.23	0.35	0.71	0.35	0.12	0.26	4.24	-	3.96	1.48	0.39	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.72	7.39	1.7	2.3	-	1.26	2.71	2.39	1.23	0.35	0.71	0.35	0.12	0.26	4.24	-	3.96	1.48	0.39	-	0.89	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.72
H3916_001_0	2006																										T	Coin		V						V	V	V					S			Coin	V		V															3000																																										-	0	0	0	0	238.97	13.81	0	217.96	0	0	0	0	0	769.08	3832.66	5411.53	0	0	0	0	246.46	0	0	10.44	239.4	0	4.1	0	0	0	0																															12/20/1930																					0	0	0	0	25	0.15	0	50	0	0	0	0	0	15	15	15	0	0	0	0	20	0	0	0.3	15	0	15	0	0	0	0												0	0	0	0	25	0.14	0	50	0	0	0	0	0	15	15	15	0	0	0	0	20	0	0	0.3	15	0	15	0	0	0	0												-	-	-	-	0.5	1.86	-	0.91	-	-	-	-	-	0.96	4.79	6.76	-	-	-	-	0.41	-	-	3.13	0.3	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.63	-	-	-	-	0.5	1.86	-	0.91	-	-	-	-	-	0.96	4.79	6.76	-	-	-	-	0.41	-	-	3.13	0.3	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.63
H3916_002_0	2006																										T	Coin		V						V	V	V					S			Coin	V		V															3000																																										-	0	0	0	0	197.55	12.15	0	215.32	0	0	0	0	0	1038.28	3854.45	5414.41	0	0	0	0	285.46	0	0	10.44	239.4	0	6.52	0	0	0	0																															12/20/1930																					0	0	0	0	25	0.15	0	50	0	0	0	0	0	15	15	15	0	0	0	0	20	0	0	0.3	15	0	15	0	0	0	0												0	0	0	0	25	0.14	0	50	0	0	0	0	0	15	15	15	0	0	0	0	20	0	0	0.3	15	0	15	0	0	0	0												-	-	-	-	0.41	1.64	-	0.9	-	-	-	-	-	1.3	4.82	6.77	-	-	-	-	0.48	-	-	3.13	0.3	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.75	-	-	-	-	0.41	1.64	-	0.9	-	-	-	-	-	1.3	4.82	6.77	-	-	-	-	0.48	-	-	3.13	0.3	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.75
H3916_003_0	2006																										T	Coin		V						V	V	V					S			Coin	V		V															3000																																										-	0	0	0	0	231.42	12.92	0	190.65	0	0	0	0	0	863.84	3906.58	5472.92	0	0	0	0	234.36	0	0	10.43	239.4	0	3.52	0	0	0	0																															12/20/1930																					0	0	0	0	25	0.15	0	50	0	0	0	0	0	15	15	15	0	0	0	0	20	0	0	0.3	15	0	15	0	0	0	0												0	0	0	0	25	0.14	0	50	0	0	0	0	0	15	15	15	0	0	0	0	20	0	0	0.3	15	0	15	0	0	0	0												-	-	-	-	0.48	1.74	-	0.79	-	-	-	-	-	1.08	4.88	6.84	-	-	-	-	0.39	-	-	3.13	0.3	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.65	-	-	-	-	0.48	1.74	-	0.79	-	-	-	-	-	1.08	4.88	6.84	-	-	-	-	0.39	-	-	3.13	0.3	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.65
H3916_005_0	2006																						D		D		T	Coin	Coin	V							V	V	V	V			S			Coin	V		V															3000																																										-	102.13	0	505.08	0	246.95	15.36	1.07	390.2	0	0	0	0	0	0	5082.5	7776.96	267.65	334.67	0	0	951.15	0	0	10.03	392.36	0	168.15	0	0	0	0																															12/20/1930																					50	0	25	0	25	0.15	0.15	50	0	0	0	0	0	0	15	15	15	15	0	0	20	0	0	0.3	15	0	15	0	0	0	0												41.67	0	25	0	25	0.14	0.14	50	0	0	0	0	0	0	15	15	15	15	0	0	20	0	0	0.3	15	0	15	0	0	0	0												0.35	-	1.05	-	0.51	2.07	0.14	1.63	-	-	-	-	-	-	6.35	9.72	0.33	0.42	-	-	1.59	-	-	3.01	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.89	0.35	-	1.05	-	0.51	2.07	0.14	1.63	-	-	-	-	-	-	6.35	9.72	0.33	0.42	-	-	1.59	-	-	3.01	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.89
H3916_006_0	2006																						D		D		T	Coin	Coin	V							V	V	V	V			S			Coin	V		V															3000																																										-	114.16	0	542.01	0	312.29	21.39	1.49	362.97	0	0	0	0	0	0	4861.53	7586.15	281.48	351.96	0	0	1056.3	0	0	10.81	392.21	0	168.09	0	0	0	0																															12/20/1930																					50	0	25	0	25	0.15	0.15	50	0	0	0	0	0	0	15	15	15	15	0	0	20	0	0	0.3	15	0	15	0	0	0	0												41.67	0	25	0	25	0.14	0.14	50	0	0	0	0	0	0	15	15	15	15	0	0	20	0	0	0.3	15	0	15	0	0	0	0												0.4	-	1.13	-	0.65	2.89	0.2	1.51	-	-	-	-	-	-	6.08	9.48	0.35	0.44	-	-	1.76	-	-	3.24	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.83	0.4	-	1.13	-	0.65	2.89	0.2	1.51	-	-	-	-	-	-	6.08	9.48	0.35	0.44	-	-	1.76	-	-	3.24	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.83
H3916_012_0	2006																						A		D		T	Coin	Coin	V	V	V	V				V	V	V	V	V	V	S			Coin	V		V															3000																																										-	353.45	0	505.08	0	246.95	15.36	1.07	390.2	394.1	1771.05	890.21	0	0	0	5082.5	7016.96	267.65	334.67	919.52	1034.62	951.15	0	0	0	392.36	0	168.15	0	0	0	0											250/admit or 50/day										20 - 50								20 - 50		12/20/1930																					260	0	25	0	25	0.15	0.15	50	50	20	25	0	0	0	15	15	15	15	25	20	20	0	0	0	15	0	15	0	0	0	0												210.1	0	25	0	25	0.14	0.14	50	50	20	25	0	0	0	15	15	15	15	25	20	20	0	0	0	15	0	15	0	0	0	0												6.19	-	1.05	-	0.51	2.07	0.14	1.63	1.64	2.95	1.85	-	-	-	6.35	8.77	0.33	0.42	1.92	1.72	1.59	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.85	6.19	-	1.05	-	0.51	2.07	0.14	1.63	1.64	2.95	1.85	-	-	-	6.35	8.77	0.33	0.42	1.92	1.72	1.59	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.85
H3916_013_0	2006																						A		D		T	Coin	Coin	V	V	V	V				V	V	V	V	V	V	S			Coin	V		V															3000																																										-	395.08	0	542.01	0	312.29	21.39	1.49	362.97	366.59	1647.43	828.08	0	0	0	4861.53	6826.15	281.48	351.96	1025.85	982.12	1056.3	0	0	0	392.21	0	168.09	0	0	0	0											250/admit or 50/day										20 - 50								20 - 50		12/20/1930																					260	0	25	0	25	0.15	0.15	50	50	20	25	0	0	0	15	15	15	15	25	20	20	0	0	0	15	0	15	0	0	0	0												210.1	0	25	0	25	0.14	0.14	50	50	20	25	0	0	0	15	15	15	15	25	20	20	0	0	0	15	0	15	0	0	0	0												6.92	-	1.13	-	0.65	2.89	0.2	1.51	1.53	2.75	1.73	-	-	-	6.08	8.53	0.35	0.44	2.14	1.64	1.76	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.93	6.92	-	1.13	-	0.65	2.89	0.2	1.51	1.53	2.75	1.73	-	-	-	6.08	8.53	0.35	0.44	2.14	1.64	1.76	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.93
H3916_015_0	2006																						D		D		T	Coin	Coin	V							V	V	V	V			S				V		V															3000																																										-	102.13	0	505.08	0	246.95	15.36	1.07	390.2	0	0	0	0	0	0	5082.5	7016.96	267.65	334.67	0	0	951.15	0	0	0	392.36	0	168.15	0	0	0	0																															12/20/1930																					50	0	25	0	25	0.15	0.15	50	0	0	0	0	0	0	15	15	15	15	0	0	20	0	0	0	15	0	15	0	0	0	0												41.67	0	25	0	25	0.14	0.14	50	0	0	0	0	0	0	15	15	15	15	0	0	20	0	0	0	15	0	15	0	0	0	0												0.35	-	1.05	-	0.51	2.07	0.14	1.63	-	-	-	-	-	-	6.35	8.77	0.33	0.42	-	-	1.59	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.93	0.35	-	1.05	-	0.51	2.07	0.14	1.63	-	-	-	-	-	-	6.35	8.77	0.33	0.42	-	-	1.59	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.93
H3916_016_0	2006																						D		D		T	Coin	Coin	V							V	V	V	V			S				V		V															3000																																										-	114.16	0	542.01	0	312.29	21.39	1.49	362.97	0	0	0	0	0	0	4861.53	6826.15	281.48	351.96	0	0	1056.3	0	0	0	392.21	0	168.09	0	0	0	0																															12/20/1930																					50	0	25	0	25	0.15	0.15	50	0	0	0	0	0	0	15	15	15	15	0	0	20	0	0	0	15	0	15	0	0	0	0												41.67	0	25	0	25	0.14	0.14	50	0	0	0	0	0	0	15	15	15	15	0	0	20	0	0	0	15	0	15	0	0	0	0												0.4	-	1.13	-	0.65	2.89	0.2	1.51	-	-	-	-	-	-	6.08	8.53	0.35	0.44	-	-	1.76	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.64	0.4	-	1.13	-	0.65	2.89	0.2	1.51	-	-	-	-	-	-	6.08	8.53	0.35	0.44	-	-	1.76	-	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.64
H3916_801_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin	Coin					Coin																																																															-	238.98	0	35.83	0	8.48	12.51	0	2.95	28.16	0	0	0	0	66.27	40.17	163.88	0	0	0	0	46.14	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing																					0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												17.41	-	6.51	-	1.98	2.91	-	0.69	6.56	-	-	-	-	15.44	9.36	38.18	-	-	-	-	10.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.79	17.41	-	6.51	-	1.98	2.91	-	0.69	6.56	-	-	-	-	15.44	9.36	38.18	-	-	-	-	10.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.79
H3916_802_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin	Coin					Coin																																																															-	238.98	0	35.83	0	8.48	12.51	0	2.95	28.16	0	0	0	0	66.27	40.17	163.88	0	0	0	0	46.14	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing																					0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												17.41	-	6.51	-	1.98	2.91	-	0.69	6.56	-	-	-	-	15.44	9.36	38.18	-	-	-	-	10.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.79	17.41	-	6.51	-	1.98	2.91	-	0.69	6.56	-	-	-	-	15.44	9.36	38.18	-	-	-	-	10.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.79
H3916_803_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin	Coin					Coin																																																															-	238.98	0	35.83	0	8.48	12.51	0	2.95	28.16	0	0	0	0	66.27	40.17	163.88	0	0	0	0	46.14	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing																					0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												17.41	-	6.51	-	1.98	2.91	-	0.69	6.56	-	-	-	-	15.44	9.36	38.18	-	-	-	-	10.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.79	17.41	-	6.51	-	1.98	2.91	-	0.69	6.56	-	-	-	-	15.44	9.36	38.18	-	-	-	-	10.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.79
H3916_804_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin	Coin					Coin																																																															-	238.98	0	35.83	0	8.48	12.51	0	2.95	28.16	0	0	0	0	66.27	40.17	163.88	0	0	0	0	46.14	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing																					0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												17.41	-	6.51	-	1.98	2.91	-	0.69	6.56	-	-	-	-	15.44	9.36	38.18	-	-	-	-	10.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.79	17.41	-	6.51	-	1.98	2.91	-	0.69	6.56	-	-	-	-	15.44	9.36	38.18	-	-	-	-	10.75	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.79
H3920_001_0	2006																						D	Coin	D		Coin	Coin	Coin	V	Coin		Coin			O	V	V	V		Coin					V																																																												-	1143.69	1.07	97.47		2.71	7.39	4.53	233.04	49.9		32.64			283.33	6481.71	10013.69	412.3		18.23					2509.73																		100 for 1st 5 days	10 Coinsurance	100 for 1st 5 days	No Cost Sharing	10 Coinsurance	10 Coinsurance	10 Coinsurance*	50/visit	10 Coinsurance	No Cost Sharing	10 Coinsurance	NAS	NAS	10 Therapy/25 MHSA	15 per Office Visit	30 per Office Visit	25 per Office Visit	NAS	10 Coinsurance		No Cost Sharing		N/A	10 per Office Visit						No Cost Sharing												100	10	100		10	10	6	50	10		10			15.74	15	30	25		10					10																			100	10	100		10	10	6	50	10		10			15.74	15	30	25		10					10																			9.53	0.11	0.81	-	0.27	0.74	0.27	0.97	4.99	-	3.26	-	-	0.37	8.1	25.03	0.86	-	1.82	-	-	-	-	2.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.24	9.53	0.11	0.81	-	0.27	0.74	0.27	0.97	4.99	-	3.26	-	-	0.37	8.1	25.03	0.86	-	1.82	-	-	-	-	2.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.24
H3920_002_0	2006																							D						V						V	V	V	V			V				V																																																												-		24.05						229.01						14.11	6414.17	9685.09	356.73			262.62				1911.19																		No Cost Sharing	25/Day - 1st 5 days	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	50/visit	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	25 Mental Health	5  per Office Visit	20 per Office Visit	25 per Office Visit	NAS	No Cost Sharing	10	No Cost Sharing		N/A	5 per Office Visit						No Cost Sharing													25						50						25	5	20	25			10				5																				25						50						25	5	20	25			10				5																			-	0.05	-	-	-	-	-	0.95	-	-	-	-	-	0.03	2.67	16.14	0.74	-	-	0.22	-	-	-	0.8	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.61	-	0.05	-	-	-	-	-	0.95	-	-	-	-	-	0.03	2.67	16.14	0.74	-	-	0.22	-	-	-	0.8	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.61
H3920_003_0	2006																						A	A	D		Coin	Coin	Coin	Coin	Coin		Coin			Coin	Coin	Coin	Coin	Coin	Coin		Coin																										0.07	0.19	0.11	0.37	1.26	0.16	0.83			1.4	0.65	2.68	0.04		0.49		0.47																					8.73	377.48	5.39	230.98		3.44	9.35	5.74	18.5	63.19		41.34			70.2	32.49	134.08	1.91		24.55		23.55			0																		956/Admission	956/Admission	119.75/Day > 20 Days	No Cost Sharing	20 Coinsurance	20 Coinsurance	20 Coinsurance	20 Coinsurance	20 Coinsurance	No Cost Sharing	20 Coinsurance	NAS	NAS	20 Coinsurance	20 Coinsurance	20 Coinsurance	20 Coinsurance	NAS	20 Coinsurance		20 Coinsurance		N/A	N/A	N/A					No Cost Sharing												956	956	119.5		0.2	0.2	0.2	0.2	0.2		0.2			0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																						956	956	119.5		0.2	0.2	0.2	0.2	0.2		0.2			0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																					123	30.07	0.43	2.3	-	0.69	1.87	1.15	3.7	12.64	-	8.27	-	-	14.04	6.5	26.82	0.38	-	4.91	-	4.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	118.47	30.07	0.43	2.3	-	0.76	2.06	1.26	4.07	13.9	0.16	9.09	-	-	15.44	7.15	29.5	0.42	-	5.4	-	5.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	127.2
H3921_001_0	2006											2800											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1573.42	80.48	778.65	0	168.73	8.42	11.74	258.22	28.14	0	19.36	1.64	0.22	17.39	3955.04	5044.83	214.84	3.38	18.99	406.97	21.07	0			117.8		210.9															295	175	150	0	150	20	20	50	20	0	0/20	20	30	20/40/20/10	Oct-00	20	20/10	20	0/20	0/20	30	0			20		20															295	175	150	0	150	0.2	0.2	50	0.2	0	0.17	0.2	0.3	0.2	10	18.46	17.5	0.2	0.11	0.29	0.3	0			20		20																164.82	97.77	83.81	0	83.81	0.11	0.11	27.94	0.11	0	0.09	0.11	0.17	0.11	10	18.46	17.5	0.11	0.06	0.29	0.17	0			20		20																21.61	0.66	5.44	-	1.18	0.94	1.31	0.6	3.14	-	1.8	0.18	0.04	1.92	3.3	7.76	0.31	0.38	1.14	0.01	3.53	-			0.2		0.35															55.8	21.61	0.66	5.44	-	1.18	0.94	1.31	0.6	3.14	-	1.8	0.18	0.04	1.92	3.3	7.76	0.31	0.38	1.14	0.01	3.53	-			0.2		0.35															55.8
H3921_003_0	2006											2300											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1566.68	80.14	775.32	0	168.01	8.35	11.64	257.12	27.9	0	19.19	1.63	0.22	17.24	3938.41	5023.53	213.92	3.35	18.82	405.23	20.89	0			117.8		210.9															200	175	120	0	150	30	30	50	20	0	0/20	20	30	20/40/20/10	Oct-00	20	20/10	20	0/20	0/20	30	0			20		20															200	175	120	0	150	0.3	0.3	50	0.2	0	0.17	0.2	0.3	0.21	10	18.46	17.5	0.2	0.11	0.3	0.3	0			20		20																110.72	96.88	66.43	0	83.04	0.17	0.17	27.68	0.11	0	0.09	0.11	0.17	0.12	10	18.46	17.5	0.11	0.06	0.3	0.17	0			20		20																14.45	0.65	4.29	-	1.16	1.39	1.93	0.59	3.09	-	1.77	0.18	0.04	1.99	3.28	7.73	0.31	0.37	1.12	0.01	3.47	-			0.2		0.35															48.37	14.45	0.65	4.29	-	1.16	1.39	1.93	0.59	3.09	-	1.77	0.18	0.04	1.99	3.28	7.73	0.31	0.37	1.12	0.01	3.47	-			0.2		0.35															48.37
H3921_005_0	2006											2650											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1573.42	80.48	778.65	0	168.73	8.42	11.74	258.22	28.14	0	19.36	1.64	0.22	17.39	3955.04	5044.83	214.84	3.38	18.99	406.97	21.07	0			117.8		210.9															265	175	125	0	150	20	20	50	20	0	0/20	20	20	20/40/20/10	May-00	10	20/10	20	0/20	0/10	20	0			10		10															265	175	125	0	150	0.2	0.2	50	0.2	0	0.17	0.2	0.2	0.2	5	9.23	17.5	0.2	0.11	0.29	0.2	0			10		10																151.16	99.82	71.3	0	85.56	0.11	0.11	28.52	0.11	0	0.1	0.11	0.11	0.11	5	9.23	17.5	0.11	0.06	0.29	0.11	0			10		10																19.82	0.67	4.63	-	1.2	0.96	1.34	0.61	3.21	-	1.84	0.19	0.02	1.96	1.65	3.88	0.31	0.39	1.16	0.01	2.4	-	-	-	0.1	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.53	19.82	0.67	4.63	-	1.2	0.96	1.34	0.61	3.21	-	1.84	0.19	0.02	1.96	1.65	3.88	0.31	0.39	1.16	0.01	2.4	-	-	-	0.1	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.53
H3921_006_0	2006											1800											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1566.68	80.14	775.32	0	168.01	8.35	11.64	257.12	27.9	0	19.19	1.63	0.22	17.24	3938.41	5023.53	213.92	3.35	18.82	405.23	20.89	0			117.8		210.9															195	175	75	0	150	20	20	50	10	0	0/10	10	20	10/40/20/10	May-00	10	20/10	10	0/10	0/10	20	0			10		10															195	175	75	0	150	0.2	0.2	50	0.1	0	0.08	0.1	0.2	0.12	5	9.23	17.5	0.1	0.05	0.3	0.2	0			10		10																108.61	97.47	41.77	0	83.55	0.11	0.11	27.85	0.06	0	0.05	0.06	0.11	0.07	5	9.23	17.5	0.06	0.03	0.3	0.11	0			10		10																14.18	0.65	2.7	-	1.17	0.93	1.3	0.6	1.55	-	0.89	0.09	0.02	1.16	1.64	3.86	0.31	0.19	0.56	0.01	2.33	-	-	-	0.1	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.42	14.18	0.65	2.7	-	1.17	0.93	1.3	0.6	1.55	-	0.89	0.09	0.02	1.16	1.64	3.86	0.31	0.19	0.56	0.01	2.33	-	-	-	0.1	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.42
H3921_801_0	2006											3000											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1655.57	74.6	810.13	0	173.68	8.69	12.26	266.72	30.29	2376.15	24.06	1.72	0.13	18.4	4232.29	5436.82	216.31	3.56	20.42	440.96	22.99	0			126.64		226.72															195	175	150	0	150	30	30	50	30	20	20/30	30	30	30/40/30	35/0	35	40/30	30	0/30	0/35	30	0			35		35															195	175	150	0	150	0.3	0.3	50	0.3	20	0.24	0.3	0.3	0.3	35	32.34	37.5	0.3	0.29	0.27	0.3	0			35		35																107.73	96.68	82.87	0	82.87	0.17	0.17	27.62	0.17	11.05	0.13	0.17	0.17	0.16	35	32.34	37.5	0.17	0.16	0.27	0.17	0			35		35																14.86	0.6	5.59	-	1.2	1.44	2.03	0.61	5.02	2.19	3.2	0.29	0.02	3.01	12.34	14.65	0.68	0.59	3.26	0.01	3.81	-			0.37		0.66															76.44	14.86	0.6	5.59	-	1.2	1.44	2.03	0.61	5.02	2.19	3.2	0.29	0.02	3.01	12.34	14.65	0.68	0.59	3.26	0.01	3.81	-			0.37		0.66															76.44
H3923_001_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	Coin	P	T																			5000																																										-	455.49		1560.28		272.35	27.11		269.69	360.73					584.44	3688.34	5242.64	141.93			342	6.45	6689	171.44																			250 Adm Copay	250	25/Day		50	20 Coins	20 Coins	50 (WIA)	50		20			20 S/A OP Rehab Svc Office Visit	20 Office Visit	20 Office Visit	20 Office Visit		20 Office Visit	R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance		25				20 Office Visit															250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				9.49	-	3.25	-	1.13	5.42	-	1.12	1.5	-	-	-	-	0.97	6.15	8.74	0.24	-	-	0.57	1.29	11.15	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.39	9.49	-	3.25	-	1.13	5.42	-	1.12	1.5	-	-	-	-	0.97	6.15	8.74	0.24	-	-	0.57	1.29	11.15	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.39
H3923_002_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	coin	P	T																			5000																																										-	495.88		1697.57		403.03	18.56		211.69	384.34					823.16	3361.87	4504.17	140.59			324.96	5.03	6689	171.44																			250 Adm Copay	250	25/Day		50	20 Coins	20 Coins	50 (WIA)	50		20			20 S/A OP Rehab Svc Office Visit	20 Office Visit	20 Office Visit	20 Office Visit		20 Office Visit	R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance		25				20 Office Visit															250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				10.33	-	3.54	-	1.68	3.71	-	0.88	1.6	-	-	-	-	1.37	5.6	7.51	0.23	-	-	0.54	1.01	11.15	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.51	10.33	-	3.54	-	1.68	3.71	-	0.88	1.6	-	-	-	-	1.37	5.6	7.51	0.23	-	-	0.54	1.01	11.15	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.51
H3923_003_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	coin	P	T																			5000																																										-	541.52		2221.67		422.27	25.12		381.82	426.49					716.47	3101.79	4136.77	141.93			324.96	4.87	6689	171.44																			250 Adm Copay		25/Day		50	20 Coins	20 Coins	50 (WIA)	50					20 S/A OP Rehab Svc Office Visit	20 Office Visit	20 Office Visit	20 Office Visit			R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance	20	25				20 Office Visit															250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				11.28	-	4.63	-	1.76	5.02	-	1.59	1.78	-	-	-	-	1.19	5.17	6.89	0.24	-	-	0.54	0.97	11.15	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.58	11.28	-	4.63	-	1.76	5.02	-	1.59	1.78	-	-	-	-	1.19	5.17	6.89	0.24	-	-	0.54	0.97	11.15	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.58
H3923_004_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	coin	P	T																			5000																																										-	479.07		1678.96		436.63	23.82		260.46						684.44	3509.16	4860.42	141.45			334.07	5.77	6689	171.44																			250 Adm Copay	250	25/Day		50	20 Coins	20 Coins	50 (WIA)	50		20			20 S/A OP Rehab Svc Office Visit	20 Office Visit	20 Office Visit	20 Office Visit		20 Office Visit	R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance		25				20 Office Visit															250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				9.98	-	3.5	-	1.82	4.76	-	1.09	-	-	-	-	-	1.14	5.85	8.1	0.24	-	-	0.56	1.15	11.15	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.69	9.98	-	3.5	-	1.82	4.76	-	1.09	-	-	-	-	-	1.14	5.85	8.1	0.24	-	-	0.56	1.15	11.15	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.69
H3923_801_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	Coin	P	T																																																													-	223.48		892.4		272.35	18.97		243.59	360.73					584.44	3568.45	3630.72	140.59			318.22	9.31	6860.51	171.44																																																												250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				4.66	-	1.86	-	1.13	3.79	-	1.01	1.5	-	-	-	-	0.97	5.95	6.05	0.23	-	-	0.53	1.86	11.43	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.35	4.66	-	1.86	-	1.13	3.79	-	1.01	1.5	-	-	-	-	0.97	5.95	6.05	0.23	-	-	0.53	1.86	11.43	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.35
H3923_802_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	Coin	P	T																																																													-	223.48		892.4		272.35	18.97		243.59	360.73					584.44	3568.45	3630.72	140.59			318.22	9.31	6860.51	171.44																																																												250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				4.66	-	1.86	-	1.13	3.79	-	1.01	1.5	-	-	-	-	0.97	5.95	6.05	0.23	-	-	0.53	1.86	11.43	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.35	4.66	-	1.86	-	1.13	3.79	-	1.01	1.5	-	-	-	-	0.97	5.95	6.05	0.23	-	-	0.53	1.86	11.43	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.35
H3923_803_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	Coin	P	T																																																													-	223.48		892.4		272.35	18.97		243.59	360.73					584.44	3568.45	3630.72	140.59			318.22	9.31	6860.51	171.44																																																												250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				4.66	-	1.86	-	1.13	3.79	-	1.01	1.5	-	-	-	-	0.97	5.95	6.05	0.23	-	-	0.53	1.86	11.43	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.35	4.66	-	1.86	-	1.13	3.79	-	1.01	1.5	-	-	-	-	0.97	5.95	6.05	0.23	-	-	0.53	1.86	11.43	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.35
H3923_804_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	Coin	P	T																																																													-	223.48		892.4		272.35	18.97		243.59	360.73					584.44	3568.45	3630.72	140.59			318.22	9.31	6860.51	171.44																																																												250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				250		25		50	0.2		50	50					20	20	20	20			20	0.2	20	25																				4.66	-	1.86	-	1.13	3.79	-	1.01	1.5	-	-	-	-	0.97	5.95	6.05	0.23	-	-	0.53	1.86	11.43	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.35	4.66	-	1.86	-	1.13	3.79	-	1.01	1.5	-	-	-	-	0.97	5.95	6.05	0.23	-	-	0.53	1.86	11.43	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.35
H3924_001_0	2006											3000											Coin	Coin	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin			V		V															Unlimited	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	248.4	2.65	36.12	1736.83	249.77	19.37	1.35	457.91	22.71	8.88	24.13	0	6.73	23.9	25.16	6188.55	1.86	1.96	23.75	119.6	16.07	2.04	0	0	377.32	0	161.71	0	0	0	0											15 Coin	15 Coin	15 Coin	10/Visit	100/Trip	15 Coin	15 Coin	50/Visit; 15 Urgent Care	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	15 Coin	15 Coin or 15/Visit or 25/Visit	15 Coin	15 Coin	15 Coin	15 Coin	15 Coin	15 Coin			15/Visit		15/Visit															0.15	0.15	0.15	10	100	0.15	0.15	46.25	0.15	0.15	0.15	0	0.15	0.15	0.15	14.53	0.15	0.15	0.15	0.15	0.15	0.15	0	0	15	0	15	0	0	0	0											Unlimited	0.09	0.09	0.09	6.3	63.05	0.09	0.09	29.16	0.09	0.09	0.09	0	0.09	0.09	0.09	9.16	0.09	0.09	0.09	0.09	0.09	0.09	0	0	9.46	0	9.46	0	0	0	0											0	23.49	0.25	3.42	0.91	1.31	1.83	0.13	1.11	2.15	0.84	2.28	-	0.64	2.26	2.38	4.72	0.18	0.18	2.25	11.31	1.52	0.19	-	-	0.3	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.78	23.49	0.25	3.42	0.91	1.31	1.83	0.13	1.11	2.15	0.84	2.28	-	0.64	2.26	2.38	4.72	0.18	0.18	2.25	11.31	1.52	0.19	-	-	0.3	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.78
H3924_002_0	2006											3000											Coin	Coin	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin			V		V															Unlimited	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	248.4	2.65	36.12	1736.83	249.77	19.37	1.35	457.91	22.71	8.88	24.13	0	6.73	23.9	25.16	6188.55	1.86	1.96	23.75	119.6	16.07	2.04	0	0	377.32	0	161.71	0	0	0	0											15 Coin	15 Coin	15 Coin	10/Visit	100/Trip	15 Coin	15 Coin	50/Visit; 15 Urgent Care	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	15 Coin	15 Coin or 15/Visit or 25/Visit	15 Coin	15 Coin	15 Coin	15 Coin	15 Coin	15 Coin			15/Visit		15/Visit															0.15	0.15	0.15	10	100	0.15	0.15	46.25	0.15	0.15	0.15	0	0.15	0.15	0.15	14.53	0.15	0.15	0.15	0.15	0.15	0.15	0	0	15	0	15	0	0	0	0											Unlimited	0.09	0.09	0.09	6.3	63.05	0.09	0.09	29.16	0.09	0.09	0.09	0	0.09	0.09	0.09	9.16	0.09	0.09	0.09	0.09	0.09	0.09	0	0	9.46	0	9.46	0	0	0	0											0	23.49	0.25	3.42	0.91	1.31	1.83	0.13	1.11	2.15	0.84	2.28	-	0.64	2.26	2.38	4.72	0.18	0.18	2.25	11.31	1.52	0.19	-	-	0.3	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.78	23.49	0.25	3.42	0.91	1.31	1.83	0.13	1.11	2.15	0.84	2.28	-	0.64	2.26	2.38	4.72	0.18	0.18	2.25	11.31	1.52	0.19	-	-	0.3	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.78
H3924_003_0	2006											3000											Coin	Coin	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin			V		V															Unlimited	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	248.4	2.65	36.12	1736.83	249.77	19.37	1.35	457.91	22.71	8.88	24.13	0	6.73	23.9	25.16	6188.55	1.86	1.96	23.75	119.6	16.07	2.04	0	0	377.32	0	161.71	0	0	0	0											15 Coin	15 Coin	15 Coin	10/Visit	100/Trip	15 Coin	15 Coin	50/Visit; 15 Urgent Care	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	15 Coin	15 Coin or 15/Visit or 25/Visit	15 Coin	15 Coin	15 Coin	15 Coin	15 Coin	15 Coin			15/Visit		15/Visit															0.15	0.15	0.15	10	100	0.15	0.15	46.25	0.15	0.15	0.15	0	0.15	0.15	0.15	14.53	0.15	0.15	0.15	0.15	0.15	0.15	0	0	15	0	15	0	0	0	0											Unlimited	0.09	0.09	0.09	6.3	63.05	0.09	0.09	29.16	0.09	0.09	0.09	0	0.09	0.09	0.09	9.16	0.09	0.09	0.09	0.09	0.09	0.09	0	0	9.46	0	9.46	0	0	0	0											0	23.49	0.25	3.42	0.91	1.31	1.83	0.13	1.11	2.15	0.84	2.28	-	0.64	2.26	2.38	4.72	0.18	0.18	2.25	11.31	1.52	0.19	-	-	0.3	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.78	23.49	0.25	3.42	0.91	1.31	1.83	0.13	1.11	2.15	0.84	2.28	-	0.64	2.26	2.38	4.72	0.18	0.18	2.25	11.31	1.52	0.19	-	-	0.3	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.78
H3924_004_0	2006											3000											Coin	Coin	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin			V		V															Unlimited	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	248.4	2.65	36.12	1736.83	249.77	19.37	1.35	457.91	22.71	8.88	24.13	0	6.73	23.9	25.16	6188.55	1.86	1.96	23.75	119.6	16.07	2.04	0	0	377.32	0	161.71	0	0	0	0											15 Coin	15 Coin	15 Coin	10/Visit	100/Trip	15 Coin	15 Coin	50/Visit; 15 Urgent Care	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	15 Coin	15 Coin or 15/Visit or 25/Visit	15 Coin	15 Coin	15 Coin	15 Coin	15 Coin	15 Coin			15/Visit		15/Visit															0.15	0.15	0.15	10	100	0.15	0.15	46.25	0.15	0.15	0.15	0	0.15	0.15	0.15	14.53	0.15	0.15	0.15	0.15	0.15	0.15	0	0	15	0	15	0	0	0	0											Unlimited	0.09	0.09	0.09	6.3	63.05	0.09	0.09	29.16	0.09	0.09	0.09	0	0.09	0.09	0.09	9.16	0.09	0.09	0.09	0.09	0.09	0.09	0	0	9.46	0	9.46	0	0	0	0											0	23.49	0.25	3.42	0.91	1.31	1.83	0.13	1.11	2.15	0.84	2.28	-	0.64	2.26	2.38	4.72	0.18	0.18	2.25	11.31	1.52	0.19	-	-	0.3	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.78	23.49	0.25	3.42	0.91	1.31	1.83	0.13	1.11	2.15	0.84	2.28	-	0.64	2.26	2.38	4.72	0.18	0.18	2.25	11.31	1.52	0.19	-	-	0.3	-	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.78
H3931_004_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1715.84		1340.57	1240.72	247.56	12.46		262.74	78.38	431.95	296.08		141.92	274.7	5064.3	4428.17	0.74	77.07	0.19	330.77	282.61																					250 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	20	47.36		20	20	10	20	20	20	2000	20	45																					40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						5.83	-	9.05	2.07	2.06	2.49	-	1.05	0.65	0.72	1.17	-	0.24	0.46	4.22	7.38	0	0.13	0	0.55	1.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.13	5.83	-	9.05	2.07	2.06	2.49	-	1.05	0.65	0.72	1.17	-	0.24	0.46	4.22	7.38	0	0.13	0	0.55	1.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.13
H3931_054_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1946.69		1337.3	1237.69	246.96	12.3		262.1	78.19	489.23	319.53		140.78	311.12	6742.52	4941.35	0.83	86	0.21	369.1	285.6																					150/day up to 8 days		0 1-10 75/day 11-100	20	100	0		48	100	25	40.39		25	25	0	25	25	25	2500	25	45				0		0			0												113.69		47.6	20	100	0.2		48	100	25	40.39		25	25	0	25	25	25	25	25	45				0		0			0													113.69		47.6	20	100	0.2		48	100	25	40.39		25	25	0	25	25	25	25	25	45				0		0			0													18.44	-	5.3	2.06	2.06	2.46	-	1.05	0.65	1.02	1.08	-	0.29	0.65	-	10.29	0	0.18	0	0.77	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.38	18.44	-	5.3	2.06	2.06	2.46	-	1.05	0.65	1.02	1.08	-	0.29	0.65	-	10.29	0	0.18	0	0.77	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.38
H3931_055_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1690.44		1354.76	1253.85	250.18	12.3		265.52	79.21	431.64	297.61		141.82	274.5	5051.53	4379.84	0.73	76.23	0.18	327.16	285.6																					750 per admission		0 1-10 75/day 11-100	20	100	0		48	100	30	43.68		30	30	15	30	30	30	3000	30	45																					122.35		47.6	20	100	0.2		48	100	30	43.68		30	30	15	30	30	30	30	30	45																						122.35		47.6	20	100	0.2		48	100	30	43.68		30	30	15	30	30	30	30	30	45																						17.24	-	5.37	2.09	2.08	2.46	-	1.06	0.66	1.08	1.08	-	0.35	0.69	6.31	10.95	0	0.19	0	0.82	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.51	17.24	-	5.37	2.09	2.08	2.46	-	1.06	0.66	1.08	1.08	-	0.35	0.69	6.31	10.95	0	0.19	0	0.82	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.51
H3931_058_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1986.62		1337.3	1237.69	246.96	12.38		262.1	78.19	491.98	319.72		141.57	312.87	5993.35	4994.48	0.84	86.92	0.21	373.07	285.6																					250 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	20	47.36		20	20	10	20	20	20	2000	20	45				0		0															40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45				0		0																40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45				0		0																6.75	-	9.03	2.06	2.06	2.48	-	1.05	0.65	0.82	1.26	-	0.24	0.52	4.99	8.32	0	0.14	0	0.62	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.07	6.75	-	9.03	2.06	2.06	2.48	-	1.05	0.65	0.82	1.26	-	0.24	0.52	4.99	8.32	0	0.14	0	0.62	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.07
H3931_060_0	2006											4000											Coin		D	V	T	Coin		P	Coin	P	P		P	P	V	V	V	V	V	V	S																						16.13					0.54			0.58																																	17.25	372.38		1337.3	1237.69	246.96	12.38		262.1	13.29	491.98	319.72		141.57	312.87	5993.35	4994.48	0.84	86.92	0.21	373.07	285.6																					0.15		0 1-7 75 8-14 125 15-100	20	100	0		48	0	20	47.36		20	20	10	20	20	20	2000	20	45																					0.15		81.02	20	100	0.2		48	0.15	20	47.36		20	20	10	20	20	20	20	20	45																						0.11		81.02	20	100	0.15		48	0.11	20	47.36		20	20	10	20	20	20	20	20	45																					500	42.64	-	9.03	2.06	2.06	1.89	-	1.05	1.52	0.82	1.26	-	0.24	0.52	4.99	8.32	0	0.14	0	0.62	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.25	58.78	-	9.03	2.06	2.06	2.43	-	1.05	2.1	0.82	1.26	-	0.24	0.52	4.99	8.32	0	0.14	0	0.62	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.49
H3931_063_0	2006											4000											Coin		D	V	T	Coin		P	Coin	P	P		P	P	V	V	V	V	V	V	S																						15.9					0.65			0.7																																	17.25	302.55		1354.76	1253.85	250.18	12.4		265.52	13.31	436.52	299.21		143.42	277.6	5117.92	4475.05	0.75	77.88	0.19	334.27	285.6																					0.15		0 1-7 75 8-14 125 15-100	20	100	0		48	0	20	47.36		20	20	10	20	20	20	2000	20	45																					0.15		81.02	20	100	0.2		48	0.15	20	47.36		20	20	10	20	20	20	20	20	45																						0.11		81.02	20	100	0.15		48	0.11	20	47.36		20	20	10	20	20	20	20	20	45																					500	34.64	-	9.15	2.09	2.08	1.89	-	1.06	1.52	0.73	1.18	-	0.24	0.46	4.26	7.46	0	0.13	0	0.56	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	68.54	50.54	-	9.15	2.09	2.08	2.55	-	1.06	2.22	0.73	1.18	-	0.24	0.46	4.26	7.46	0	0.13	0	0.56	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.79
H3931_064_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1690.44		1354.76	1253.85	250.18	12.3		265.52	79.21	431.64	297.61		141.82	274.5	5051.53	4379.84	0.73	76.23	0.18	327.16	285.6																					750 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	30	43.68		30	30	15	30	30	30	3000	30	45																					122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						17.24	-	9.15	2.09	2.08	2.46	-	1.06	0.66	1.08	1.34	-	0.35	0.69	6.31	10.95	0	0.19	0	0.82	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.54	17.24	-	9.15	2.09	2.08	2.46	-	1.06	0.66	1.08	1.34	-	0.35	0.69	6.31	10.95	0	0.19	0	0.82	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.54
H3931_065_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																																																															-	1946.69		1337.3	1237.69	246.96	12.3		262.1	78.19	489.23	319.53		140.78	311.12	6742.52	4941.35	0.83	86	0.21	369.1	285.6																					150/day up to 8 days		0 1-7 75 8-14 125 15-100	20	100	0		48	100	25	50.65		25	25	0	25	25	25	2500	25	45				0		0			0												113.69		81.02	20	100	0.2		48	100	25	50.65		25	25	0	25	25	25	25	25	45				0		0			0													113.69		81.02	20	100	0.2		48	100	25	50.65		25	25	0	25	25	25	25	25	45				0		0			0													18.44	-	9.03	2.06	2.06	2.46	-	1.05	0.65	1.02	1.35	-	0.29	0.65	-	10.29	0	0.18	0	0.77	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.38	18.44	-	9.03	2.06	2.06	2.46	-	1.05	0.65	1.02	1.35	-	0.29	0.65	-	10.29	0	0.18	0	0.77	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.38
H3931_801_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	Coin																																																															-	1985.5		1392.45	1221.18	254.49	12.3		267.18	79.73	500.75	325.93		144.1	318.45	5404.16	4982.59	0.83	86.72	0.21	372.18	7.37																					200/day up to 7 days		35/day	35	150	0		50	150	35	46.97		35	35	35	35	35	35	3500	35	0.2																					143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																						143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																					0	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.57	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.57
H3931_804_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	Coin																																																															-	1985.5		1392.45	1221.18	254.49	12.3		267.18	79.73	500.75	325.93		144.1	318.45	5404.16	4982.59	0.83	86.72	0.21	372.18	7.16																					200/day up to 7 days		35/day	35	150	0		50	150	35	46.97		35	35	35	35	35	35	3500	35	0.2																					143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																						143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																					0	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.53	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.53
H3931_805_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	Coin																																																															-	1985.5		1392.45	1221.18	254.49	12.3		267.18	79.73	500.75	325.93		144.1	318.45	5404.16	4982.59	0.83	86.72	0.21	372.18	7.11																					200/day up to 7 days		35/day	35	150	0		50	150	35	46.97		35	35	35	35	35	35	3500	35	0.2																					143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																						143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																					0	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.52	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.52
H3949_002_0	2006																						D	D	Coin	Coin	T	P	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P								0				0	0	0	0		0	0		0		0																					0	3025.95	97.79	45.44	0	626.36	1069.87	7.14	578.2	515.44	0	55.05	0.64	0.2	22.63	0	145.84	3.24	1185.26	15.7	2.16	19.51	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1-8:100; 9-90:0	1-8:100; 9-90:0	mcare ffs ded/coin	0	50	25	mcare ffs ded/coin	50	0/200	0	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	25/50/mcare ffs ded/coin	0	25/mcare ffs ded/coin	mcare ffs ded/coin	25	mcare ffs ded/coin	0 for NP/mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				83.4	80.13	0.16	0	50	25	0.23	50	157.5	0	0.23	0.23	0.23	0.24	0	0.21	0.23	25	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		83.4	80.13	0.16	0	50	25	0.23	50	157.5	0	0.23	0.23	0.23	0.24	0	0.21	0.23	25	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	21.03	0.65	7.38	-	2.61	2.23	1.66	2.41	6.77	-	12.83	0.15	0.05	5.32	-	30.64	0.75	2.47	3.66	0.5	4.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	105.65	21.03	0.65	7.38	-	2.61	2.23	1.66	2.41	6.77	-	12.83	0.15	0.05	5.32	-	30.64	0.75	2.47	3.66	0.5	4.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	105.65
H3949_009_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P					0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	451.92	6.04	45.43	0	9.16	19.08	9.3	762.62	53.73	12.36	42.85	0.87	0.05	23.27	10.18	182.42	3.51	4.21	17.42	2.49	13.82	0.24	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	50	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	0 ER phys/mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin																				0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.16	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.16	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	28.47	0.38	7.37	-	2.13	4.44	2.17	3.18	12.52	2.88	9.98	0.2	0.01	5.42	2.37	42.5	0.57	0.98	4.06	0.58	3.22	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	133.51	28.47	0.38	7.37	0	2.13	4.45	2.17	3.18	12.52	2.88	9.98	0.2	0.01	5.42	2.37	42.5	0.57	0.98	4.06	0.58	3.22	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	133.51
H3949_011_0	2006																						D	D	Coin	V	T	Coin	Coin	V	V	P	Coin	Coin	Coin	Coin	V	V	V	V	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P							0	0				0	0	0	0						0	0																					0	2218.59	68.6	63.11	0	218.6	11.79	15.42	330.25	312.93	0	24.91	2.31	0.98	23.18	0	4358.9	305.1	596.35	0	9043.05	19.56	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	In 0/OON Med Ded	In 0/OON Med Ded	21-100:114 (SA Med)	0	100	med ded/coins	med ded/coins	50	0 @ ASC;310 @ hosp	0	med ded/coins	med ded/coins	med ded/coins	med ded/coins		25	25	25	0	med ded/coins	med ded/coins																					12.56	6.66	0.17	0	100	0.24	0.24	50	340	0	0.24	0.24	0.24	0.16	0	25	25	25	0	26.15	0.24	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		12.56	6.66	0.17	0	100	0.24	0.24	50	340	0	0.24	0.24	0.24	0.16	0	25	25	25	0	26.15	0.24	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	2.32	0.04	10.82	-	1.82	2.85	3.73	1.38	8.87	-	6.03	0.56	0.24	3.67	-	9.08	0.64	1.24	-	19.71	4.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.72	2.32	0.04	10.82	-	1.82	2.85	3.73	1.38	8.87	-	6.03	0.56	0.24	3.67	-	9.08	0.64	1.24	-	19.71	4.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.72
H3952_008_0	2006																						D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V																																																									-	1733.6	10.1	1218.4		331.5	13.91	3.48	313.3	324.1					27.9	6605.8	4575	322.2	428			6.1	695.9		797.1	520.4		33.6															100/day 10 day  Max	100/day 10 day  Max	25/Day 100 day limit		50	20 coin	20 coin	40	100					25	10	25	25	25			25	25		10	25		25																																																									100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	9.53	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.96	14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	9.53	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.96
H3952_009_0	2006																						D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V																																																									-	1423.9	4.7	1215.9		311.8	11.17	2.79	242.5	409.1					112.6	6428.1	4844.5	309.9	432.9			5	615.1		797.1	499.2		40															100/day 10 day Max	100/day 10 day Max	25/ day		50	20  Coin	20  Coin	40	150					25	10	25	25	25			25	25		10	25		25																																																									100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	10.09	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.76	11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	10.09	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.76
H3952_018_0	2006	Professional											Podiatry										bp	bp	d		coin	coin	coin	coin	coin	coin	v	coin	coin	coin	v	coin	v	v	coin	coin	o	coin			v		v					v																																																				-	332.02	4.03	363.57		16.49	15.06	3.77	29.55	66.13	78.81	276	1.25	2.38	13.28	9336	28.62	486	624	36.25	119.71	30	5.91			750		24					1188												117.5/day days 21-100																																									117.5		0.2	0.2	0.2	0.2	0.2	0.2	20	0.2	0.2	0.2	10	0.2	20	20	0.2	0.2	20	0.2			20		20					20											912	912	117.5		0.2	0.2	0.2	0.2	0.2	0.2	20	0.2	0.2	0.2	10	0.2	20	20	0.2	0.2	20	0.2			20		20					20											25.23	0.31	3.56	-	3.3	3.01	0.75	5.91	13.23	15.76	0.46	0.25	0.48	2.66	7.78	5.72	0.81	1.04	7.25	23.94	0.05	1.18	-	-	1.25	-	0.04	-	-	-	-	1.98	-	-	-	-	-	-	-	-	-	125.95	25.23	0.31	3.56	-	3.3	3.01	0.75	5.91	13.23	15.76	0.46	0.25	0.48	2.66	7.78	5.72	0.81	1.04	7.25	23.94	0.05	1.18	-	-	1.25	-	0.04	-	-	-	-	1.98	-	-	-	-	-	-	-	-	-	125.95
H3952_020_0	2006																						d	d	d		t	Coin	Coin	v	v					v	v	v	v	v			o	p		v	v		v																																																									-	1600	9.9	1098.3		268.2	13.63	3.41	303.9	335.1					35.5	6598.2	4795.2	325.9	424.6			52.4	634.9		797.1	521.1		28.5															100/day 10 day max	100/day 10 day max	25/day		50	20 Coin	20 Coin	40	150					25	10	25	25	25			25	25		10	25		25																																																									100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																13.33	0.08	2.29	-	1.12	2.73	0.68	1.01	4.19	-	-	-	-	0.07	5.5	9.99	0.68	0.88	-	-	0.11	1.32	-	0.66	1.09	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.8	13.33	0.08	2.29	-	1.12	2.73	0.68	1.01	4.19	-	-	-	-	0.07	5.5	9.99	0.68	0.88	-	-	0.11	1.32	-	0.66	1.09	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.8
H3952_024_0	2006																						D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V	V	V	V		V																																																									-	1560.6	7.7	1319.2		298.8	12.9	3.22	270.9	400					89.5	6414.4	5091.1	313.4	859.7			38.5	544.6		797.1	816		33.9																																																																																																		100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																13.01	0.06	2.75	-	1.25	2.58	0.64	0.9	5	-	-	-	-	0.19	5.35	10.61	0.65	1.79	-	-	0.08	1.13	-	0.66	1.7	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.42	13.01	0.06	2.75	-	1.25	2.58	0.64	0.9	5	-	-	-	-	0.19	5.35	10.61	0.65	1.79	-	-	0.08	1.13	-	0.66	1.7	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.42
H3952_025_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H3952_026_0	2006																						D	D	coin		coin			coin	coin	coin	V	coin	coin	coin	V	V	V	V	coin	coin	S	coin		V	V		V																																																									-	1312.35	7.65	29.37		6.35			9.51	50.6	39	840	0.62	1.18	6.57	5724	4008	282	372	27.65	91.35	4.8	4.96		696	456		30																																																								150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																16.4	0.1	2.94	-	0.63	-	-	0.95	5.06	3.9	1.4	0.06	0.12	0.66	4.77	6.68	0.47	0.62	2.77	9.14	0.01	0.5	-	0.58	0.76	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.56	16.4	0.1	2.94	-	0.63	-	-	0.95	5.06	3.9	1.4	0.06	0.12	0.66	4.77	6.68	0.47	0.62	2.77	9.14	0.01	0.5	-	0.58	0.76	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.56
H3952_027_0	2006																						D	D	COIN		COIN			COIN	COIN	COIN	P	COIN	COIN	COIN	V	V	V	V	COIN	COIN	O	COIN		V	V		V																																																									-	992.72	3.28	24.25		6.74			6.33	52.98	33.15	840	0.53	1	5.59	5124	3906	252	348	27.1	89.6	4.8	4.86		636	402		30															100/200 per day; 5 day max (tiered network)	100/200 per day; 5 day max (tiered network)						10 to 50																																		150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																12.41	0.04	2.43	-	0.67	-	-	0.63	5.3	3.32	1.4	0.05	0.1	0.56	4.27	6.51	0.42	0.58	2.71	8.96	0.01	0.49	-	0.53	0.67	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.1	12.41	0.04	2.43	-	0.67	-	-	0.63	5.3	3.32	1.4	0.05	0.1	0.56	4.27	6.51	0.42	0.58	2.71	8.96	0.01	0.49	-	0.53	0.67	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.1
H3952_028_0	2006																						d	d	d		t	Coin	Coin	v	v					v	v	v	v	v			o	p		v	v		v																																																									-	1600	9.9	1098.3		268.2	13.63	3.41	303.9	335.1					35.5	6598.2	4795.2	325.9	424.6			52.4	634.9		797.1	521.1		28.5															100/day 10 day max	100/day 10 day max	25/day		50	20 Coin	20 Coin	40	150					25	10	25	25	25			25	25		10	25		25																																																									100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																13.33	0.08	2.29	-	1.12	2.73	0.68	1.01	4.19	-	-	-	-	0.07	5.5	9.99	0.68	0.88	-	-	0.11	1.32	-	0.66	1.09	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.8	13.33	0.08	2.29	-	1.12	2.73	0.68	1.01	4.19	-	-	-	-	0.07	5.5	9.99	0.68	0.88	-	-	0.11	1.32	-	0.66	1.09	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.8
H3952_029_0	2006																						D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V	V	V	V		V																																																									-	1560.6	7.7	1319.2		298.8	12.9	3.22	270.9	400					89.5	6414.4	5091.1	313.4	859.7			38.5	544.6		797.1	816		33.9																																																																																																		100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																13.01	0.06	2.75	-	1.25	2.58	0.64	0.9	5	-	-	-	-	0.19	5.35	10.61	0.65	1.79	-	-	0.08	1.13	-	0.66	1.7	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.42	13.01	0.06	2.75	-	1.25	2.58	0.64	0.9	5	-	-	-	-	0.19	5.35	10.61	0.65	1.79	-	-	0.08	1.13	-	0.66	1.7	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.42
H3952_030_0	2006											N/A											D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V															1000																																										-	1733.6	10.1	1218.4		331.5	13.91	3.48	313.3	324.1					27.9	6605.8	5490	322.2	428			6.1	695.9		797.1	520.4		33.6															100/day 10 day  Max	100/day 10 day  Max	25/Day 100 day limit		50	20 coin	20 coin	40	100					25	10	25	25	25			25	25		10	25		25																																																								N/A	100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	11.44	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.87	14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	11.44	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.87
H3952_031_0	2006											N/A											D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V															1000																																										-	1423.9	4.7	1215.9		311.8	11.17	2.79	242.5	409.1					112.6	6428.1	5813.4	309.9	432.9			5	615.1		797.1	499.2		40															100/day 10 day Max	100/day 10 day Max	25/ day		50	20  Coin	20  Coin	40	150					25	10	25	25	25			25	25		10	25		25																																																								N/A	100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	12.11	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.78	11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	12.11	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.78
H3952_032_0	2006											N/A											D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V															1000																																										-	1733.6	10.1	1218.4		331.5	13.91	3.48	313.3	324.1					27.9	6605.8	5490	322.2	428			6.1	695.9		797.1	520.4		33.6															100/day 10 day  Max	100/day 10 day  Max	25/Day 100 day limit		50	20 coin	20 coin	40	100					25	10	25	25	25			25	25		10	25		25																																																								N/A	100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	11.44	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.87	14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	11.44	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.87
H3952_033_0	2006											N/A											D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V															1000																																										-	1423.9	4.7	1215.9		311.8	11.17	2.79	242.5	409.1					112.6	6428.1	5813.4	309.9	432.9			5	615.1		797.1	499.2		40															100/day 10 day Max	100/day 10 day Max	25/ day		50	20  Coin	20  Coin	40	150					25	10	25	25	25			25	25		10	25		25																																																								N/A	100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	12.11	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.78	11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	12.11	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.78
H3952_034_0	2006											N/A											D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V															1000																																										-	1733.6	10.1	1218.4		331.5	13.91	3.48	313.3	324.1					27.9	6605.8	5490	322.2	428			6.1	695.9		797.1	520.4		33.6															100/day 10 day  Max	100/day 10 day  Max	25/Day 100 day limit		50	20 coin	20 coin	40	100					25	10	25	25	25			25	25		10	25		25																																																								N/A	100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	11.44	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.87	14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	11.44	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.87
H3952_035_0	2006											N/A											D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V															1000																																										-	1423.9	4.7	1215.9		311.8	11.17	2.79	242.5	409.1					112.6	6428.1	5813.4	309.9	432.9			5	615.1		797.1	499.2		40															100/day 10 day Max	100/day 10 day Max	25/ day		50	20  Coin	20  Coin	40	150					25	10	25	25	25			25	25		10	25		25																																																								N/A	100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	12.11	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.78	11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	12.11	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.78
H3952_036_0	2006																						D	D	coin		coin			coin	coin	coin	V	coin	coin	coin	V	V	V	V	coin	coin	S	coin		V	V		V																																																									-	1312.35	7.65	29.37		6.35			9.51	50.6	39	840	0.62	1.18	6.57	5724	4008	282	372	27.65	91.35	4.8	4.96		696	456		30																																																								150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																16.4	0.1	2.94	-	0.63	-	-	0.95	5.06	3.9	1.4	0.06	0.12	0.66	4.77	6.68	0.47	0.62	2.77	9.14	0.01	0.5	-	0.58	0.76	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.56	16.4	0.1	2.94	-	0.63	-	-	0.95	5.06	3.9	1.4	0.06	0.12	0.66	4.77	6.68	0.47	0.62	2.77	9.14	0.01	0.5	-	0.58	0.76	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.56
H3952_037_0	2006																						D	D	COIN		COIN			COIN	COIN	COIN	P	COIN	COIN	COIN	V	V	V	V	COIN	COIN	O	COIN		V	V		V																																																									-	992.72	3.28	24.25		6.74			6.33	52.98	33.15	840	0.53	1	5.59	5124	3906	252	348	27.1	89.6	4.8	4.86		636	402		30															100/200 per day; 5 day max (tiered network)	100/200 per day; 5 day max (tiered network)						10 to 50																																		150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																12.41	0.04	2.43	-	0.67	-	-	0.63	5.3	3.32	1.4	0.05	0.1	0.56	4.27	6.51	0.42	0.58	2.71	8.96	0.01	0.49	-	0.53	0.67	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.1	12.41	0.04	2.43	-	0.67	-	-	0.63	5.3	3.32	1.4	0.05	0.1	0.56	4.27	6.51	0.42	0.58	2.71	8.96	0.01	0.49	-	0.53	0.67	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.1
H3952_038_0	2006																						D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V																																																									-	1733.6	10.1	1218.4		331.5	13.91	3.48	313.3	324.1					27.9	6605.8	4575	322.2	428			6.1	695.9		797.1	520.4		33.6															100/day 10 day  Max	100/day 10 day  Max	25/Day 100 day limit		50	20 coin	20 coin	40	100					25	10	25	25	25			25	25		10	25		25																																																									100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	9.53	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.96	14.45	0.08	2.54	-	1.38	2.78	0.7	1.04	4.05	-	-	-	-	0.06	5.5	9.53	0.67	0.89	-	-	0.01	1.45	-	0.66	1.08	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.96
H3952_039_0	2006																						D	D	D		T	Coin	Coin	V	V					V	V	V	V	V			O	V		V	V		V																																																									-	1423.9	4.7	1215.9		311.8	11.17	2.79	242.5	409.1					112.6	6428.1	4844.5	309.9	432.9			5	615.1		797.1	499.2		40															100/day 10 day Max	100/day 10 day Max	25/ day		50	20  Coin	20  Coin	40	150					25	10	25	25	25			25	25		10	25		25																																																									100	100	25		50	0.2	0.2	40	150					25	10	25	25	25			25	25		10	25		25																11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	10.09	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.76	11.87	0.04	2.53	-	1.3	2.23	0.56	0.81	5.11	-	-	-	-	0.23	5.36	10.09	0.65	0.9	-	-	0.01	1.28	-	0.66	1.04	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.76
H3952_040_0	2006																						D	D	coin		coin			coin	coin	coin	V	coin	coin	coin	V	V	V	V	coin	coin	S	coin		V	V		V																																																									-	1312.35	7.65	29.37		6.35			9.51	50.6	39	840	0.62	1.18	6.57	5724	4008	282	372	27.65	91.35	4.8	4.96		696	456		30																																																								150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																16.4	0.1	2.94	-	0.63	-	-	0.95	5.06	3.9	1.4	0.06	0.12	0.66	4.77	6.68	0.47	0.62	2.77	9.14	0.01	0.5	-	0.58	0.76	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.56	16.4	0.1	2.94	-	0.63	-	-	0.95	5.06	3.9	1.4	0.06	0.12	0.66	4.77	6.68	0.47	0.62	2.77	9.14	0.01	0.5	-	0.58	0.76	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.56
H3952_041_0	2006																						D	D	COIN		COIN			COIN	COIN	COIN	P	COIN	COIN	COIN	V	V	V	V	COIN	COIN	O	COIN		V	V		V																																																									-	992.72	3.28	24.25		6.74			6.33	52.98	33.15	840	0.53	1	5.59	5124	3906	252	348	27.1	89.6	4.8	4.86		636	402		30															100/200 per day; 5 day max (tiered network)	100/200 per day; 5 day max (tiered network)						10 to 50																																		150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																150	150	0.1		0.1			0.1	0.1	0.1	20	0.1	0.1	0.1	10	20	20	20	0.1	0.1	25	0.1		10	20		20																12.41	0.04	2.43	-	0.67	-	-	0.63	5.3	3.32	1.4	0.05	0.1	0.56	4.27	6.51	0.42	0.58	2.71	8.96	0.01	0.49	-	0.53	0.67	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.1	12.41	0.04	2.43	-	0.67	-	-	0.63	5.3	3.32	1.4	0.05	0.1	0.56	4.27	6.51	0.42	0.58	2.71	8.96	0.01	0.49	-	0.53	0.67	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.1
H3952_801_0	2006																						coin	coin	coin		coin	coin	coin	coin	coin		coin	coin			coin	coin	coin	coin	coin	coin	O	coin																																																														-	332.71	1.1	30.23		8.85	11.16	2.79	8.28	80.71		17.93	0.76			50.33	32.13	6.69	1.87	40.69	134.39	23.57	8.03																																								Certain Drugs																					0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	25	0.2																					0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	25	0.2																					19.96	0.07	4.84	-	1.77	2.23	0.56	1.66	16.14	-	3.59	0.15	-	-	10.07	6.43	1.34	0.37	8.14	26.88	0.05	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	105.84	19.96	0.07	4.84	-	1.77	2.23	0.56	1.66	16.14	-	3.59	0.15	-	-	10.07	6.43	1.34	0.37	8.14	26.88	0.05	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	105.84
H3952_802_0	2006																						coin	coin	coin		coin	coin	coin	coin	coin		coin	coin			coin	coin	coin	coin	coin	coin	O	coin																																																														-	448.7	2.62	39.73		8.37	17.78	4.45	11.27	76.01		20.11	0.85			49.61	31.67	6.6	1.85	40.11	132.47	44.08	7.52																																								Certain Drugs																					0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	25	0.2																					0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	25	0.2																					26.92	0.16	6.36	-	1.67	3.56	0.89	2.25	15.2	-	4.02	0.17	-	-	9.92	6.33	1.32	0.37	8.02	26.49	0.09	1.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	115.26	26.92	0.16	6.36	-	1.67	3.56	0.89	2.25	15.2	-	4.02	0.17	-	-	9.92	6.33	1.32	0.37	8.02	26.49	0.09	1.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	115.26
H3952_803_0	2006																						coin	coin	coin		coin	coin	coin	coin	coin		coin	coin			coin	coin	coin	coin	coin	coin	O	coin																																																														-	332.71	1.1	30.23		8.85	11.16	2.79	8.28	80.71		17.93	0.76			50.33	32.13	6.69	1.87	40.69	134.39	23.57	8.03																																								Certain Drugs																					0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	25	0.2																					0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	25	0.2																					19.96	0.07	4.84	-	1.77	2.23	0.56	1.66	16.14	-	3.59	0.15	-	-	10.07	6.43	1.34	0.37	8.14	26.88	0.05	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	105.84	19.96	0.07	4.84	-	1.77	2.23	0.56	1.66	16.14	-	3.59	0.15	-	-	10.07	6.43	1.34	0.37	8.14	26.88	0.05	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	105.84
H3952_804_0	2006																						coin	coin	coin		coin	coin	coin	coin	coin		coin	coin			coin	coin	coin	coin	coin	coin	O	coin																																																														-	448.7	2.62	39.73		8.37	17.78	4.45	11.27	76.01		20.11	0.85			49.61	31.67	6.6	1.85	40.11	132.47	44.08	7.52																																								Certain Drugs																					0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	25	0.2																					0.06	0.06	0.16		0.2	0.2	0.2	0.2	0.2		0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	25	0.2																					26.92	0.16	6.36	-	1.67	3.56	0.89	2.25	15.2	-	4.02	0.17	-	-	9.92	6.33	1.32	0.37	8.02	26.49	0.09	1.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	115.26	26.92	0.16	6.36	-	1.67	3.56	0.89	2.25	15.2	-	4.02	0.17	-	-	9.92	6.33	1.32	0.37	8.02	26.49	0.09	1.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	115.26
H3954_003_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1158.49	20.71	891.93	737.28	231.38	10.06	0	920.85	837.87	0	1716.26	0	0	0	3458.21	3844.78	172.86	136.8	292.13	0	14.97	0	0	0	313.33	0	23.31	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	4.83	0.09	1.86	0.61	0.96	1.01	-	3.84	3.49	-	2.57	-	-	-	2.88	6.41	0.29	0.11	0.44	-	1.5	-	-	-	0.52	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.45	4.83	0.09	1.86	0.61	0.96	1.01	-	3.84	3.49	-	2.57	-	-	-	2.88	6.41	0.29	0.11	0.44	-	1.5	-	-	-	0.52	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.45
H3954_004_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1529.48	20.74	1083.31	932.62	292.83	10.03	0	736.53	1190.65	0	2527.08	0	0	0	4441.5	4310.32	172.88	549.23	329.33	0	18.62	0	0	0	378.52	0	4.96	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	6.37	0.09	2.26	0.78	1.22	1	-	3.07	4.96	-	3.79	-	-	-	3.7	7.18	0.29	0.46	0.49	-	1.86	-	-	-	0.63	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.16	6.37	0.09	2.26	0.78	1.22	1	-	3.07	4.96	-	3.79	-	-	-	3.7	7.18	0.29	0.46	0.49	-	1.86	-	-	-	0.63	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.16
H3954_005_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1190.73	20.72	1212.63	865.37	136.54	11.37	0	553.7	721.85	0	1200.77	0	0	0	4110.31	4771.46	172.87	7.37	239.65	0	9.72	0	0	0	229.91	0	1.56	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	4.96	0.09	2.53	0.72	0.57	1.14	-	2.31	3.01	-	1.8	-	-	-	3.43	7.95	0.29	0.01	0.36	-	0.97	-	-	-	0.38	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.51	4.96	0.09	2.53	0.72	0.57	1.14	-	2.31	3.01	-	1.8	-	-	-	3.43	7.95	0.29	0.01	0.36	-	0.97	-	-	-	0.38	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.51
H3954_006_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1320.7	20.71	949.02	1088.39	223.31	14.52	0	828.04	863.05	0	2840.24	0	0	0	4036.08	4924.57	172.81	158	375.55	0	17.42	0	0	0	292.98	0	5.5	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	5.5	0.09	1.98	0.91	0.93	1.45	-	3.45	3.6	-	4.26	-	-	-	3.36	8.21	0.29	0.13	0.56	-	1.74	-	-	-	0.49	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.96	5.5	0.09	1.98	0.91	0.93	1.45	-	3.45	3.6	-	4.26	-	-	-	3.36	8.21	0.29	0.13	0.56	-	1.74	-	-	-	0.49	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.96
H3954_007_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1270.41	20.71	850.62	737.05	263.12	11.7	0	911.95	804.04	0	1710.81	0	0	0	3672.78	4369.64	172.84	483.04	271.06	0	12.34	0	0	0	254.98	0	2.8	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	5.29	0.09	1.77	0.61	1.1	1.17	-	3.8	3.35	-	2.57	-	-	-	3.06	7.28	0.29	0.4	0.41	-	1.23	-	-	-	0.42	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.85	5.29	0.09	1.77	0.61	1.1	1.17	-	3.8	3.35	-	2.57	-	-	-	3.06	7.28	0.29	0.4	0.41	-	1.23	-	-	-	0.42	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.85
H3954_008_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1514.1	20.74	432.8	829.11	132.11	8.93	0	752.85	765.02	0	1241.09	0	0	0	4029.01	3688.6	172.92	1244.82	186.31	0	8.69	0	0	0	133.26	0	3.28	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	6.31	0.09	0.9	0.69	0.55	0.89	-	3.14	3.19	-	1.86	-	-	-	3.36	6.15	0.29	1.04	0.28	-	0.87	-	-	-	0.22	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.82	6.31	0.09	0.9	0.69	0.55	0.89	-	3.14	3.19	-	1.86	-	-	-	3.36	6.15	0.29	1.04	0.28	-	0.87	-	-	-	0.22	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.82
H3954_009_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	201.49	32.71	27.72	749.83	212.15	10.06	3.07	983.48	42.81	25.92	43.82	0.68	0.75	48.72	3541.74	3411.95	162.58	38.97	7.62	7.32	14.67	0.26	0	0	288.85	2.01	82.3	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	27.2	0.12	3.74	0.56	0.8	1.36	0.41	3.69	5.78	3.5	5.92	0.09	0.1	6.58	2.66	5.12	0.24	0.03	1.03	0.99	1.98	0.04	-	-	0.43	0.27	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.76	27.2	0.12	3.74	0.56	0.8	1.36	0.41	3.69	5.78	3.5	5.92	0.09	0.1	6.58	2.66	5.12	0.24	0.03	1.03	0.99	1.98	0.04	-	-	0.43	0.27	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.76
H3954_010_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	266.01	32.75	33.67	948.49	268.49	10.03	1.84	786.62	60.83	30.15	64.53	36.11	0.34	61.02	4548.78	3825.08	162.59	156.45	8.6	8.89	18.25	0.64	0	0	348.95	2.37	17.53	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	35.91	0.12	4.55	0.71	1.01	1.35	0.25	2.95	8.21	4.07	8.71	4.87	0.05	8.24	3.41	5.74	0.24	0.12	1.16	1.2	2.46	0.09	-	-	0.52	0.32	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.29	35.91	0.12	4.55	0.71	1.01	1.35	0.25	2.95	8.21	4.07	8.71	4.87	0.05	8.24	3.41	5.74	0.24	0.12	1.16	1.2	2.46	0.09	-	-	0.52	0.32	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.29
H3954_011_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	207.09	32.72	37.69	880.1	125.19	11.37	2.1	591.36	36.88	31.68	30.66	5.24	0.82	38.15	4209.6	4234.31	162.59	2.1	6.26	16.56	9.52	0.22	0	0	211.95	1.68	5.5	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	27.96	0.12	5.09	0.66	0.47	1.54	0.28	2.22	4.98	4.28	4.14	0.71	0.11	5.15	3.16	6.35	0.24	0	0.84	2.24	1.29	0.03	-	-	0.32	0.23	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.4	27.96	0.12	5.09	0.66	0.47	1.54	0.28	2.22	4.98	4.28	4.14	0.71	0.11	5.15	3.16	6.35	0.24	0	0.84	2.24	1.29	0.03	-	-	0.32	0.23	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.4
H3954_012_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	229.7	32.7	29.5	1106.91	204.75	14.52	2.86	884.37	44.09	32.23	72.53	3.17	1.51	60.4	4133.57	4370.18	162.53	45.01	9.8	7	17.07	0.18	0	0	270.09	2.09	19.41	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	31.01	0.12	3.98	0.83	0.77	1.96	0.39	3.32	5.95	4.35	9.79	0.43	0.2	8.15	3.1	6.56	0.24	0.03	1.32	0.94	2.3	0.02	-	-	0.41	0.28	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.5	31.01	0.12	3.98	0.83	0.77	1.96	0.39	3.32	5.95	4.35	9.79	0.43	0.2	8.15	3.1	6.56	0.24	0.03	1.32	0.94	2.3	0.02	-	-	0.41	0.28	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.5
H3954_013_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	220.95	32.7	26.44	749.59	241.24	11.7	3.12	973.98	41.08	24.65	43.69	6.02	0.86	45.12	3761.5	3877.72	162.56	137.6	7.07	6.03	12.09	0.2	0	0	235.06	1.86	9.89	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	29.83	0.12	3.57	0.56	0.9	1.58	0.42	3.65	5.55	3.33	5.9	0.81	0.12	6.09	2.82	5.82	0.24	0.1	0.96	0.81	1.63	0.03	-	-	0.35	0.25	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.46	29.83	0.12	3.57	0.56	0.9	1.58	0.42	3.65	5.55	3.33	5.9	0.81	0.12	6.09	2.82	5.82	0.24	0.1	0.96	0.81	1.63	0.03	-	-	0.35	0.25	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.46
H3954_014_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	263.33	32.75	13.45	843.22	121.13	8.93	0.87	804.06	39.08	23.05	31.69	0.06	3.62	59.61	4126.33	3273.35	162.64	354.59	4.86	27.47	8.52	2.11	0	0	122.85	1.23	11.59	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	35.55	0.12	1.82	0.63	0.45	1.21	0.12	3.02	5.28	3.11	4.28	0.01	0.49	8.05	3.09	4.91	0.24	0.27	0.66	3.71	1.15	0.29	-	-	0.18	0.17	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.81	35.55	0.12	1.82	0.63	0.45	1.21	0.12	3.02	5.28	3.11	4.28	0.01	0.49	8.05	3.09	4.91	0.24	0.27	0.66	3.71	1.15	0.29	-	-	0.18	0.17	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.81
H3954_015_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	227.04	33.33	18.59	683.64	195.53	8.51	1.39	682.22	43.3	22.37	42.42	14.24	1.06	34.46	3549.73	3187.86	163.62	240.38	6.21	5.77	12.87	0.26	0	0	245.27	2.15	16.48	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	30.65	0.13	2.51	0.51	0.73	1.15	0.19	2.56	5.85	3.02	5.73	1.92	0.14	4.65	2.66	4.78	0.25	0.18	0.84	0.78	1.74	0.04	-	-	0.37	0.29	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.68	30.65	0.13	2.51	0.51	0.73	1.15	0.19	2.56	5.85	3.02	5.73	1.92	0.14	4.65	2.66	4.78	0.25	0.18	0.84	0.78	1.74	0.04	-	-	0.37	0.29	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.68
H3954_018_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	279.87	32.77	21.32	789.74	213.39	13.3	2.16	762.18	48.16	37.97	56.41	2.17	2.46	45.21	3546.54	4882.01	162.63	290.47	7.55	19.35	15.62	0.21	0	0	283.54	1.57	3.39	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	37.78	0.12	2.88	0.59	0.8	1.8	0.29	2.86	6.5	5.13	7.62	0.29	0.33	6.1	2.66	7.32	0.24	0.22	1.02	2.61	2.11	0.03	-	-	0.43	0.21	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.95	37.78	0.12	2.88	0.59	0.8	1.8	0.29	2.86	6.5	5.13	7.62	0.29	0.33	6.1	2.66	7.32	0.24	0.22	1.02	2.61	2.11	0.03	-	-	0.43	0.21	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.95
H3954_019_0	2006											2000											Coin	D	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	242.77	20.09	50.31	1647.38	267.9	19.83	1.38	600.8	30.53	11.94	32.44	0	9.05	32.13	5155.75	5145.18	199.51	266.1	19.88	110.54	14.2	1.82	0	0	336.78	0	144.33	0	0	0	0											15 Coin	50/day for days 1-5	15 Coin	10 Copay/Visit	50 Copay/Trip	15 Coin	15 Coin	50 Copay/Visit	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	10/Visit or 15 Coin	20 Copay/Visit	25 indiv/10 group	10 Copay/Visit	15/Visit or 15	15 Coin	15 Coin	15 Coin			20/Visit; 1 per year	150 max benefit	20/Visit; 1 per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	47.48	0.15	0.15	0.15	0	0.15	0.15	9.09	20	20	10	0.18	0.14	0.15	0.15	0	0	20	0	20	0	0	0	0											2000	0.11	36.08	0.11	7.22	36.08	0.11	0.11	34.26	0.11	0.11	0.11	0	0.11	0.11	6.56	14.43	14.43	7.22	0.13	0.1	0.11	0.11	0	0	14.43	0	14.43	0	0	0	0											0	26.28	0.06	5.44	0.99	0.81	2.15	0.15	1.72	3.3	1.29	3.51	-	0.98	3.48	2.82	6.19	0.24	0.16	2.58	11.37	1.54	0.2	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.82	26.28	0.06	5.44	0.99	0.81	2.15	0.15	1.72	3.3	1.29	3.51	-	0.98	3.48	2.82	6.19	0.24	0.16	2.58	11.37	1.54	0.2	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.82
H3954_020_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1158.49	20.71	891.93	737.28	231.38	10.06	0	920.85	837.87	0	1716.26	0	0	0	3458.21	3844.78	172.86	136.8	292.13	0	14.97	0	0	0	313.33	0	23.31	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	4.83	0.09	1.86	0.61	0.96	1.01	-	3.84	3.49	-	2.57	-	-	-	2.88	6.41	0.29	0.11	0.44	-	1.5	-	-	-	0.52	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.45	4.83	0.09	1.86	0.61	0.96	1.01	-	3.84	3.49	-	2.57	-	-	-	2.88	6.41	0.29	0.11	0.44	-	1.5	-	-	-	0.52	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.45
H3954_021_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1158.49	20.71	891.93	737.28	231.38	10.06	0	920.85	837.87	0	1716.26	0	0	0	3458.21	3844.78	172.86	136.8	292.13	0	14.97	0	0	0	313.33	0	23.31	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	4.83	0.09	1.86	0.61	0.96	1.01	-	3.84	3.49	-	2.57	-	-	-	2.88	6.41	0.29	0.11	0.44	-	1.5	-	-	-	0.52	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.45	4.83	0.09	1.86	0.61	0.96	1.01	-	3.84	3.49	-	2.57	-	-	-	2.88	6.41	0.29	0.11	0.44	-	1.5	-	-	-	0.52	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.45
H3954_022_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1158.49	20.71	891.93	737.28	231.38	10.06	0	920.85	837.87	0	1716.26	0	0	0	3458.21	3844.78	172.86	136.8	292.13	0	14.97	0	0	0	313.33	0	23.31	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	4.83	0.09	1.86	0.61	0.96	1.01	-	3.84	3.49	-	2.57	-	-	-	2.88	6.41	0.29	0.11	0.44	-	1.5	-	-	-	0.52	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.45	4.83	0.09	1.86	0.61	0.96	1.01	-	3.84	3.49	-	2.57	-	-	-	2.88	6.41	0.29	0.11	0.44	-	1.5	-	-	-	0.52	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.45
H3954_023_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1529.48	20.74	1083.31	932.62	292.83	10.03	0	736.53	1190.65	0	2527.08	0	0	0	4441.5	4310.32	172.88	549.23	329.33	0	18.62	0	0	0	378.52	0	4.96	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	6.37	0.09	2.26	0.78	1.22	1	-	3.07	4.96	-	3.79	-	-	-	3.7	7.18	0.29	0.46	0.49	-	1.86	-	-	-	0.63	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.16	6.37	0.09	2.26	0.78	1.22	1	-	3.07	4.96	-	3.79	-	-	-	3.7	7.18	0.29	0.46	0.49	-	1.86	-	-	-	0.63	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.16
H3954_024_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1529.48	20.74	1083.31	932.62	292.83	10.03	0	736.53	1190.65	0	2527.08	0	0	0	4441.5	4310.32	172.88	549.23	329.33	0	18.62	0	0	0	378.52	0	4.96	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	6.37	0.09	2.26	0.78	1.22	1	-	3.07	4.96	-	3.79	-	-	-	3.7	7.18	0.29	0.46	0.49	-	1.86	-	-	-	0.63	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.16	6.37	0.09	2.26	0.78	1.22	1	-	3.07	4.96	-	3.79	-	-	-	3.7	7.18	0.29	0.46	0.49	-	1.86	-	-	-	0.63	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.16
H3954_025_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1529.48	20.74	1083.31	932.62	292.83	10.03	0	736.53	1190.65	0	2527.08	0	0	0	4441.5	4310.32	172.88	549.23	329.33	0	18.62	0	0	0	378.52	0	4.96	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	6.37	0.09	2.26	0.78	1.22	1	-	3.07	4.96	-	3.79	-	-	-	3.7	7.18	0.29	0.46	0.49	-	1.86	-	-	-	0.63	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.16	6.37	0.09	2.26	0.78	1.22	1	-	3.07	4.96	-	3.79	-	-	-	3.7	7.18	0.29	0.46	0.49	-	1.86	-	-	-	0.63	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.16
H3954_026_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1190.73	20.72	1212.63	865.37	136.54	11.37	0	553.7	721.85	0	1200.77	0	0	0	4110.31	4771.46	172.87	7.37	239.65	0	9.72	0	0	0	229.91	0	1.56	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	4.96	0.09	2.53	0.72	0.57	1.14	-	2.31	3.01	-	1.8	-	-	-	3.43	7.95	0.29	0.01	0.36	-	0.97	-	-	-	0.38	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.51	4.96	0.09	2.53	0.72	0.57	1.14	-	2.31	3.01	-	1.8	-	-	-	3.43	7.95	0.29	0.01	0.36	-	0.97	-	-	-	0.38	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.51
H3954_027_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1190.73	20.72	1212.63	865.37	136.54	11.37	0	553.7	721.85	0	1200.77	0	0	0	4110.31	4771.46	172.87	7.37	239.65	0	9.72	0	0	0	229.91	0	1.56	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	4.96	0.09	2.53	0.72	0.57	1.14	-	2.31	3.01	-	1.8	-	-	-	3.43	7.95	0.29	0.01	0.36	-	0.97	-	-	-	0.38	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.51	4.96	0.09	2.53	0.72	0.57	1.14	-	2.31	3.01	-	1.8	-	-	-	3.43	7.95	0.29	0.01	0.36	-	0.97	-	-	-	0.38	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.51
H3954_028_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1190.73	20.72	1212.63	865.37	136.54	11.37	0	553.7	721.85	0	1200.77	0	0	0	4110.31	4771.46	172.87	7.37	239.65	0	9.72	0	0	0	229.91	0	1.56	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	4.96	0.09	2.53	0.72	0.57	1.14	-	2.31	3.01	-	1.8	-	-	-	3.43	7.95	0.29	0.01	0.36	-	0.97	-	-	-	0.38	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.51	4.96	0.09	2.53	0.72	0.57	1.14	-	2.31	3.01	-	1.8	-	-	-	3.43	7.95	0.29	0.01	0.36	-	0.97	-	-	-	0.38	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.51
H3954_029_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1320.7	20.71	949.02	1088.39	223.31	14.52	0	828.04	863.05	0	2840.24	0	0	0	4036.08	4924.57	172.81	158	375.55	0	17.42	0	0	0	292.98	0	5.5	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	5.5	0.09	1.98	0.91	0.93	1.45	-	3.45	3.6	-	4.26	-	-	-	3.36	8.21	0.29	0.13	0.56	-	1.74	-	-	-	0.49	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.96	5.5	0.09	1.98	0.91	0.93	1.45	-	3.45	3.6	-	4.26	-	-	-	3.36	8.21	0.29	0.13	0.56	-	1.74	-	-	-	0.49	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.96
H3954_030_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1320.7	20.71	949.02	1088.39	223.31	14.52	0	828.04	863.05	0	2840.24	0	0	0	4036.08	4924.57	172.81	158	375.55	0	17.42	0	0	0	292.98	0	5.5	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	5.5	0.09	1.98	0.91	0.93	1.45	-	3.45	3.6	-	4.26	-	-	-	3.36	8.21	0.29	0.13	0.56	-	1.74	-	-	-	0.49	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.96	5.5	0.09	1.98	0.91	0.93	1.45	-	3.45	3.6	-	4.26	-	-	-	3.36	8.21	0.29	0.13	0.56	-	1.74	-	-	-	0.49	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.96
H3954_031_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1320.7	20.71	949.02	1088.39	223.31	14.52	0	828.04	863.05	0	2840.24	0	0	0	4036.08	4924.57	172.81	158	375.55	0	17.42	0	0	0	292.98	0	5.5	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	5.5	0.09	1.98	0.91	0.93	1.45	-	3.45	3.6	-	4.26	-	-	-	3.36	8.21	0.29	0.13	0.56	-	1.74	-	-	-	0.49	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.96	5.5	0.09	1.98	0.91	0.93	1.45	-	3.45	3.6	-	4.26	-	-	-	3.36	8.21	0.29	0.13	0.56	-	1.74	-	-	-	0.49	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.96
H3954_032_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1270.41	20.71	850.62	737.05	263.12	11.7	0	911.95	804.04	0	1710.81	0	0	0	3672.78	4369.64	172.84	483.04	271.06	0	12.34	0	0	0	254.98	0	2.8	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	5.29	0.09	1.77	0.61	1.1	1.17	-	3.8	3.35	-	2.57	-	-	-	3.06	7.28	0.29	0.4	0.41	-	1.23	-	-	-	0.42	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.85	5.29	0.09	1.77	0.61	1.1	1.17	-	3.8	3.35	-	2.57	-	-	-	3.06	7.28	0.29	0.4	0.41	-	1.23	-	-	-	0.42	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.85
H3954_033_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1270.41	20.71	850.62	737.05	263.12	11.7	0	911.95	804.04	0	1710.81	0	0	0	3672.78	4369.64	172.84	483.04	271.06	0	12.34	0	0	0	254.98	0	2.8	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	5.29	0.09	1.77	0.61	1.1	1.17	-	3.8	3.35	-	2.57	-	-	-	3.06	7.28	0.29	0.4	0.41	-	1.23	-	-	-	0.42	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.85	5.29	0.09	1.77	0.61	1.1	1.17	-	3.8	3.35	-	2.57	-	-	-	3.06	7.28	0.29	0.4	0.41	-	1.23	-	-	-	0.42	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.85
H3954_034_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1270.41	20.71	850.62	737.05	263.12	11.7	0	911.95	804.04	0	1710.81	0	0	0	3672.78	4369.64	172.84	483.04	271.06	0	12.34	0	0	0	254.98	0	2.8	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	5.29	0.09	1.77	0.61	1.1	1.17	-	3.8	3.35	-	2.57	-	-	-	3.06	7.28	0.29	0.4	0.41	-	1.23	-	-	-	0.42	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.85	5.29	0.09	1.77	0.61	1.1	1.17	-	3.8	3.35	-	2.57	-	-	-	3.06	7.28	0.29	0.4	0.41	-	1.23	-	-	-	0.42	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.85
H3954_035_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1514.1	20.74	432.8	829.11	132.11	8.93	0	752.85	765.02	0	1241.09	0	0	0	4029.01	3688.6	172.92	1244.82	186.31	0	8.69	0	0	0	133.26	0	3.28	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	6.31	0.09	0.9	0.69	0.55	0.89	-	3.14	3.19	-	1.86	-	-	-	3.36	6.15	0.29	1.04	0.28	-	0.87	-	-	-	0.22	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.82	6.31	0.09	0.9	0.69	0.55	0.89	-	3.14	3.19	-	1.86	-	-	-	3.36	6.15	0.29	1.04	0.28	-	0.87	-	-	-	0.22	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.82
H3954_036_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1514.1	20.74	432.8	829.11	132.11	8.93	0	752.85	765.02	0	1241.09	0	0	0	4029.01	3688.6	172.92	1244.82	186.31	0	8.69	0	0	0	133.26	0	3.28	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	6.31	0.09	0.9	0.69	0.55	0.89	-	3.14	3.19	-	1.86	-	-	-	3.36	6.15	0.29	1.04	0.28	-	0.87	-	-	-	0.22	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.82	6.31	0.09	0.9	0.69	0.55	0.89	-	3.14	3.19	-	1.86	-	-	-	3.36	6.15	0.29	1.04	0.28	-	0.87	-	-	-	0.22	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.82
H3954_037_0	2006											0											D	D	D	V	T	COIN	P	V	V	P	V	P	P	P	V	V	V	V	V	P	COIN	P	P	P	V	P	V	P	P	P	P											N/A																																										-	1514.1	20.74	432.8	829.11	132.11	8.93	0	752.85	765.02	0	1241.09	0	0	0	4029.01	3688.6	172.92	1244.82	186.31	0	8.69	0	0	0	133.26	0	3.28	0	0	0	0											Days 1-5	Days 1-5	Days 11-100								75 MRI/CAT/PET; 15 Other						25 indiv / 10 group		75 MRI/CAT/PET; 15 Other						1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	50	50	25	10	50	0.1	0	50	50	0	18	0	0	0	10	20	20	10	18	0	0.1	0	0	0	20	0	20	0	0	0	0											0	6.31	0.09	0.9	0.69	0.55	0.89	-	3.14	3.19	-	1.86	-	-	-	3.36	6.15	0.29	1.04	0.28	-	0.87	-	-	-	0.22	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.82	6.31	0.09	0.9	0.69	0.55	0.89	-	3.14	3.19	-	1.86	-	-	-	3.36	6.15	0.29	1.04	0.28	-	0.87	-	-	-	0.22	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.82
H3954_038_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	201.49	32.71	27.72	749.83	212.15	10.06	3.07	983.48	42.81	25.92	43.82	0.68	0.75	48.72	3541.74	3411.95	162.58	38.97	7.62	7.32	14.67	0.26	0	0	288.85	2.01	82.3	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	27.2	0.12	3.74	0.56	0.8	1.36	0.41	3.69	5.78	3.5	5.92	0.09	0.1	6.58	2.66	5.12	0.24	0.03	1.03	0.99	1.98	0.04	-	-	0.43	0.27	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.76	27.2	0.12	3.74	0.56	0.8	1.36	0.41	3.69	5.78	3.5	5.92	0.09	0.1	6.58	2.66	5.12	0.24	0.03	1.03	0.99	1.98	0.04	-	-	0.43	0.27	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.76
H3954_039_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	201.49	32.71	27.72	749.83	212.15	10.06	3.07	983.48	42.81	25.92	43.82	0.68	0.75	48.72	3541.74	3411.95	162.58	38.97	7.62	7.32	14.67	0.26	0	0	288.85	2.01	82.3	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	27.2	0.12	3.74	0.56	0.8	1.36	0.41	3.69	5.78	3.5	5.92	0.09	0.1	6.58	2.66	5.12	0.24	0.03	1.03	0.99	1.98	0.04	-	-	0.43	0.27	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.76	27.2	0.12	3.74	0.56	0.8	1.36	0.41	3.69	5.78	3.5	5.92	0.09	0.1	6.58	2.66	5.12	0.24	0.03	1.03	0.99	1.98	0.04	-	-	0.43	0.27	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.76
H3954_040_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	201.49	32.71	27.72	749.83	212.15	10.06	3.07	983.48	42.81	25.92	43.82	0.68	0.75	48.72	3541.74	3411.95	162.58	38.97	7.62	7.32	14.67	0.26	0	0	288.85	2.01	82.3	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	27.2	0.12	3.74	0.56	0.8	1.36	0.41	3.69	5.78	3.5	5.92	0.09	0.1	6.58	2.66	5.12	0.24	0.03	1.03	0.99	1.98	0.04	-	-	0.43	0.27	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.76	27.2	0.12	3.74	0.56	0.8	1.36	0.41	3.69	5.78	3.5	5.92	0.09	0.1	6.58	2.66	5.12	0.24	0.03	1.03	0.99	1.98	0.04	-	-	0.43	0.27	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.76
H3954_041_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	266.01	32.75	33.67	948.49	268.49	10.03	1.84	786.62	60.83	30.15	64.53	36.11	0.34	61.02	4548.78	3825.08	162.59	156.45	8.6	8.89	18.25	0.64	0	0	348.95	2.37	17.53	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	35.91	0.12	4.55	0.71	1.01	1.35	0.25	2.95	8.21	4.07	8.71	4.87	0.05	8.24	3.41	5.74	0.24	0.12	1.16	1.2	2.46	0.09	-	-	0.52	0.32	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.29	35.91	0.12	4.55	0.71	1.01	1.35	0.25	2.95	8.21	4.07	8.71	4.87	0.05	8.24	3.41	5.74	0.24	0.12	1.16	1.2	2.46	0.09	-	-	0.52	0.32	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.29
H3954_042_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	266.01	32.75	33.67	948.49	268.49	10.03	1.84	786.62	60.83	30.15	64.53	36.11	0.34	61.02	4548.78	3825.08	162.59	156.45	8.6	8.89	18.25	0.64	0	0	348.95	2.37	17.53	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	35.91	0.12	4.55	0.71	1.01	1.35	0.25	2.95	8.21	4.07	8.71	4.87	0.05	8.24	3.41	5.74	0.24	0.12	1.16	1.2	2.46	0.09	-	-	0.52	0.32	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.29	35.91	0.12	4.55	0.71	1.01	1.35	0.25	2.95	8.21	4.07	8.71	4.87	0.05	8.24	3.41	5.74	0.24	0.12	1.16	1.2	2.46	0.09	-	-	0.52	0.32	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.29
H3954_043_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	266.01	32.75	33.67	948.49	268.49	10.03	1.84	786.62	60.83	30.15	64.53	36.11	0.34	61.02	4548.78	3825.08	162.59	156.45	8.6	8.89	18.25	0.64	0	0	348.95	2.37	17.53	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	35.91	0.12	4.55	0.71	1.01	1.35	0.25	2.95	8.21	4.07	8.71	4.87	0.05	8.24	3.41	5.74	0.24	0.12	1.16	1.2	2.46	0.09	-	-	0.52	0.32	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.29	35.91	0.12	4.55	0.71	1.01	1.35	0.25	2.95	8.21	4.07	8.71	4.87	0.05	8.24	3.41	5.74	0.24	0.12	1.16	1.2	2.46	0.09	-	-	0.52	0.32	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.29
H3954_044_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	207.09	32.72	37.69	880.1	125.19	11.37	2.1	591.36	36.88	31.68	30.66	5.24	0.82	38.15	4209.6	4234.31	162.59	2.1	6.26	16.56	9.52	0.22	0	0	211.95	1.68	5.5	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	27.96	0.12	5.09	0.66	0.47	1.54	0.28	2.22	4.98	4.28	4.14	0.71	0.11	5.15	3.16	6.35	0.24	0	0.84	2.24	1.29	0.03	-	-	0.32	0.23	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.4	27.96	0.12	5.09	0.66	0.47	1.54	0.28	2.22	4.98	4.28	4.14	0.71	0.11	5.15	3.16	6.35	0.24	0	0.84	2.24	1.29	0.03	-	-	0.32	0.23	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.4
H3954_045_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	207.09	32.72	37.69	880.1	125.19	11.37	2.1	591.36	36.88	31.68	30.66	5.24	0.82	38.15	4209.6	4234.31	162.59	2.1	6.26	16.56	9.52	0.22	0	0	211.95	1.68	5.5	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	27.96	0.12	5.09	0.66	0.47	1.54	0.28	2.22	4.98	4.28	4.14	0.71	0.11	5.15	3.16	6.35	0.24	0	0.84	2.24	1.29	0.03	-	-	0.32	0.23	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.4	27.96	0.12	5.09	0.66	0.47	1.54	0.28	2.22	4.98	4.28	4.14	0.71	0.11	5.15	3.16	6.35	0.24	0	0.84	2.24	1.29	0.03	-	-	0.32	0.23	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.4
H3954_046_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	207.09	32.72	37.69	880.1	125.19	11.37	2.1	591.36	36.88	31.68	30.66	5.24	0.82	38.15	4209.6	4234.31	162.59	2.1	6.26	16.56	9.52	0.22	0	0	211.95	1.68	5.5	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	27.96	0.12	5.09	0.66	0.47	1.54	0.28	2.22	4.98	4.28	4.14	0.71	0.11	5.15	3.16	6.35	0.24	0	0.84	2.24	1.29	0.03	-	-	0.32	0.23	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.4	27.96	0.12	5.09	0.66	0.47	1.54	0.28	2.22	4.98	4.28	4.14	0.71	0.11	5.15	3.16	6.35	0.24	0	0.84	2.24	1.29	0.03	-	-	0.32	0.23	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.4
H3954_047_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	229.7	32.7	29.5	1106.91	204.75	14.52	2.86	884.37	44.09	32.23	72.53	3.17	1.51	60.4	4133.57	4370.18	162.53	45.01	9.8	7	17.07	0.18	0	0	270.09	2.09	19.41	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	31.01	0.12	3.98	0.83	0.77	1.96	0.39	3.32	5.95	4.35	9.79	0.43	0.2	8.15	3.1	6.56	0.24	0.03	1.32	0.94	2.3	0.02	-	-	0.41	0.28	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.5	31.01	0.12	3.98	0.83	0.77	1.96	0.39	3.32	5.95	4.35	9.79	0.43	0.2	8.15	3.1	6.56	0.24	0.03	1.32	0.94	2.3	0.02	-	-	0.41	0.28	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.5
H3954_048_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	229.7	32.7	29.5	1106.91	204.75	14.52	2.86	884.37	44.09	32.23	72.53	3.17	1.51	60.4	4133.57	4370.18	162.53	45.01	9.8	7	17.07	0.18	0	0	270.09	2.09	19.41	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	31.01	0.12	3.98	0.83	0.77	1.96	0.39	3.32	5.95	4.35	9.79	0.43	0.2	8.15	3.1	6.56	0.24	0.03	1.32	0.94	2.3	0.02	-	-	0.41	0.28	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.5	31.01	0.12	3.98	0.83	0.77	1.96	0.39	3.32	5.95	4.35	9.79	0.43	0.2	8.15	3.1	6.56	0.24	0.03	1.32	0.94	2.3	0.02	-	-	0.41	0.28	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.5
H3954_049_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	229.7	32.7	29.5	1106.91	204.75	14.52	2.86	884.37	44.09	32.23	72.53	3.17	1.51	60.4	4133.57	4370.18	162.53	45.01	9.8	7	17.07	0.18	0	0	270.09	2.09	19.41	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	31.01	0.12	3.98	0.83	0.77	1.96	0.39	3.32	5.95	4.35	9.79	0.43	0.2	8.15	3.1	6.56	0.24	0.03	1.32	0.94	2.3	0.02	-	-	0.41	0.28	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.5	31.01	0.12	3.98	0.83	0.77	1.96	0.39	3.32	5.95	4.35	9.79	0.43	0.2	8.15	3.1	6.56	0.24	0.03	1.32	0.94	2.3	0.02	-	-	0.41	0.28	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.5
H3954_050_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	220.95	32.7	26.44	749.59	241.24	11.7	3.12	973.98	41.08	24.65	43.69	6.02	0.86	45.12	3761.5	3877.72	162.56	137.6	7.07	6.03	12.09	0.2	0	0	235.06	1.86	9.89	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	29.83	0.12	3.57	0.56	0.9	1.58	0.42	3.65	5.55	3.33	5.9	0.81	0.12	6.09	2.82	5.82	0.24	0.1	0.96	0.81	1.63	0.03	-	-	0.35	0.25	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.46	29.83	0.12	3.57	0.56	0.9	1.58	0.42	3.65	5.55	3.33	5.9	0.81	0.12	6.09	2.82	5.82	0.24	0.1	0.96	0.81	1.63	0.03	-	-	0.35	0.25	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.46
H3954_051_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	220.95	32.7	26.44	749.59	241.24	11.7	3.12	973.98	41.08	24.65	43.69	6.02	0.86	45.12	3761.5	3877.72	162.56	137.6	7.07	6.03	12.09	0.2	0	0	235.06	1.86	9.89	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	29.83	0.12	3.57	0.56	0.9	1.58	0.42	3.65	5.55	3.33	5.9	0.81	0.12	6.09	2.82	5.82	0.24	0.1	0.96	0.81	1.63	0.03	-	-	0.35	0.25	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.46	29.83	0.12	3.57	0.56	0.9	1.58	0.42	3.65	5.55	3.33	5.9	0.81	0.12	6.09	2.82	5.82	0.24	0.1	0.96	0.81	1.63	0.03	-	-	0.35	0.25	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.46
H3954_052_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	220.95	32.7	26.44	749.59	241.24	11.7	3.12	973.98	41.08	24.65	43.69	6.02	0.86	45.12	3761.5	3877.72	162.56	137.6	7.07	6.03	12.09	0.2	0	0	235.06	1.86	9.89	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	29.83	0.12	3.57	0.56	0.9	1.58	0.42	3.65	5.55	3.33	5.9	0.81	0.12	6.09	2.82	5.82	0.24	0.1	0.96	0.81	1.63	0.03	-	-	0.35	0.25	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.46	29.83	0.12	3.57	0.56	0.9	1.58	0.42	3.65	5.55	3.33	5.9	0.81	0.12	6.09	2.82	5.82	0.24	0.1	0.96	0.81	1.63	0.03	-	-	0.35	0.25	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.46
H3954_053_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	263.33	32.75	13.45	843.22	121.13	8.93	0.87	804.06	39.08	23.05	31.69	0.06	3.62	59.61	4126.33	3273.35	162.64	354.59	4.86	27.47	8.52	2.11	0	0	122.85	1.23	11.59	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	35.55	0.12	1.82	0.63	0.45	1.21	0.12	3.02	5.28	3.11	4.28	0.01	0.49	8.05	3.09	4.91	0.24	0.27	0.66	3.71	1.15	0.29	-	-	0.18	0.17	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.81	35.55	0.12	1.82	0.63	0.45	1.21	0.12	3.02	5.28	3.11	4.28	0.01	0.49	8.05	3.09	4.91	0.24	0.27	0.66	3.71	1.15	0.29	-	-	0.18	0.17	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.81
H3954_054_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	263.33	32.75	13.45	843.22	121.13	8.93	0.87	804.06	39.08	23.05	31.69	0.06	3.62	59.61	4126.33	3273.35	162.64	354.59	4.86	27.47	8.52	2.11	0	0	122.85	1.23	11.59	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	35.55	0.12	1.82	0.63	0.45	1.21	0.12	3.02	5.28	3.11	4.28	0.01	0.49	8.05	3.09	4.91	0.24	0.27	0.66	3.71	1.15	0.29	-	-	0.18	0.17	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.81	35.55	0.12	1.82	0.63	0.45	1.21	0.12	3.02	5.28	3.11	4.28	0.01	0.49	8.05	3.09	4.91	0.24	0.27	0.66	3.71	1.15	0.29	-	-	0.18	0.17	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.81
H3954_055_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	263.33	32.75	13.45	843.22	121.13	8.93	0.87	804.06	39.08	23.05	31.69	0.06	3.62	59.61	4126.33	3273.35	162.64	354.59	4.86	27.47	8.52	2.11	0	0	122.85	1.23	11.59	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	35.55	0.12	1.82	0.63	0.45	1.21	0.12	3.02	5.28	3.11	4.28	0.01	0.49	8.05	3.09	4.91	0.24	0.27	0.66	3.71	1.15	0.29	-	-	0.18	0.17	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.81	35.55	0.12	1.82	0.63	0.45	1.21	0.12	3.02	5.28	3.11	4.28	0.01	0.49	8.05	3.09	4.91	0.24	0.27	0.66	3.71	1.15	0.29	-	-	0.18	0.17	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.81
H3954_056_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	227.04	33.33	18.59	683.64	195.53	8.51	1.39	682.22	43.3	22.37	42.42	14.24	1.06	34.46	3549.73	3187.86	163.62	240.38	6.21	5.77	12.87	0.26	0	0	245.27	2.15	16.48	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	30.65	0.13	2.51	0.51	0.73	1.15	0.19	2.56	5.85	3.02	5.73	1.92	0.14	4.65	2.66	4.78	0.25	0.18	0.84	0.78	1.74	0.04	-	-	0.37	0.29	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.68	30.65	0.13	2.51	0.51	0.73	1.15	0.19	2.56	5.85	3.02	5.73	1.92	0.14	4.65	2.66	4.78	0.25	0.18	0.84	0.78	1.74	0.04	-	-	0.37	0.29	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.68
H3954_057_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	227.04	33.33	18.59	683.64	195.53	8.51	1.39	682.22	43.3	22.37	42.42	14.24	1.06	34.46	3549.73	3187.86	163.62	240.38	6.21	5.77	12.87	0.26	0	0	245.27	2.15	16.48	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	30.65	0.13	2.51	0.51	0.73	1.15	0.19	2.56	5.85	3.02	5.73	1.92	0.14	4.65	2.66	4.78	0.25	0.18	0.84	0.78	1.74	0.04	-	-	0.37	0.29	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.68	30.65	0.13	2.51	0.51	0.73	1.15	0.19	2.56	5.85	3.02	5.73	1.92	0.14	4.65	2.66	4.78	0.25	0.18	0.84	0.78	1.74	0.04	-	-	0.37	0.29	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.68
H3954_058_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	227.04	33.33	18.59	683.64	195.53	8.51	1.39	682.22	43.3	22.37	42.42	14.24	1.06	34.46	3549.73	3187.86	163.62	240.38	6.21	5.77	12.87	0.26	0	0	245.27	2.15	16.48	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	30.65	0.13	2.51	0.51	0.73	1.15	0.19	2.56	5.85	3.02	5.73	1.92	0.14	4.65	2.66	4.78	0.25	0.18	0.84	0.78	1.74	0.04	-	-	0.37	0.29	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.68	30.65	0.13	2.51	0.51	0.73	1.15	0.19	2.56	5.85	3.02	5.73	1.92	0.14	4.65	2.66	4.78	0.25	0.18	0.84	0.78	1.74	0.04	-	-	0.37	0.29	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.68
H3954_059_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	279.87	32.77	21.32	789.74	213.39	13.3	2.16	762.18	48.16	37.97	56.41	2.17	2.46	45.21	3546.54	4882.01	162.63	290.47	7.55	19.35	15.62	0.21	0	0	283.54	1.57	3.39	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	37.78	0.12	2.88	0.59	0.8	1.8	0.29	2.86	6.5	5.13	7.62	0.29	0.33	6.1	2.66	7.32	0.24	0.22	1.02	2.61	2.11	0.03	-	-	0.43	0.21	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.95	37.78	0.12	2.88	0.59	0.8	1.8	0.29	2.86	6.5	5.13	7.62	0.29	0.33	6.1	2.66	7.32	0.24	0.22	1.02	2.61	2.11	0.03	-	-	0.43	0.21	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.95
H3954_060_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	279.87	32.77	21.32	789.74	213.39	13.3	2.16	762.18	48.16	37.97	56.41	2.17	2.46	45.21	3546.54	4882.01	162.63	290.47	7.55	19.35	15.62	0.21	0	0	283.54	1.57	3.39	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	37.78	0.12	2.88	0.59	0.8	1.8	0.29	2.86	6.5	5.13	7.62	0.29	0.33	6.1	2.66	7.32	0.24	0.22	1.02	2.61	2.11	0.03	-	-	0.43	0.21	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.95	37.78	0.12	2.88	0.59	0.8	1.8	0.29	2.86	6.5	5.13	7.62	0.29	0.33	6.1	2.66	7.32	0.24	0.22	1.02	2.61	2.11	0.03	-	-	0.43	0.21	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.95
H3954_061_0	2006											2000											COIN	D	COIN	V	T	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	V	V	V	V	COIN	COIN	COIN	COIN			V	COIN	V															N/A																																										-	279.87	32.77	21.32	789.74	213.39	13.3	2.16	762.18	48.16	37.97	56.41	2.17	2.46	45.21	3546.54	4882.01	162.63	290.47	7.55	19.35	15.62	0.21	0	0	283.54	1.57	3.39	0	0	0	0												Days 1-5															25 indiv / 10 group								1 exam per year	150 max benefit	1 exam per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	50	0.15	0.15	0.15	0.15	0.15	0.15	10	20	20	10	0.15	0.15	0.15	0.15	0	0	20	0.15	20	0	0	0	0											2000	0.14	45	0.14	9	45	0.14	0.14	45	0.14	0.14	0.14	0.14	0.14	0.14	9	18	18	9	0.14	0.14	0.14	0.14	0	0	18	0.14	18	0	0	0	0											0	37.78	0.12	2.88	0.59	0.8	1.8	0.29	2.86	6.5	5.13	7.62	0.29	0.33	6.1	2.66	7.32	0.24	0.22	1.02	2.61	2.11	0.03	-	-	0.43	0.21	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.95	37.78	0.12	2.88	0.59	0.8	1.8	0.29	2.86	6.5	5.13	7.62	0.29	0.33	6.1	2.66	7.32	0.24	0.22	1.02	2.61	2.11	0.03	-	-	0.43	0.21	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.95
H3954_062_0	2006											2000											Coin	D	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	242.77	20.09	50.31	1647.38	267.9	19.83	1.38	600.8	30.53	11.94	32.44	0	9.05	32.13	5155.75	5145.18	199.51	266.1	19.88	110.54	14.2	1.82	0	0	336.78	0	144.33	0	0	0	0											15 Coin	50/day for days 1-5	15 Coin	10 Copay/Visit	50 Copay/Trip	15 Coin	15 Coin	50 Copay/Visit	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	10/Visit or 15 Coin	20 Copay/Visit	25 indiv/10 group	10 Copay/Visit	15/Visit or 15	15 Coin	15 Coin	15 Coin			20/Visit; 1 per year	150 max benefit	20/Visit; 1 per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	47.48	0.15	0.15	0.15	0	0.15	0.15	9.09	20	20	10	0.18	0.14	0.15	0.15	0	0	20	0	20	0	0	0	0											2000	0.11	36.08	0.11	7.22	36.08	0.11	0.11	34.26	0.11	0.11	0.11	0	0.11	0.11	6.56	14.43	14.43	7.22	0.13	0.1	0.11	0.11	0	0	14.43	0	14.43	0	0	0	0											0	26.28	0.06	5.44	0.99	0.81	2.15	0.15	1.72	3.3	1.29	3.51	-	0.98	3.48	2.82	6.19	0.24	0.16	2.58	11.37	1.54	0.2	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.82	26.28	0.06	5.44	0.99	0.81	2.15	0.15	1.72	3.3	1.29	3.51	-	0.98	3.48	2.82	6.19	0.24	0.16	2.58	11.37	1.54	0.2	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.82
H3954_063_0	2006											2000											Coin	D	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	242.77	20.09	50.31	1647.38	267.9	19.83	1.38	600.8	30.53	11.94	32.44	0	9.05	32.13	5155.75	5145.18	199.51	266.1	19.88	110.54	14.2	1.82	0	0	336.78	0	144.33	0	0	0	0											15 Coin	50/day for days 1-5	15 Coin	10 Copay/Visit	50 Copay/Trip	15 Coin	15 Coin	50 Copay/Visit	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	10/Visit or 15 Coin	20 Copay/Visit	25 indiv/10 group	10 Copay/Visit	15/Visit or 15	15 Coin	15 Coin	15 Coin			20/Visit; 1 per year	150 max benefit	20/Visit; 1 per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	47.48	0.15	0.15	0.15	0	0.15	0.15	9.09	20	20	10	0.18	0.14	0.15	0.15	0	0	20	0	20	0	0	0	0											2000	0.11	36.08	0.11	7.22	36.08	0.11	0.11	34.26	0.11	0.11	0.11	0	0.11	0.11	6.56	14.43	14.43	7.22	0.13	0.1	0.11	0.11	0	0	14.43	0	14.43	0	0	0	0											0	26.28	0.06	5.44	0.99	0.81	2.15	0.15	1.72	3.3	1.29	3.51	-	0.98	3.48	2.82	6.19	0.24	0.16	2.58	11.37	1.54	0.2	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.82	26.28	0.06	5.44	0.99	0.81	2.15	0.15	1.72	3.3	1.29	3.51	-	0.98	3.48	2.82	6.19	0.24	0.16	2.58	11.37	1.54	0.2	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.82
H3954_064_0	2006											2000											Coin	D	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	242.77	20.09	50.31	1647.38	267.9	19.83	1.38	600.8	30.53	11.94	32.44	0	9.05	32.13	5155.75	5145.18	199.51	266.1	19.88	110.54	14.2	1.82	0	0	336.78	0	144.33	0	0	0	0											15 Coin	50/day for days 1-5	15 Coin	10 Copay/Visit	50 Copay/Trip	15 Coin	15 Coin	50 Copay/Visit	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	10/Visit or 15 Coin	20 Copay/Visit	25 indiv/10 group	10 Copay/Visit	15/Visit or 15	15 Coin	15 Coin	15 Coin			20/Visit; 1 per year	150 max benefit	20/Visit; 1 per year	400 max benefit; 1 per 3 years														0.15	50	0.15	10	50	0.15	0.15	47.48	0.15	0.15	0.15	0	0.15	0.15	9.09	20	20	10	0.18	0.14	0.15	0.15	0	0	20	0	20	0	0	0	0											2000	0.11	36.08	0.11	7.22	36.08	0.11	0.11	34.26	0.11	0.11	0.11	0	0.11	0.11	6.56	14.43	14.43	7.22	0.13	0.1	0.11	0.11	0	0	14.43	0	14.43	0	0	0	0											0	26.28	0.06	5.44	0.99	0.81	2.15	0.15	1.72	3.3	1.29	3.51	-	0.98	3.48	2.82	6.19	0.24	0.16	2.58	11.37	1.54	0.2	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.82	26.28	0.06	5.44	0.99	0.81	2.15	0.15	1.72	3.3	1.29	3.51	-	0.98	3.48	2.82	6.19	0.24	0.16	2.58	11.37	1.54	0.2	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.82
H3954_801_0	2006											0											COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																				N/A																																										-	225.29	3.22	29.47	11.5	12.63	11.11	2.59	15.92	42.77	28.46	45.71	4.38	1.11	47.84	38.97	148.42	2.52	0.03	7.54	9.31	13.76	0.32	0	0	0	0	0	0	0	0	0											Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits																				0.08	0.08	0.19	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	0.08	0.08	0.19	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	17.08	0.24	5.56	-	2.94	2.59	0.6	3.71	9.96	6.63	10.65	1.02	0.26	11.15	9.08	34.58	0.59	0.01	1.76	2.17	3.21	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.86	17.08	0.24	5.56	-	2.94	2.59	0.6	3.71	9.96	6.63	10.65	1.02	0.26	11.15	9.08	34.58	0.59	0.01	1.76	2.17	3.21	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.86
H3954_802_0	2006											0											COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																				N/A																																										-	225.29	3.22	29.47	11.5	12.63	11.11	2.59	15.92	42.77	28.46	45.71	4.38	1.11	47.84	38.97	148.42	2.52	0.03	7.54	9.31	13.76	0.32	0	0	0	0	0	0	0	0	0											Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits	Medicare FFS Benefits																				0.08	0.08	0.19	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	0.08	0.08	0.19	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	17.08	0.24	5.56	-	2.94	2.59	0.6	3.71	9.96	6.63	10.65	1.02	0.26	11.15	9.08	34.58	0.59	0.01	1.76	2.17	3.21	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.86	17.08	0.24	5.56	-	2.94	2.59	0.6	3.71	9.96	6.63	10.65	1.02	0.26	11.15	9.08	34.58	0.59	0.01	1.76	2.17	3.21	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.86
H3957_003_0	2006																										T	Coin		V						V	V	V					S				V		V																																																									-	0	0	0	0	251.55	14.54	0	229.43	0	0	0	0	0	809.56	4034.37	5637.91	0	0	0	0	259.43	0	0	0	252	0	4.49	0	0	0	0																															12/20/1930																					0	0	0	0	25	0.15	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												0	0	0	0	25	0.14	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												-	-	-	-	0.52	1.96	-	0.96	-	-	-	-	-	1.35	3.36	9.4	-	-	-	-	0.43	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.41	-	-	-	-	0.52	1.96	-	0.96	-	-	-	-	-	1.35	3.36	9.4	-	-	-	-	0.43	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.41
H3957_006_0	2006																										T	Coin		V						V	V	V					S				V		V																																																									-	0	0	0	0	207.95	12.79	0	226.66	0	0	0	0	0	1092.93	4057.32	5630.05	0	0	0	0	300.48	0	0	0	252	0	7.13	0	0	0	0																															12/20/1930																					0	0	0	0	25	0.15	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												0	0	0	0	25	0.14	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												-	-	-	-	0.43	1.73	-	0.94	-	-	-	-	-	1.82	3.38	9.38	-	-	-	-	0.5	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.62	-	-	-	-	0.43	1.73	-	0.94	-	-	-	-	-	1.82	3.38	9.38	-	-	-	-	0.5	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.62
H3957_016_0	2006																										T	Coin		V						V	V	V					S				V		V																																																									-	0	0	0	0	243.6	13.6	0	200.68	0	0	0	0	0	909.31	4112.19	5697.69	0	0	0	0	246.7	0	0	0	252	0	3.85	0	0	0	0																															12/20/1930																					0	0	0	0	25	0.15	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												0	0	0	0	25	0.14	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												-	-	-	-	0.51	1.84	-	0.84	-	-	-	-	-	1.52	3.43	9.5	-	-	-	-	0.41	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.46	-	-	-	-	0.51	1.84	-	0.84	-	-	-	-	-	1.52	3.43	9.5	-	-	-	-	0.41	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.46
H3957_020_0	2006																										T	Coin		V						V	V	V					S			Coin	V		V																																																									-	0	0	0	0	251.55	14.54	0	229.43	0	0	0	0	0	809.56	4034.37	5696.35	0	0	0	0	259.43	0	0	9.89	252	0	4.49	0	0	0	0																															12/20/1930																					0	0	0	0	25	0.15	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0.4	20	0	20	0	0	0	0												0	0	0	0	25	0.14	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0.4	20	0	20	0	0	0	0												-	-	-	-	0.52	1.96	-	0.96	-	-	-	-	-	1.35	3.36	9.49	-	-	-	-	0.43	-	-	3.96	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.46	-	-	-	-	0.52	1.96	-	0.96	-	-	-	-	-	1.35	3.36	9.49	-	-	-	-	0.43	-	-	3.96	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.46
H3957_021_0	2006																										T	Coin		V						V	V	V					S			Coin	V		V																																																									-	0	0	0	0	207.95	12.79	0	226.66	0	0	0	0	0	1092.93	4057.32	5699.38	0	0	0	0	300.48	0	0	9.9	252	0	7.13	0	0	0	0																															12/20/1930																					0	0	0	0	25	0.15	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0.4	20	0	20	0	0	0	0												0	0	0	0	25	0.14	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0.4	20	0	20	0	0	0	0												-	-	-	-	0.43	1.73	-	0.94	-	-	-	-	-	1.82	3.38	9.5	-	-	-	-	0.5	-	-	3.96	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.7	-	-	-	-	0.43	1.73	-	0.94	-	-	-	-	-	1.82	3.38	9.5	-	-	-	-	0.5	-	-	3.96	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.7
H3957_022_0	2006																										T	Coin		V						V	V	V					S			Coin	V		V																																																									-	0	0	0	0	243.6	13.6	0	200.68	0	0	0	0	0	909.31	4112.19	5760.97	0	0	0	0	246.7	0	0	9.9	252	0	3.85	0	0	0	0																															12/20/1930																					0	0	0	0	25	0.15	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0.4	20	0	20	0	0	0	0												0	0	0	0	25	0.14	0	50	0	0	0	0	0	20	10	20	0	0	0	0	20	0	0	0.4	20	0	20	0	0	0	0												-	-	-	-	0.51	1.84	-	0.84	-	-	-	-	-	1.52	3.43	9.6	-	-	-	-	0.41	-	-	3.96	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.52	-	-	-	-	0.51	1.84	-	0.84	-	-	-	-	-	1.52	3.43	9.6	-	-	-	-	0.41	-	-	3.96	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.52
H3957_024_0	2006																						A		D		T	Coin		V	V					V	V	V					S				V		V																																																									-	394	0	600	0	251.55	14.54	0	229.43	540	0	0	0	0	5404.36	4034.37	5637.91	0	0	0	0	259.43	0	0	0	252	0	4.49	0	0	0	0											250/admit or 50/day													20 - 50							12/20/1930																					260	0	25	0	25	0.15	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												210.1	0	25	0	25	0.14	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												6.9	-	1.25	-	0.52	1.96	-	0.96	2.25	-	-	-	-	9.91	3.36	9.4	-	-	-	-	0.43	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.37	6.9	-	1.25	-	0.52	1.96	-	0.96	2.25	-	-	-	-	9.91	3.36	9.4	-	-	-	-	0.43	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.37
H3957_025_0	2006																						A		D		T	Coin		V	V					V	V	V					S				V		V																																																									-	394	0	600	0	207.95	12.79	0	226.66	540	0	0	0	0	5687.72	4057.32	5630.05	0	0	0	0	300.48	0	0	0	252	0	7.13	0	0	0	0											250/admit or 50/day													20 - 50							12/20/1930																					260	0	25	0	25	0.15	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												210.1	0	25	0	25	0.14	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												6.9	-	1.25	-	0.43	1.73	-	0.94	2.25	-	-	-	-	10.43	3.38	9.38	-	-	-	-	0.5	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.63	6.9	-	1.25	-	0.43	1.73	-	0.94	2.25	-	-	-	-	10.43	3.38	9.38	-	-	-	-	0.5	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.63
H3957_026_0	2006																						A		D		T	Coin		V	V					V	V	V					S				V		V																																																									-	394	0	600	0	243.6	13.6	0	200.68	540	0	0	0	0	5504.1	4112.19	5697.69	0	0	0	0	246.7	0	0	0	252	0	3.85	0	0	0	0											250/admit or 50/day													20 - 50							12/20/1930																					260	0	25	0	25	0.15	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												210.1	0	25	0	25	0.14	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												6.9	-	1.25	-	0.51	1.84	-	0.84	2.25	-	-	-	-	10.09	3.43	9.5	-	-	-	-	0.41	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.43	6.9	-	1.25	-	0.51	1.84	-	0.84	2.25	-	-	-	-	10.09	3.43	9.5	-	-	-	-	0.41	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.43
H3957_027_0	2006																						A		D		T	Coin		V	V					V	V	V					S				V		V																																																									-	394	0	600	0	251.55	14.54	0	229.43	540	0	0	0	0	5404.36	4034.37	5637.91	0	0	0	0	259.43	0	0	0	252	0	4.49	0	0	0	0											250/admit or 50/day													20 - 50							12/20/1930																					260	0	25	0	25	0.15	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												210.1	0	25	0	25	0.14	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												6.9	-	1.25	-	0.52	1.96	-	0.96	2.25	-	-	-	-	9.91	3.36	9.4	-	-	-	-	0.43	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.37	6.9	-	1.25	-	0.52	1.96	-	0.96	2.25	-	-	-	-	9.91	3.36	9.4	-	-	-	-	0.43	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.37
H3957_028_0	2006																						A		D		T	Coin		V	V					V	V	V					S				V		V																																																									-	394	0	600	0	207.95	12.79	0	226.66	540	0	0	0	0	5687.72	4057.32	5630.05	0	0	0	0	300.48	0	0	0	252	0	7.13	0	0	0	0											250/admit or 50/day													20 - 50							12/20/1930																					260	0	25	0	25	0.15	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												210.1	0	25	0	25	0.14	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												6.9	-	1.25	-	0.43	1.73	-	0.94	2.25	-	-	-	-	10.43	3.38	9.38	-	-	-	-	0.5	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.63	6.9	-	1.25	-	0.43	1.73	-	0.94	2.25	-	-	-	-	10.43	3.38	9.38	-	-	-	-	0.5	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.63
H3957_029_0	2006																						A		D		T	Coin		V	V					V	V	V					S				V		V																																																									-	394	0	600	0	243.6	13.6	0	200.68	540	0	0	0	0	5504.1	4112.19	5697.69	0	0	0	0	246.7	0	0	0	252	0	3.85	0	0	0	0											250/admit or 50/day													20 - 50							12/20/1930																					260	0	25	0	25	0.15	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												210.1	0	25	0	25	0.14	0	50	50	0	0	0	0	22	10	20	0	0	0	0	20	0	0	0	20	0	20	0	0	0	0												6.9	-	1.25	-	0.51	1.84	-	0.84	2.25	-	-	-	-	10.09	3.43	9.5	-	-	-	-	0.41	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.43	6.9	-	1.25	-	0.51	1.84	-	0.84	2.25	-	-	-	-	10.09	3.43	9.5	-	-	-	-	0.41	-	-	-	0.42	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.43
H3957_805_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin	Coin					Coin																																																															-	269.86	0	40.46	0	9.58	14.12	0	3.33	31.79	0	0	0	0	74.83	45.36	185.05	0	0	0	0	52.1	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing																					0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												19.79	-	7.09	-	2.23	3.29	-	0.78	7.41	-	-	-	-	17.43	10.57	43.12	-	-	-	-	12.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.85	19.79	-	7.09	-	2.23	3.29	-	0.78	7.41	-	-	-	-	17.43	10.57	43.12	-	-	-	-	12.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.85
H3957_806_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin	Coin					Coin																																																															-	269.86	0	40.46	0	9.58	14.12	0	3.33	31.79	0	0	0	0	74.83	45.36	185.05	0	0	0	0	52.1	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing																					0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												19.79	-	7.09	-	2.23	3.29	-	0.78	7.41	-	-	-	-	17.43	10.57	43.12	-	-	-	-	12.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.85	19.79	-	7.09	-	2.23	3.29	-	0.78	7.41	-	-	-	-	17.43	10.57	43.12	-	-	-	-	12.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.85
H3957_807_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin	Coin					Coin																																																															-	269.86	0	40.46	0	9.58	14.12	0	3.33	31.79	0	0	0	0	74.83	45.36	185.05	0	0	0	0	52.1	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing																					0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												19.79	-	7.09	-	2.23	3.29	-	0.78	7.41	-	-	-	-	17.43	10.57	43.12	-	-	-	-	12.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.85	19.79	-	7.09	-	2.23	3.29	-	0.78	7.41	-	-	-	-	17.43	10.57	43.12	-	-	-	-	12.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.85
H3957_808_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin	Coin					Coin																																																															-	269.86	0	40.46	0	9.58	14.12	0	3.33	31.79	0	0	0	0	74.83	45.36	185.05	0	0	0	0	52.1	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing																					0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												0.07	0	0.18	0	0.23	0.23	0	0.23	0.23	0	0	0	0	0.23	0.23	0.23	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0												19.79	-	7.09	-	2.23	3.29	-	0.78	7.41	-	-	-	-	17.43	10.57	43.12	-	-	-	-	12.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.85	19.79	-	7.09	-	2.23	3.29	-	0.78	7.41	-	-	-	-	17.43	10.57	43.12	-	-	-	-	12.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	123.85
H3959_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	Coin	Coin	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	0	0	28.98	0	289.61	10.13	6.16	282.08	413.06	0	432.9	0	0	0	4072.08	4970.76	137.02	584.7	0	6.53	1032.54	0	0	504	118.04	0	223.58	0	0	0	204.11	0	0	0	93.95	0.15								20 days 11+		50 per trip	20 - 200 Max	20 - 200 Max	50	75		25				10	25	25	35		25	VARIES			15	25		25				25					50						0	0	0.1	0	50	0.19	0.19	50	75	0	25	0	0	0	9.94	25	25	35	0	25	35.62	0	0	15	25	0	25	0	0	0	25	0	0	0	25	50							0	0	0.1	0	50	0.19	0.19	50	75	0	25	0	0	0	9.94	25	25	35	0	25	35.62	0	0	15	25	0	25	0	0	0	25	0	0	0	25	50							-	-	2.99	-	1.21	1.92	1.17	1.18	2.58	-	0.9	-	-	-	3.37	10.35	0.29	1.71	-	0.01	3.07	-	-	0.63	0.25	-	0.47	-	-	-	0.43	-	-	-	0.2	0	-	-	-	-	-	32.71	-	-	2.99	-	1.21	1.92	1.17	1.18	2.58	-	0.9	-	-	-	3.37	10.35	0.29	1.71	-	0.01	3.07	-	-	0.63	0.25	-	0.47	-	-	-	0.43	-	-	-	0.2	0	-	-	-	-	-	32.71
H3959_002_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	Coin	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	0	0	29.83	0	289.61	10.6	6.3	282.08	413.06	0	432.9	0	0	0	4032.75	4970.76	137.02	584.7	0	6.53	1032.54	0	0	504	118.04	0	223.58	0	0	0	204.11	0	0	0	93.95	0.15								20 days 11+		50 per trip	20 - 200 Max	20 - 200 Max	50	75		25				10	25	25	35		25	VARIES			15	25		25				25				25	50						0	0	0.1	0	50	0.19	0.19	50	75	0	25	0	0	0	10	25	25	35	0	25	35.62	0	0	15	25	0	25	0	0	0	25	0	0	0	25	50							0	0	0.1	0	50	0.19	0.19	50	75	0	25	0	0	0	10	25	25	35	0	25	35.62	0	0	15	25	0	25	0	0	0	25	0	0	0	25	50							-	-	3.07	-	1.21	2.01	1.2	1.18	2.58	-	0.9	-	-	-	3.36	10.35	0.29	1.71	-	0.01	3.07	-	-	0.63	0.25	-	0.47	-	-	-	0.43	-	-	-	0.2	0	-	-	-	-	-	32.9	-	-	3.07	-	1.21	2.01	1.2	1.18	2.58	-	0.9	-	-	-	3.36	10.35	0.29	1.71	-	0.01	3.07	-	-	0.63	0.25	-	0.47	-	-	-	0.43	-	-	-	0.2	0	-	-	-	-	-	32.9
H3959_004_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	Coin	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	0	0	32.5	0	321.88	10	6.22	313.52	459.09	0	481.13	0	0	0	4482.11	5524.64	152.29	649.85	0	7.26	1147.59	0	0	504	131.19	0	248.49	0	0	0	226.85	0	0	0	104.42	0.16								20 days 11+		50 per trip	20 - 200 Max	20 - 200 Max	50	75		25				10	25	25	35		25	Varies			15	25		25				25				25	50						0	0	0.1	0	50	0.19	0.19	50	75	0	25	0	0	0	10	25	25	35	0	25	35.62	0	0	15	25	0	25	0	0	0	25	0	0	0	25	50							0	0	0.1	0	50	0.19	0.19	50	75	0	25	0	0	0	10	25	25	35	0	25	35.62	0	0	15	25	0	25	0	0	0	25	0	0	0	25	50							-	-	3.35	-	1.34	1.9	1.18	1.31	2.87	-	1	-	-	-	3.74	11.51	0.32	1.9	-	0.02	3.41	-	-	0.63	0.27	-	0.52	-	-	-	0.47	-	-	-	0.22	0	-	-	-	-	-	35.94	-	-	3.35	-	1.34	1.9	1.18	1.31	2.87	-	1	-	-	-	3.74	11.51	0.32	1.9	-	0.02	3.41	-	-	0.63	0.27	-	0.52	-	-	-	0.47	-	-	-	0.22	0	-	-	-	-	-	35.94
H3959_006_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	D	D	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	2052.62	0	881.68	0	287.98	0	0	282.08	413.06	0	0	0	0	0	4032.75	4970.76	136.97	584.7	0	5.86	1032.54	0	0	504	118.04	0	223.58	0	0	0	204.11	0	0	0	0	0.15						250/admit		0 1-5/40 6+		25 per trip			50	50						25	35	25	35		35	Varies			15	35		35				35					50						46.22	0	28.44	0	25	0	0	50	50	0	0	0	0	0	25	34.89	25	34.78	0	35	27.2	0	0	15	35	0	35	0	0	0	28.03	0	0	0	0	36.15							46.22	0	28.44	0	25	0	0	50	50	0	0	0	0	0	25	34.89	25	34.78	0	35	27.2	0	0	15	35	0	35	0	0	0	28.03	0	0	0	0	36.15							7.91	-	2.09	-	0.6	-	-	1.18	1.72	-	-	-	-	-	8.4	14.45	0.29	1.69	-	0.02	2.34	-	-	0.63	0.34	-	0.65	-	-	-	0.48	-	-	-	-	0	-	-	-	-	-	42.79	7.91	-	2.09	-	0.6	-	-	1.18	1.72	-	-	-	-	-	8.4	14.45	0.29	1.69	-	0.02	2.34	-	-	0.63	0.34	-	0.65	-	-	-	0.48	-	-	-	-	0	-	-	-	-	-	42.79
H3959_008_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	Coin	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	0	0	28.28	0	303.95	10.09	5.81	296.05	433.5	0	454.32	0	0	0	4232.35	5216.79	143.81	613.64	0	6.85	1083.65	0	0	504	123.88	0	234.65	0	0	0	214.21	0	0	0	98.61	0.16								20 days 11+		50 per trip	20 - 200 Max	20 - 200 Max	50	75		25				10	25	25	35		25	VARIES			15	25		25				25				25	50						0	0	0.1	0	50	0.19	0.19	50	75	0	25	0	0	0	10	25	25	35	0	25	35.62	0	0	15	25	0	25	0	0	0	25	0	0	0	25	50							0	0	0.1	0	50	0.19	0.19	50	75	0	25	0	0	0	10	25	25	35	0	25	35.62	0	0	15	25	0	25	0	0	0	25	0	0	0	25	50							-	-	2.91	-	1.27	1.92	1.1	1.23	2.71	-	0.95	-	-	-	3.53	10.87	0.3	1.79	-	0.01	3.22	-	-	0.63	0.26	-	0.49	-	-	-	0.45	-	-	-	0.21	0	-	-	-	-	-	33.84	-	-	2.91	-	1.27	1.92	1.1	1.23	2.71	-	0.95	-	-	-	3.53	10.87	0.3	1.79	-	0.01	3.22	-	-	0.63	0.26	-	0.49	-	-	-	0.45	-	-	-	0.21	0	-	-	-	-	-	33.84
H3959_010_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	2052.62	0	881.68	0	289.61	10.13	6.16	282.08	413.06	0	0	0	0	0	4072.08	4970.76	137.02	584.7	0	5.86	1032.54	0	0	504	118.04	0	223.58	0	0	0	204.11	0	0	0	0	0.15						100 per admit		20 coins days 11+		50 per trip	20 - 200 Max	20 - 200 Max	50	75						15	VARIES	25	35		30	VARIES			15	25		25				30					50						18.49	0	40.65	0	50	0.19	0.19	50	75	0	0	0	0	0	14.89	29	25	35	0	30	27.2	0	0	15	25	0	25	0	0	0	30	0	0	0	0	50							18.49	0	40.65	0	50	0.19	0.19	50	75	0	0	0	0	0	14.89	29	25	35	0	30	27.2	0	0	15	25	0	25	0	0	0	30	0	0	0	0	50							3.16	-	2.99	-	1.21	1.92	1.17	1.18	2.58	-	-	-	-	-	5.05	12.01	0.29	1.71	-	0.01	2.34	-	-	0.63	0.25	-	0.47	-	-	-	0.51	-	-	-	-	0	-	-	-	-	-	37.47	3.16	-	2.99	-	1.21	1.92	1.17	1.18	2.58	-	-	-	-	-	5.05	12.01	0.29	1.71	-	0.01	2.34	-	-	0.63	0.25	-	0.47	-	-	-	0.51	-	-	-	-	0	-	-	-	-	-	37.47
H3959_011_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	1939.73	0	881.68	0	289.61	10.6	6.3	282.08	413.06	0	0	0	0	0	4032.75	4970.76	137.02	584.7	0	5.86	1032.54	0	0	504	118.04	0	223.58	0	0	0	204.11	0	0	0	0	0.15						100 per admit		0 1-10/20 11+		50 per trip	20 - 200 Max	20 - 200 Max	50	75						15	VARIES	25	35		30	VARIES			15	25		25				30					50						18.49	0	41.84	0	50	0.19	0.19	50	75	0	0	0	0	0	15	29	25	35	0	30	27.2	0	0	15	25	0	25	0	0	0	30	0	0	0	0	50							18.49	0	41.84	0	50	0.19	0.19	50	75	0	0	0	0	0	15	29	25	35	0	30	27.2	0	0	15	25	0	25	0	0	0	30	0	0	0	0	50							2.99	-	3.07	-	1.21	2.01	1.2	1.18	2.58	-	-	-	-	-	5.04	12.01	0.29	1.71	-	0.01	2.34	-	-	0.63	0.25	-	0.47	-	-	-	0.51	-	-	-	-	0	-	-	-	-	-	37.49	2.99	-	3.07	-	1.21	2.01	1.2	1.18	2.58	-	-	-	-	-	5.04	12.01	0.29	1.71	-	0.01	2.34	-	-	0.63	0.25	-	0.47	-	-	-	0.51	-	-	-	-	0	-	-	-	-	-	37.49
H3959_012_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other						2000	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	Coin	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	1999.95	0	912.53	0	287.76	10.23	6.15	267.17	391.22	0	510.36	0	0	0	3930.12	4859.13	141.05	565.92	5.19	6.36	1006.26	0	0	0	118.04	0	0	0	0	0	0	0	0	0	417.87	0.14						150 1-5		0 1-5/40 6+		50 per trip	20 w/ 200 max	20 w/ 200 max	50	75		VARIES				10	VARIES	VARIES	10	10 Rad Therapy	30	VARIES				20										10	50						93	0	31.4	0	50	0.19	0.19	50	75	0	21.64	0	0	0	10	27.97	24.76	10	0.1	30	27.2	0	0	0	20	0	0	0	0	0	0	0	0	0	10	50							89.06	0	30.07	0	50	0.19	0.19	50	71.83	0	20.73	0	0	0	10	27.97	24.76	9.58	0.1	30	27.2	0	0	0	20	0	0	0	0	0	0	0	0	0	10	50							14.84	-	2.29	-	1.2	1.94	1.17	1.11	2.34	-	0.88	-	-	-	3.28	11.33	0.29	0.45	0.52	0.02	2.28	-	-	-	0.2	-	-	-	-	-	-	-	-	-	0.35	0	-	-	-	-	-	44.48	14.84	-	2.29	-	1.2	1.94	1.17	1.11	2.34	-	0.88	-	-	-	3.28	11.33	0.29	0.45	0.52	0.02	2.28	-	-	-	0.2	-	-	-	-	-	-	-	-	-	0.35	0	-	-	-	-	-	44.48
H3959_013_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	D	D	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	2021.83	0	868.45	0	285.27	9.97	6.07	277.85	406.86	0	530.77	0	0	0	3972.26	4896.2	134.97	575.93	472.55	6.43	1017.05	0	0	0	118.04	0	0	0	0	0	201.05	0	0	0	92.55	0.15						100 per admit		0 1-5/40 6+		50 per trip	20 - 200 Max	20 - 200 Max	50	100		VARIES				15	30	30	35		30	VARIES				30						30				10	50						46.22	0	2844	0	50	19	19	50	100	0	21.5	0	0	0	15	30	30	35	20.37	30	34.47	0	0	0	30	0	0	0	0	0	30	0	0	0	10	50							46.22	0	2844	0	50	19	19	50	100	0	21.5	0	0	0	15	30	30	35	20.37	30	34.47	0	0	0	30	0	0	0	0	0	30	0	0	0	10	50							7.79	-	2.06	-	1.19	1.9	1.15	1.16	3.39	-	0.95	-	-	-	4.97	12.24	0.34	1.68	0.8	0.02	2.92	-	-	-	0.3	-	-	-	-	-	0.5	-	-	-	0.08	0	-	-	-	-	-	43.42	7.79	-	2.06	-	1.19	1.9	1.15	1.16	3.39	-	0.95	-	-	-	4.97	12.24	0.34	1.68	0.8	0.02	2.92	-	-	-	0.3	-	-	-	-	-	0.5	-	-	-	0.08	0	-	-	-	-	-	43.42
H3959_014_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	Coin	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	2052.62	0	29.24	0	289.61	8.99	5.59	282.08	413.06	0	0	0	0	0	4032.75	4970.76	137.02	584.7	0	5.86	1032.54	0	0	504	118.04	0	223.58	0	0	0	204.11	0	0	0	0	0.15						100 per admit		20 coins days 11+		50 per trip	20 - 200 Max	20 - 200 Max	50	75						15	VARIES	25	35		30	VARIES			15	25		25				30					50						18.49	0	0.1	0	50	0.19	0.19	50	75	0	0	0	0	0	15	29	25	35	0	30	27.2	0	0	15	25	0	25	0	0	0	30	0	0	0	0	50							18.49	0	0.1	0	50	0.19	0.19	50	75	0	0	0	0	0	15	29	25	35	0	30	27.2	0	0	15	25	0	25	0	0	0	30	0	0	0	0	50							3.16	-	3.01	-	1.21	1.71	1.06	1.18	2.58	-	-	-	-	-	5.04	12.01	0.29	1.71	-	0.01	2.34	-	-	0.63	0.25	-	0.47	-	-	-	0.51	-	-	-	-	0	-	-	-	-	-	37.16	3.16	-	3.01	-	1.21	1.71	1.06	1.18	2.58	-	-	-	-	-	5.04	12.01	0.29	1.71	-	0.01	2.34	-	-	0.63	0.25	-	0.47	-	-	-	0.51	-	-	-	-	0	-	-	-	-	-	37.16
H3959_015_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	Coin	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	2052.62	0	26.94	0	289.61	9.61	5.54	282.08	413.06	0	0	0	0	0	4032.75	4970.76	137.02	584.7	0	5.86	1032.54	0	0	504	118.04	0	223.58	0	0	0	204.11	0	0	0	0	0.15						100 per admit		20 coins days 11+		50 per trip	20 - 200 Max	20 - 200 Max	50	75						15	VARIES	25	35		30	VARIES			15	25		25				30					50						18.49	0	0.1	0	50	0.19	0.19	50	75	0	0	0	0	0	15	29	25	35	0	30	27.2	0	0	15	25	0	25	0	0	0	30	0	0	0	0	50							18.49	0	0.1	0	50	0.19	0.19	50	75	0	0	0	0	0	15	29	25	35	0	30	27.2	0	0	15	25	0	25	0	0	0	30	0	0	0	0	50							3.16	-	2.78	-	1.21	1.83	1.05	1.18	2.58	-	-	-	-	-	5.04	12.01	0.29	1.71	-	0.01	2.34	-	-	0.63	0.25	-	0.47	-	-	-	0.51	-	-	-	-	0	-	-	-	-	-	37.03	3.16	-	2.78	-	1.21	1.83	1.05	1.18	2.58	-	-	-	-	-	5.04	12.01	0.29	1.71	-	0.01	2.34	-	-	0.63	0.25	-	0.47	-	-	-	0.51	-	-	-	-	0	-	-	-	-	-	37.03
H3959_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	2165.03	40.36	836.94	0	10.09	12.02	6.56	261.74	445.67	2.48	17.62	33.79	0.83	14.19	26.21	145.05	2.37	7.32	51.54	7.06	31.93	2.48	0	0	0.37	2.16	0.37	0.67	0	3.01	1.23	0	0	5.21	0.66	0						500 per admit	500 per admit	114 per day 21+		23.3 coin	23.3 coin	23.3 coin	50 per visit	35 per visit	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin			23.3 coin	23.3 coin	23.3 coin	23.3 coin		23.3 coin	23.3 coin			23.3 coin	23.3 coin							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96	8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96
H3959_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	2165.03	40.36	836.94	0	10.09	12.02	6.56	261.74	445.67	2.48	17.62	33.79	0.83	14.19	26.21	145.05	2.37	7.32	51.54	7.06	31.93	2.48	0	0	0.37	2.16	0.37	0.67	0	3.01	1.23	0	0	5.21	0.66	0						500 per admit	500 per admit	114 per day 21+		23.3 coin	23.3 coin	23.3 coin	50 per visit	35 per visit	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin			23.3 coin	23.3 coin	23.3 coin	23.3 coin		23.3 coin	23.3 coin			23.3 coin	23.3 coin							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96	8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96
H3959_804_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	2165.03	40.36	836.94	0	10.09	12.02	6.56	261.74	445.67	2.48	17.62	33.79	0.83	14.19	26.21	145.05	2.37	7.32	51.54	7.06	31.93	2.48	0	0	0.37	2.16	0.37	0.67	0	3.01	1.23	0	0	5.21	0.66	0						500 per admit	500 per admit	114 per day 21+		23.3 coin	23.3 coin	23.3 coin	50 per visit	35 per visit	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin			23.3 coin	23.3 coin	23.3 coin	23.3 coin		23.3 coin	23.3 coin			23.3 coin	23.3 coin							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96	8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96
H3959_805_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	2165.03	40.36	836.94	0	10.09	12.02	6.56	261.74	445.67	2.48	17.62	33.79	0.83	14.19	26.21	145.05	2.37	7.32	51.54	7.06	31.93	2.48	0	0	0.37	2.16	0.37	0.67	0	3.01	1.23	0	0	5.21	0.66	0						500 per admit	500 per admit	114 per day 21+		23.3 coin	23.3 coin	23.3 coin	50 per visit	35 per visit	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin			23.3 coin	23.3 coin	23.3 coin	23.3 coin		23.3 coin	23.3 coin			23.3 coin	23.3 coin							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96	8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96
H3959_806_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	2165.03	40.36	836.94	0	10.09	12.02	6.56	261.74	445.67	2.48	17.62	33.79	0.83	14.19	26.21	145.05	2.37	7.32	51.54	7.06	31.93	2.48	0	0	0.37	2.16	0.37	0.67	0	3.01	1.23	0	0	5.21	0.66	0						500 per admit	500 per admit	114 per day 21+		23.3 coin	23.3 coin	23.3 coin	50 per visit	35 per visit	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin			23.3 coin	23.3 coin	23.3 coin	23.3 coin		23.3 coin	23.3 coin			23.3 coin	23.3 coin							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96	8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96
H3959_807_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																-	2165.03	40.36	836.94	0	10.09	12.02	6.56	261.74	445.67	2.48	17.62	33.79	0.83	14.19	26.21	145.05	2.37	7.32	51.54	7.06	31.93	2.48	0	0	0.37	2.16	0.37	0.67	0	3.01	1.23	0	0	5.21	0.66	0						500 per admit	500 per admit	114 per day 21+		23.3 coin	23.3 coin	23.3 coin	50 per visit	35 per visit	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin	23.3 coin			23.3 coin	23.3 coin	23.3 coin	23.3 coin		23.3 coin	23.3 coin			23.3 coin	23.3 coin							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							45.42	121.19	31.81	0	0.23	0.23	0.23	50	35	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0	0.23	0.23	0	0	0.23	0.23	0							8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96	8.2	0.41	2.22	-	2.35	2.8	1.53	1.09	1.3	0.58	4.11	7.87	0.19	3.31	6.1	33.8	0.55	1.71	12.01	1.65	7.44	0.58	-	-	0.09	0.5	0.09	0.16	-	0.7	0.29	-	-	1.21	0.15	-	-	-	-	-	-	102.96
H3962_001_0	2006																													V						V	V	V	V	V		V	Coin																																																															-								279						40.36	3815.69	5423.65	146.83			327.88	6.16																												50 (WIA)						25 S/A Office Visit	10 Office Visit	10 Office Visit	10 Office Visit			R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance																												50						25	10	10	9.95			10	0.2																													50						25	10	10	9.95			10	0.2																						-	-	-	-	-	-	-	1.16	-	-	-	-	-	0.08	3.18	4.52	0.12	-	-	0.27	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.57	-	-	-	-	-	-	-	1.16	-	-	-	-	-	0.08	3.18	4.52	0.12	-	-	0.27	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.57
H3962_002_0	2006																													V						V	V	V	V			V	COIN																																																															-								219						40.36	3477.94	4659.69	146.83			310.25	4.8																												50 (WIA)						25 S/A Office Visit	10 Office Visit	10 Office Visit	10 Office Visit			R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance																												50						25	10	10	9.95			10																														50						25	10	10	9.95			10	0.2																						-	-	-	-	-	-	-	0.91	-	-	-	-	-	0.08	2.9	3.88	0.12	-	-	0.26	0.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9.12	-	-	-	-	-	-	-	0.91	-	-	-	-	-	0.08	2.9	3.88	0.12	-	-	0.26	0.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9.12
H3962_003_0	2006																													V						V	V	V	V			V	COIN																																																															-								394.64						40.36	3208.88	4279.6	146.83			253.81	4.65																												50 (WIA)						25 S/A Office Visit	10 Office Visit	10 Office Visit	10 Office Visit			R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance																												50						25	10	10	9.95	10		10	0.2																													50						25	10	10	9.95	10		10	0.2																						-	-	-	-	-	-	-	1.64	-	-	-	-	-	0.08	2.67	3.57	0.12	-	-	0.21	0.93	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9.23	-	-	-	-	-	-	-	1.64	-	-	-	-	-	0.08	2.67	3.57	0.12	-	-	0.21	0.93	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9.23
H3962_004_0	2006																						A		D			Coin	Coin	V						V	V	V	V	V		V	COIN	P																																																														-	461.98		1582.5			25.87		279						40.36	3815.69	5423.65	146.83			327.88	6.16	6919.95																				150 Adm Copay	150	25/Day			20 Coins	20 Coins	50 (WIA)						25 S/A Office Visit	10 Office Visit	10 Office Visit	10 Office Visit		20 Office Visit	R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance																					150		25			0.2	0.2	50						25	10	10	9.95	10		10	0.2	20																					150		25			0.2	0.2	50						25	10	10	9.95	10		10	0.2	20																					5.77	-	3.3	-	-	5.17	-	1.16	-	-	-	-	-	0.08	3.18	4.52	0.12	-	-	0.27	1.23	11.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.35	5.77	-	3.3	-	-	5.17	-	1.16	-	-	-	-	-	0.08	3.18	4.52	0.12	-	-	0.27	1.23	11.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.35
H3962_005_0	2006																						A		D			Coin		V						V	V	V	V			V	COIN	P																																																														-	502.94		1722			16.18		219.22						40.36	3477.94	4659.69	146.83			310.25	4.8	6919.95																				150 Adm Copay		25/Day			20 Coins		50 (WIA)						25 S/A Office Visit	10 Office Visit	10 Office Visit	10 Office Visit			R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance	20																				150		25			0.2		50						25	10	10	9.95			10	0.2	20																					150		25			0.2		50						25	10	10	9.95			10	0.2	20																					6.29	-	3.59	-	-	3.24	-	0.91	-	-	-	-	-	0.08	2.9	3.88	0.12	-	-	0.26	0.96	11.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.76	6.29	-	3.59	-	-	3.24	-	0.91	-	-	-	-	-	0.08	2.9	3.88	0.12	-	-	0.26	0.96	11.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.76
H3962_006_0	2006																						A		D			Coin		V						V	V	V	V	V		V	COIN	P																																																														-	549.23		2253			26.22		394.64						40.36	3208.88	4279.6	146.83			253.81	4.65	6919.95																				150 Adm Copay	150	25/Day			20 Coins	20 Coins	50 (WIA)						25 S/A Office Visit	10 Office Visit	10 Office Visit	10 Office Visit		20 Office Visit	R.Phy Chiro Pod Pap&Pelvic 10	20 Coinsurance																					150		25			0.2		50						25	10	10	9.95	10		10	0.2	20																					150		25			0.2		50						25	10	10	9.95	10		10	0.2	20																					6.87	-	4.69	-	-	5.24	-	1.64	-	-	-	-	-	0.08	2.67	3.57	0.12	-	-	0.21	0.93	11.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.57	6.87	-	4.69	-	-	5.24	-	1.64	-	-	-	-	-	0.08	2.67	3.57	0.12	-	-	0.21	0.93	11.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.57
H3962_007_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	Coin	P	T																																																													-	461.98		1582.5		281.75	25.87		279	373.18					604.62	3815.69	5423.65	146.82			3495.41	6.16	6919.95	177.36																			500 Adm Copay		50/Day		75	30 Coins		50 (WIA)	100					30 S/A & Rehab svc Office Visit	10 Office Visit	30 Office Visit	30 Office Visit			R.Phy Bone Mass Mammogram Col. Screening Prostate Scr Pap&Pelvic 10 Chiro Pod 30	20 Coinsurance	30	50																			500		50		75	0.3		50	100					30	10	30	30			11.95	0.2	30	50																				500		50		75	0.3		50	100					30	10	30	30			11.95	0.2	30	50																				19.25	-	6.59	-	1.76	7.76	-	1.16	3.11	-	-	-	-	1.51	3.18	13.56	0.37	-	-	3.48	1.23	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.01	19.25	-	6.59	-	1.76	7.76	-	1.16	3.11	-	-	-	-	1.51	3.18	13.56	0.37	-	-	3.48	1.23	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.01
H3962_008_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	Coin	P	T																																																													-	502.94		1722		249.12	16.18		219.22	397.61					851.58	3477.94	4659.69	146.83			3477.78	4.8	6919.95	177.36																			500 Adm Copay		50/Day		75	30 Coins		50 (WIA)	100					30 S/A & Rehab svc Office Visit	10 Office Visit	30 Office Visit	30 Office Visit			R.Phy Bone Mass Mammogram Col. Screening Prostate Scr Pap&Pelvic 10 Chiro Pod 30	20 Coinsurance	30	50																			500		50		75	0.3		50	100					30	10	30	30			11.84	0.2	30	50																				500		50		75	0.3		50	100					30	10	30	30			11.84	0.2	30	50																				20.96	-	7.18	-	1.56	4.85	-	0.91	3.31	-	-	-	-	2.13	2.9	11.65	0.37	-	-	3.43	0.96	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.24	20.96	-	7.18	-	1.56	4.85	-	0.91	3.31	-	-	-	-	2.13	2.9	11.65	0.37	-	-	3.43	0.96	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.24
H3962_009_0	2006																						A		D		T	Coin		V	V					V	V	V	V			V	Coin	P	T																																																													-	549.23		2253		436.85	27.6		394.64	441.21					741.21	3208.88	4279.6	146.83			3421.34	4.65	6919.95	177.36																			500 Adm Copay		50/Day		75	30 Coins		50 (WIA)	100					30 S/A & Rehab svc Office Visit	10 Office Visit	30 Office Visit	30 Office Visit			R.Phy Bone Mass Mammogram Col. Screening Prostate Scr Pap&Pelvic 10 Chiro Pod 30	20 Coinsurance	30	50																			500		50		75	0.3		50	100					30	10	30	30			11.55	0.2	30	50																				500		50		75	0.3		50	100					30	10	30	30			11.55	0.2	30	50																				22.88	-	9.39	-	2.73	8.28	-	1.64	3.68	-	-	-	-	1.85	2.67	10.7	0.37	-	-	3.29	0.93	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.46	22.88	-	9.39	-	2.73	8.28	-	1.64	3.68	-	-	-	-	1.85	2.67	10.7	0.37	-	-	3.29	0.93	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.46
H3962_010_0	2006																						A		D		T	Coin		V	V					V	V	V	V	V		V	Coin	P	T																																																													-	461.98		1582.5		281.75	25.87		279	373.18					604.62	3911.08	5559.24	150.49			3495.41	6.16	6919.95	177.36																			500 Adm Copay		50/Day		75	30 Coins		50 (WIA)	100					30 S/A & Rehab svc Office Visit	10 Office Visit	30 Office Visit	30 Office Visit			R.Phy Bone Mass Mammogram Col. Screening Prostate Scr Pap&Pelvic 10 Chiro Pod 30	20 Coinsurance	30	50				30 Office Visit															500		50		75	0.3		50	100					30	10	30	30			11.95	0.2	30	50																				500		50		75	0.3		50	100					30	10	30	30			11.95	0.2	30	50																				19.25	-	6.59	-	1.76	7.76	-	1.16	3.11	-	-	-	-	1.51	3.26	13.9	0.38	-	-	3.48	1.23	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.43	19.25	-	6.59	-	1.76	7.76	-	1.16	3.11	-	-	-	-	1.51	3.26	13.9	0.38	-	-	3.48	1.23	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.43
H3962_011_0	2006																						A		D		T	Coin		V	V					V	V	V	V	V		V	Coin	P	T																																																													-	502.94		1722		249.12	16.18		219.22	397.61					851.58	3564.89	4776.18	150.5			3477.78	4.8	6919.95	177.36																			500 Adm Copay		50/Day		75	30 Coins		50 (WIA)	100					30 S/A & Rehab svc Office Visit	10 Office Visit	30 Office Visit	30 Office Visit			R.Phy Bone Mass Mammogram Col. Screening Prostate Scr Pap&Pelvic 10 Chiro Pod 30	20 Coinsurance	30	50																			500		50		75	0.3		50	100					30	10	30	30			11.84	0.2	30	50																				500		50		75	0.3		50	100					30	10	30	30			11.84	0.2	30	50																				20.96	-	7.18	-	1.56	4.85	-	0.91	3.31	-	-	-	-	2.13	2.97	11.94	0.38	-	-	3.43	0.96	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.62	20.96	-	7.18	-	1.56	4.85	-	0.91	3.31	-	-	-	-	2.13	2.97	11.94	0.38	-	-	3.43	0.96	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.62
H3962_012_0	2006																						A		D		T	Coin		V	V					V	V	V	V	V		V	Coin	P	T																																																													-	549.23		2253		436.85	26.22		394.64	441.21					741.21	3289.11	4386.59	150.5			3421.34	4.65	6919.95	177.36																			500 Adm Copay		50/Day		75	30 Coins		50 (WIA)	100					30 S/A & Rehab svc Office Visit	10 Office Visit	30 Office Visit	30 Office Visit			R.Phy Bone Mass Mammogram Col. Screening Prostate Scr Pap&Pelvic 10 Chiro Pod 30	20 Coinsurance	30	50																			500		50		75	0.3		50	100					30	10	30	30			11.55	0.2	30	50																				500		50		75	0.3		50	100					30	10	30	30			11.55	0.2	30	50																				22.88	-	9.39	-	2.73	7.87	-	1.64	3.68	-	-	-	-	1.85	2.74	10.97	0.38	-	-	3.29	0.93	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.39	22.88	-	9.39	-	2.73	7.87	-	1.64	3.68	-	-	-	-	1.85	2.74	10.97	0.38	-	-	3.29	0.93	17.3	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.39
H3962_801_0	2006																						A		D		T	Coin		V						V	V	V	V	V		V	Coin	P	T				V																																																									-	220.86		877.43		281.75	18.1		263.74	373.18					40.36	3691.66	3756.08	146.83			3470.81	8.88	6919.95	177.36				24.03																																																								500		50		75	0.3		50	100					30	10	30	30			11.87	0.2	30	50				30																500		50		75	0.3		50	100					30	10	30	30			11.87	0.2	30	50				30																9.2	-	3.66	-	1.76	5.43	-	1.1	3.11	-	-	-	-	0.1	3.08	9.39	0.37	-	-	3.43	1.78	17.3	0.74	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.5	9.2	-	3.66	-	1.76	5.43	-	1.1	3.11	-	-	-	-	0.1	3.08	9.39	0.37	-	-	3.43	1.78	17.3	0.74	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.5
H3962_802_0	2006																						A		D		T	Coin		V						V	V	V	V	V		V	Coin	P	T				V																																																									-	220.86		877.43		281.75	18.1		263.74	373.18					40.36	3691.66	3756.08	146.83			3470.81	8.88	6919.95	177.36				24.03																																																								500		50		75	0.3		50	100					30	10	30	30			11.87	0.2	30	50				30																500		50		75	0.3		50	100					30	10	30	30			11.87	0.2	30	50				30																9.2	-	3.66	-	1.76	5.43	-	1.1	3.11	-	-	-	-	0.1	3.08	9.39	0.37	-	-	3.43	1.78	17.3	0.74	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.5	9.2	-	3.66	-	1.76	5.43	-	1.1	3.11	-	-	-	-	0.1	3.08	9.39	0.37	-	-	3.43	1.78	17.3	0.74	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.5
H3962_803_0	2006																						A		D		T	Coin		V						V	V	V	V	V		V	Coin	P	T				V																																																									-	220.86		877.43		281.75	18.1		263.74	373.18					40.36	3691.66	3756.08	146.83			3470.81	8.88	6919.95	177.36				24.03																																																								500		50		75	0.3		50	100					30	10	30	30			11.87	0.2	30	50				30																500		50		75	0.3		50	100					30	10	30	30			11.87	0.2	30	50				30																9.2	-	3.66	-	1.76	5.43	-	1.1	3.11	-	-	-	-	0.1	3.08	9.39	0.37	-	-	3.43	1.78	17.3	0.74	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.5	9.2	-	3.66	-	1.76	5.43	-	1.1	3.11	-	-	-	-	0.1	3.08	9.39	0.37	-	-	3.43	1.78	17.3	0.74	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.5
H3962_804_0	2006																						A		D		T	Coin		V						V	V	V	V	V		V	Coin	P	T				V																																																									-	220.86		877.43		281.75	18.1		263.74	373.18					40.36	3691.66	3756.08	146.83			3470.81	8.88	6919.95	177.36				24.03																																																								500		50		75	0.3		50	100					30	10	30	30			11.87	0.2	30	50				30																500		50		75	0.3		50	100					30	10	30	30			11.87	0.2	30	50				30																9.2	-	3.66	-	1.76	5.43	-	1.1	3.11	-	-	-	-	0.1	3.08	9.39	0.37	-	-	3.43	1.78	17.3	0.74	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.5	9.2	-	3.66	-	1.76	5.43	-	1.1	3.11	-	-	-	-	0.1	3.08	9.39	0.37	-	-	3.43	1.78	17.3	0.74	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.5
H3964_001_0	2006																						A	A						V	V							V	V	V																																																																		-	377.41	5.54	0	0	0	0	0	358.11	155.11	0	0	0	0	0	0	7346.08	383.89	850.92	0	0	0	0	0	0	0	0	0	0	0	0	0																																																				800	800	0	0	0	0	0	50	150	0	0	0	0	0	0	40	20	10	0	0	0	0	0	0	0	0	0	0	0	0	0												800	800	0	0	0	0	0	50	150	0	0	0	0	0	0	40	20	10	0	0	0	0	0	0	0	0	0	0	0	0	0												25.16	0.37	-	-	-	-	-	1.49	1.94	-	-	-	-	-	-	24.49	0.64	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.8	25.16	0.37	-	-	-	-	-	1.49	1.94	-	-	-	-	-	-	24.49	0.64	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.8
H3964_002_0	2006																						BP	BP			Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin		Coin																																																														-	435.12	6.38	6.34	3.34	9.78	12.66	5.15	578.22	20.81	4.74	37.44	0.06	0.61	15.31	45.41	151.76	20.74	5.03	14.07	0.25	61.79	0	1.68	13.46	1.2	3.45	0.09	1.4	0	0.06	17.59																																																				500	500	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0	0.19	0.5	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0												500	500	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0	0.19	0.5	0.2	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0											500	18.13	0.27	-	-	1.96	2.53	1.03	2.41	4.16	0.95	7.49	0.01	0.12	3.06	-	29.45	10.37	1.01	2.81	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.81	18.13	0.27	-	-	1.96	2.53	1.03	2.41	4.16	0.95	7.49	0.01	0.12	3.06	-	29.45	10.37	1.01	2.81	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	85.81
H3964_003_0	2006																						A	A						V	V							V	V	V																																																																		-	377.41	5.54	0	0	0	0	0	358.11	155.11	0	0	0	0	0	0	7346.08	383.89	850.92	0	0	0	0	0	0	0	0	0	0	0	0	0																																																				800	800	0	0	0	0	0	50	150	0	0	0	0	0	0	40	20	10	0	0	0	0	0	0	0	0	0	0	0	0	0												800	800	0	0	0	0	0	50	150	0	0	0	0	0	0	40	20	10	0	0	0	0	0	0	0	0	0	0	0	0	0												25.16	0.37	-	-	-	-	-	1.49	1.94	-	-	-	-	-	-	24.49	0.64	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.8	25.16	0.37	-	-	-	-	-	1.49	1.94	-	-	-	-	-	-	24.49	0.64	0.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.8
H3972_001_0	2006											-											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	P											-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	607.54	25.67	36.97	16.3	13.92	23.92	4.15	565.28	50.58	15.73	48.51	0	0.8	0.03	39.16	156.4	4.69	5.4	7.35	0.27	8.54	0.17	2	0.26	7.03	0.06	0.48	0.04	0	0	3.39																																																				0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											-	0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	38.27	1.62	6	-	3.24	5.57	0.97	2.36	11.79	3.67	11.3	-	0.19	0.01	9.12	36.44	1.09	1.26	1.71	0.06	1.99	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	136.7	38.27	1.62	6	-	3.24	5.57	0.97	2.36	11.79	3.67	11.3	-	0.19	0.01	9.12	36.44	1.09	1.26	1.71	0.06	1.99	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	136.7
H4003_001_0	2006																											Coin	Coin	V																V																																																												-						20	3.05	802.89																2455.81																							0.2	0.2	25																2																							0.2	0.2	25																1																								0.2	0.2	25																1																			-	-	-	-	-	4	0.61	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.49	-	-	-	-	-	4	0.61	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	6.49
H4003_008_0	2006																													V																																																																												-								802.89																																									25																																									25																																										25																																			-	-	-	-	-	-	-	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.67	-	-	-	-	-	-	-	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.67
H4003_009_0	2006																											Coin	Coin	V																																																																												-						20	5.24	1271.97																																							0.2	0.2	25																																							0.2	0.2	25																																								0.2	0.2	25																																			-	-	-	-	-	4	1.05	2.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.7	-	-	-	-	-	4	1.05	2.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.7
H4003_010_0	2006																											Coin	Coin	V																																																																												-						20	5.14	1010.2																																							0.2	0.2	25																																							0.2	0.2	25																																								0.2	0.2	25																																			-	-	-	-	-	4	1.03	2.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.13	-	-	-	-	-	4	1.03	2.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.13
H4003_801_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	114.4	2.78	1.51	0	4.99	26.08	7.26	10.1	0.04	0.42	0.02	0	0.19	0.18	65.38	144.51	2.37	6.98	0	0	17.67	6.66																				0.16449	16	0.14503	0	0	0.23	0.23	0	0	0	0.233	0.233	0.233	0	0.233	0.233	0	0	23	0.233	0.233	0.233																				0.16	0.16	0.15	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23																					0.16	0.16	0.15	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23																				110	18.82	0.46	0.22	-	1.16	6.08	1.69	2.35	0.01	0.1	0	-	0.04	0.04	15.23	33.67	0.55	1.63	-	-	4.12	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.72	18.82	0.46	0.22	-	1.16	6.08	1.69	2.35	0.01	0.1	0	0	0.04	0.04	15.23	33.67	0.55	1.63	0	0	4.12	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.72
H4003_802_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	114.4	2.78	1.51	0	4.99	26.08	7.26	10.1	0.04	0.42	0.02	0	0.19	0.18	65.38	144.51	2.37	6.98	0	0	17.67	6.66																				0.16449	16	0.14503	0	0	0.23	0.23	0	0	0	0.233	0.233	0.233	0	0.233	0.233	0	0	23	0.233	0.233	0.233																				0.16	0.16	0.15	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23																					0.16	0.16	0.15	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23																				110	18.82	0.46	0.22	-	1.16	6.08	1.69	2.35	0.01	0.1	0	-	0.04	0.04	15.23	33.67	0.55	1.63	-	-	4.12	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.72	18.82	0.46	0.22	-	1.16	6.08	1.69	2.35	0.01	0.1	0	0	0.04	0.04	15.23	33.67	0.55	1.63	0	0	4.12	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.72
H4003_803_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	114.4	2.78	1.51	0	4.99	26.08	7.26	10.1	0.04	0.42	0.02	0	0.19	0.18	65.38	144.51	2.37	6.98	0	0	17.67	6.66																				0.16449	16	0.14503	0	0	0.23	0.23	0	0	0	0.233	0.233	0.233	0	0.233	0.233	0	0	23	0.233	0.233	0.233																				0.16	0.16	0.15	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23																					0.16	0.16	0.15	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23																				110	18.82	0.46	0.22	-	1.16	6.08	1.69	2.35	0.01	0.1	0	-	0.04	0.04	15.23	33.67	0.55	1.63	-	-	4.12	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.72	18.82	0.46	0.22	-	1.16	6.08	1.69	2.35	0.01	0.1	0	0	0.04	0.04	15.23	33.67	0.55	1.63	0	0	4.12	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.72
H4003_804_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	114.4	2.78	1.51	0	4.99	26.08	7.26	10.1	0.04	0.42	0.02	0	0.19	0.18	65.38	144.51	2.37	6.98	0	0	17.67	6.66																				0.16449	16	0.14503	0	0	0.23	0.23	0	0	0	0.233	0.233	0.233	0	0.233	0.233	0	0	23	0.233	0.233	0.233																				0.16	0.16	0.15	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23																					0.16	0.16	0.15	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23																				110	18.82	0.46	0.22	-	1.16	6.08	1.69	2.35	0.01	0.1	0	-	0.04	0.04	15.23	33.67	0.55	1.63	-	-	4.12	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.72	18.82	0.46	0.22	-	1.16	6.08	1.69	2.35	0.01	0.1	0	0	0.04	0.04	15.23	33.67	0.55	1.63	0	0	4.12	1.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.72
H4004_001_0	2006																													V																																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	158.99	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																		25-May																																		0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.07	-	-	-	-	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.07
H4004_015_0	2006																													V									P																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	218.57	0	0	0	0	0	0	0	0	301.28	0	0	0	0	0	0	0	0	0	0	0	0	0	0																		25-May																																		0	0	0	0	0	0	0	18.35	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	18.35	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	0.33	-	-	-	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.59	-	-	-	-	-	-	-	0.33	-	-	-	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.59
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H4004_021_0	2006																						coin	coin			Coin			V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin					Coin																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	54.44	0.58	0	0	7.09	0	0	270.16	6.46	2.53	6.86	0	1.91	6.8	41.93	61.92	2.35	2.47	21.57	114.23	20.31	2.69	0	0	0	0	1.27	0	0	0	0											0-20	0-20						25-May								0-20	20-50																									0.01	0.01	0	0	0.2	0	0	19.48	0.2	0.2	0.2	0	0.2	0.2	0.2	0.17	0.48	0.2	0.2	0.08	0.2	0.2	0	0	0	0	0.2	0	0	0	0												0.01	0.01	0	0	0.2	0	0	19.48	0.2	0.2	0.2	0	0.2	0.2	0.2	0.17	0.48	0.2	0.2	0.08	0.2	0.2	0	0	0	0	0.2	0	0	0	0											0	0.54	0.01	-	-	1.42	-	-	0.44	1.29	0.51	1.37	-	0.38	1.36	8.18	10.59	1.12	0.49	4.31	9.2	4.06	0.54	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.08	0.54	0.01	-	-	1.42	-	-	0.44	1.29	0.51	1.37	-	0.38	1.36	8.18	10.59	1.12	0.49	4.31	9.2	4.06	0.54	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.08
H4004_022_0	2006																						coin	coin						V																																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	54.44	0.58	0	0	0	0	0	220.67	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0-20	0-20						25-May																																		0.01	0.01	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0.01	0.01	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0.54	0.01	-	-	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.64	0.54	0.01	-	-	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.64
H4004_024_0	2006																						coin	coin						V									V																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	54.44	0.58	0	0	0	0	0	270.16	0	0	0	0	0	0	0	0	328.22	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0-20	0-20						25-May																																		0.01	0.01	0	0	0	0	0	19.48	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0.01	0.01	0	0	0	0	0	19.48	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0.54	0.01	-	-	-	-	-	0.44	-	-	-	-	-	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.26	0.54	0.01	-	-	-	-	-	0.44	-	-	-	-	-	-	-	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.26
H4004_025_0	2006																													V									P																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	218.57	0	0	0	0	0	0	0	0	301.28	0	0	0	0	0	0	0	0	0	0	0	0	0	0																		25-May																																		0	0	0	0	0	0	0	18.35	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	18.35	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	0.33	-	-	-	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.59	-	-	-	-	-	-	-	0.33	-	-	-	-	-	-	-	-	0.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.59
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H4004_030_0	2006																													V																																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	158.99	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																																																				0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.07	-	-	-	-	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.07
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H4004_032_0	2006																						coin	coin						V																																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	163.53	1.75	0	0	0	0	0	158.99	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0-20	0-20						25-May																																		0.01	0.01	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0.01	0.01	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	1.64	0.02	-	-	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.72	1.64	0.02	-	-	-	-	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.72
H4004_033_0	2006																						Coin	Coin			Coin			V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin					Coin																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	163.53	1.75	0	0	4.31	0	0	185.01	5.85	2.29	6.22	0	1.73	6.16	24.84	36.38	1.31	1.38	13.13	67.64	11.32	1.51	0	0	0	0	0.76	0	0	0	0											0-20	0-20						25-May								0-20	20-50			0-20																						0.01	0.01	0	0	0.2	0	0	20.24	0.2	0.2	0.2	0	0.2	0.2	0.2	0.17	0.48	0.2	0.2	0.08	0.2	0.2	0	0	0	0	0.2	0	0	0	0												0.01	0.01	0	0	0.2	0	0	20.24	0.2	0.2	0.2	0	0.2	0.2	0.2	0.17	0.48	0.2	0.2	0.08	0.2	0.2	0	0	0	0	0.2	0	0	0	0											0	1.64	0.02	-	-	0.86	-	-	0.31	1.17	0.46	1.24	-	0.35	1.23	4.85	6.28	0.62	0.28	2.63	5.21	2.26	0.3	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.85	1.64	0.02	-	-	0.86	-	-	0.31	1.17	0.46	1.24	-	0.35	1.23	4.85	6.28	0.62	0.28	2.63	5.21	2.26	0.3	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.85
H4004_034_0	2006																													V																																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	37.08	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																																																				0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.02
H4004_035_0	2006																													V																																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	0	0	0	0	0	37.08	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																																																				0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.02
H4005_001_0	2006																													V									V			V																																																																-	1622.15	93.49	292.99	1323.66	260.44	2653.54	1576.03	279.03	559.41	0	1750.86	0	322.49	6267.34	0	0	142.98	0	1215.03	21830.53	0	84.21	0	2185.91	486.95	137.86	172.98	0	0	0	0																																																																																														0	0	0	0	0	0	0	23.47	0	0	0	0	0	0	0	0	10	0	0	2.12	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52
H4005_003_0	2006																													V									V			V																																																																-	1622.15	93.49	292.99	1323.66	260.44	2653.54	1576.03	279.03	559.41	0	1750.86	0	322.49	6267.34	0	0	142.98	0	1215.03	21830.53	0	84.21	0	2185.91	486.95	137.86	172.98	0	0	0	0																																																																																														0	0	0	0	0	0	0	23.47	0	0	0	0	0	0	0	0	10	0	0	2.12	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52
H4005_004_0	2006																													V									V			V																																																																-	1622.15	93.49	292.99	1323.66	260.44	2653.54	1576.03	279.03	559.41	0	1750.86	0	322.49	6267.34	0	0	142.98	0	1215.03	21830.53	0	84.21	0	2185.91	486.95	137.86	172.98	0	0	0	0																																																																																														0	0	0	0	0	0	0	23.47	0	0	0	0	0	0	0	0	10	0	0	2.12	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52
H4005_801_0	2006																													V									V			V																																																																-	1622.15	93.49	292.99	1323.66	260.44	2653.54	1576.03	279.03	559.41	0	1750.86	0	322.49	6267.34	0	0	142.98	0	1215.03	21830.53	0	84.21	0	2185.91	486.95	137.86	172.98	0	0	0	0																																																																																														0	0	0	0	0	0	0	23.47	0	0	0	0	0	0	0	0	10	0	0	2.12	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52
H4005_802_0	2006																													V									V			V																																																																-	1622.15	93.49	292.99	1323.66	260.44	2653.54	1576.03	279.03	559.41	0	1750.86	0	322.49	6267.34	0	0	142.98	0	1215.03	21830.53	0	84.21	0	2185.91	486.95	137.86	172.98	0	0	0	0																																																																																														0	0	0	0	0	0	0	23.47	0	0	0	0	0	0	0	0	10	0	0	2.12	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52	-	-	-	-	-	-	-	0.55	-	-	-	-	-	-	-	-	0.12	-	-	3.85	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.52
H4006_001_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	P	P																																																					-	0	0	0	0	0	0	0	368.61	0	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																		Emerg. 25 - Urg. 5						OP-MA 10 - OP-SA 10																												0	0	0	0	0	0	0	10.5	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	10.5	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	0.32	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.32	-	-	-	-	-	-	-	0.32	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.32
H4006_002_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	60.74	18.98	29.03	36.92	219.6	3.06	34.62	163.91	539.96	24.49	10.55	12.36	15.24	10.02	0.2	14.19	0.2	11.15	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	60.74	18.98	29.03	36.92	219.6	3.06	34.62	163.91	539.96	24.49	10.55	12.36	15.24	10.02	0.2	14.19	0.2	11.15	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.54	7.01	3.97	1.13	2.38	2.79	0.94	0.14	0.09	0.74	5.91	5.46	0.64	0.73	3.14	11.82	2.6	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.33	14.84	0.28	0.17	-	0.54	7.01	3.97	1.13	2.38	2.79	0.94	0.14	0.09	0.74	5.91	5.46	0.64	0.73	3.14	11.82	2.6	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.33
H4006_007_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	P	P																																																					-	0	0	0	0	0	0	0	368.61	0	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																		Emerg. 25 - Urg. 5						OP-MA 10 - OP-SA 10																												0	0	0	0	0	0	0	10.5	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	10.5	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	0.32	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.32	-	-	-	-	-	-	-	0.32	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.32
H4006_008_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	P	P																																																					-	0	0	0	0	0	0	0	368.61	0	0	0	0	0	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.87	0	0																		Emerg. 25 - Urg. 5						OP-MA 10 - OP-SA 10																												0	0	0	0	0	0	0	10.5	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0												0	0	0	0	0	0	0	10.5	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0												-	-	-	-	-	-	-	0.32	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.57	-	-	-	-	-	-	-	-	-	-	-	-	1.9	-	-	-	-	-	-	-	0.32	-	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.57	-	-	-	-	-	-	-	-	-	-	-	-	1.9
H4006_009_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	0	0	0	0	0	0	0	424.7	0	0	0	0	0	115.03	0	0	1074.12	0	0	0	0	0	0	0	0	0	0	0	0	0	0																																																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4006_011_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																																																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4006_013_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1693.07	474.64	825.42	0	175.95	3947.38	3160.53	424.7	227.71	8568.67	382.98	29.6	6.54	1027.06	3425.04	4213.11	1074.12	709.67	15.75	12987.69	35.29	40.21	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				167.13	69.26	35.7	0	71.23	22.43	40.68	54.72	151.41	3.7	51.62	115.88	407.42	65.19	11.13	12.85	11.7	14.45	0.23	13.66	0.23	9.81	0	0	0	0	0	0	0	0	0												167.13	69.26	35.7	0	71.23	22.43	40.68	54.72	151.41	3.7	51.62	115.88	407.42	65.19	11.13	12.85	11.7	14.45	0.23	13.66	0.23	9.81	0	0	0	0	0	0	0	0	0											110	23.58	2.74	2.46	-	1.04	7.38	10.71	1.94	2.87	2.64	1.65	0.29	0.22	5.58	3.18	4.51	1.05	0.85	3.67	14.78	8.22	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.4	23.58	2.74	2.46	-	1.04	7.38	10.71	1.94	2.87	2.64	1.65	0.29	0.22	5.58	3.18	4.51	1.05	0.85	3.67	14.78	8.22	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.4
H4006_803_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_804_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_805_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_806_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_807_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_808_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_809_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_810_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_811_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_812_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_813_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4006_814_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1636.44	53.27	61.06	0	106.71	4430.58	1640.44	368.61	129.97	10962.48	324.34	10.09	1.93	363.84	6720.2	5299.48	506.6	874.85	15.71	9998.11	12.99	9.14	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												108.79	62.93	33.49	0	70.76	22.12	33.82	43.01	255.83	3.56	40.33	190.95	629.05	28.53	12.29	14.4	17.76	11.67	0.23	16.53	0.23	12.99	0	0	0	0	0	0	0	0	0												14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59	14.84	0.28	0.17	-	0.63	8.17	4.62	1.32	2.77	3.26	1.09	0.16	0.1	0.87	6.89	6.36	0.75	0.85	3.66	13.78	3.03	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.59
H4007_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	A	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	242.65	2.88	66.89	1487.47	207.44	381.26	28.7	735.58	593.24				15.2	562.83	5453.68	3576.36					4.45			2.83	356		230					0	0	11059.79	0	0	0	0				75 per admit (0-0)	75 per admit (0-0)	0 per day (1--1) 0 per day (0-0)	0	10	0	0	0-25	0-5				0	0-5	0	0-5					0			0 - 0	0		0					0 per day (0-0)	0 per day (0-0)	0	0	0	0	0				75	75	0	0	10	0	0	20	1.65				0	3.25	0	4.9					0			0	0		0					0	0	0	0	0	0	0					75	75	0	0	10	0	0	20	1.65				0	3.25	0	4.9					0			0	0		0					0	0	0	0	0	0	0				0	1.52	0.02	-	-	0.17	-	-	1.23	0.08	-	-	-	-	0.15	-	1.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.63	1.52	0.02	-	-	0.17	-	-	1.23	0.08	-	-	-	-	0.15	-	1.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.63
H4007_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	A	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	242.65	2.88	66.89	1487.47	207.44	381.26	28.7	735.58	593.24				15.2	562.83	5453.68	3576.36					4.45			2.83	356		230					0	0	11059.79	0	0	0	0				75 per admit (0-0)	75 per admit (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0	0	0-25	0				0	0	0	0					0			0 - 0	0		0					0 per day (0-0)	0 per day (0-0)	0	0	0	0	0				75	75	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0					75	75	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0				0	1.52	0.02	-	-	-	-	-	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.76	1.52	0.02	-	-	-	-	-	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.76
H4007_005_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	0	0	0	0	0	0	0	0	0				0	0	0	0					4.45			2.83	0		0					0	0	0	0	0	0	0				0 per day (0-0)	0 per day (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0	0	0	0				0	0	0	0					0			0 - 0	0		0					0 per day (0-0)	0 per day (0-0)	0	0	0	0	0				0	0	0	0	0	0	0	0	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0				0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4007_007_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	A	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	242.65	2.88	66.89	1487.47	207.44	381.26	28.7	735.58	593.24				15.2	562.83	5453.68	3576.36					4.45			2.83	356		230					0	0	11059.79	0	0	0	0				75 per admit (0-0)	75 per admit (0-0)	0 per day (1--1) 0 per day (0-0)	0	0	0	0	0-25	0				0	0	0	0					0			0 - 0	0		0					0 per day (0-0)	0 per day (0-0)	0	0	0	0	0				75	75	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0					75	75	0	0	0	0	0	20	0				0	0	0	0					0			0	0		0					0	0	0	0	0	0	0				0	1.52	0.02	-	-	-	-	-	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.76	1.52	0.02	-	-	-	-	-	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.76
H4007_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1300.64	8.19	1506.77	1675.94	233.73	0.55	0.04	828.78	668.41				17.12	634.15	6144.7	4029.51					4.45			0	0		0					68.45	0.43	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	43.26	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	43.26	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	22.12	0.14	1.38	-	1.95	0.11	0.01	3.2	11.14	-	-	-	-	2.29	11.55	12.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.16	0.01	-	-	-	-	-	-	-	-	68.45	22.12	0.14	1.38	-	1.95	0.11	0.01	3.2	11.14	-	-	-	-	2.29	11.55	12.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.16	0.01	-	-	-	-	-	-	-	-	68.45
H4007_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1300.64	8.19	1506.77	1675.94	233.73	0.55	0.04	828.78	668.41				17.12	634.15	6144.7	4029.51					4.45			0	0		0					68.45	0.43	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	43.26	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	43.26	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	22.12	0.14	1.38	-	1.95	0.11	0.01	3.2	11.14	-	-	-	-	2.29	11.55	12.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.16	0.01	-	-	-	-	-	-	-	-	68.45	22.12	0.14	1.38	-	1.95	0.11	0.01	3.2	11.14	-	-	-	-	2.29	11.55	12.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.16	0.01	-	-	-	-	-	-	-	-	68.45
H4007_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1300.64	8.19	1506.77	1675.94	233.73	0.55	0.04	828.78	668.41				17.12	634.15	6144.7	4029.51					4.45			0	0		0					68.45	0.43	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	43.26	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	43.26	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	22.12	0.14	1.38	-	1.95	0.11	0.01	3.2	11.14	-	-	-	-	2.29	11.55	12.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.16	0.01	-	-	-	-	-	-	-	-	68.45	22.12	0.14	1.38	-	1.95	0.11	0.01	3.2	11.14	-	-	-	-	2.29	11.55	12.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.16	0.01	-	-	-	-	-	-	-	-	68.45
H4007_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1300.64	8.19	1506.77	1675.94	233.73	0.55	0.04	828.78	668.41				17.12	634.15	6144.7	4029.51					4.45			0	0		0					68.45	0.43	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	43.26	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	43.26	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	22.12	0.14	1.38	-	1.95	0.11	0.01	3.2	11.14	-	-	-	-	2.29	11.55	12.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.16	0.01	-	-	-	-	-	-	-	-	68.45	22.12	0.14	1.38	-	1.95	0.11	0.01	3.2	11.14	-	-	-	-	2.29	11.55	12.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.16	0.01	-	-	-	-	-	-	-	-	68.45
H4008_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	215.03	4.89	0	501.77	158.24	698.16	52.55	445.91	314.04				19.26	2048.98	5881.49	10826.91					4.45			0	0		0					11.32	0.26	0	0	0	0	0				100 per admit (0-0)	100 per admit (0-0)	0 per day (1--1) 0 per day (0-0)	0	10	0	0	0-25	0-5				0	0-5	0	0-5					0			0 - 0	0		0					100 per admit (0-0)	100 per admit (0-0)	0	0	0	0	0				100	100	0	0	10	0	0	20	1.65				0	3.15	0	4.9					0			0	0		0					100	100	0	0	0	0	0					100	100	0	0	10	0	0	20	1.65				0	3.15	0	4.9					0			0	0		0					100	100	0	0	0	0	0				0	1.79	0.04	-	-	0.13	-	-	0.74	0.04	-	-	-	-	0.54	-	4.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.09	0	-	-	-	-	-	-	-	-	7.81	1.79	0.04	-	-	0.13	-	-	0.74	0.04	-	-	-	-	0.54	-	4.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.09	0	-	-	-	-	-	-	-	-	7.81
H4008_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	O	O	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	211.28	4.8	0	493.01	155.48	685.97	51.63	438.13	308.56				18.93	2013.2	5778.79	10637.86					4.45			0	0		0					11.12	0.25	0	0	0	0	0				100 per admit (0-0)	100 per admit (0-0)	0 per day (1--1) 0 per day (0-0)	0	10	0	0	0-25	0-5				0	0-5	0	0-5					0			0 - 0	0		0					100 per admit (0-0)	100 per admit (0-0)	0	0	0	0	0				100	100	0	0	10	0	0	20	1.65				0	3.15	0	4.9					0			0	0		0					100	100	0	0	0	0	0					100	100	0	0	10	0	0	20	1.65				0	3.15	0	4.9					0			0	0		0					100	100	0	0	0	0	0				0	1.76	0.04	-	-	0.13	-	-	0.73	0.04	-	-	-	-	0.53	-	4.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.09	0	-	-	-	-	-	-	-	-	7.67	1.76	0.04	-	-	0.13	-	-	0.73	0.04	-	-	-	-	0.53	-	4.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.09	0	-	-	-	-	-	-	-	-	7.67
H4008_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	982.5	20.81	1028.56	479.43	151.2	14.7	1.11	426.05	300.06				18.41	1957.73	5619.56	10344.74					4.45			0	0		0					51.71	1.1	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	100 per day (1-20) 100 per day (21-100)	0	100	25	25	30-50	50-200				0	30-100	20-50	30-50					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	26.64	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	26.64	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0				0	16.71	0.35	0.75	-	1.26	3.68	0.28	1.44	2.49	-	-	-	-	4.35	9.64	26.2	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.88	0.02	-	-	-	-	-	-	-	-	68.93	16.71	0.35	0.75	-	1.26	3.68	0.28	1.44	2.49	-	-	-	-	4.35	9.64	26.2	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.88	0.02	-	-	-	-	-	-	-	-	68.93
H4008_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	982.5	20.81	1028.56	479.43	151.2	14.7	1.11	426.05	300.06				18.41	1957.73	5619.56	10344.74					4.45			0	0		0					51.71	1.1	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	100 per day (1-20) 100 per day (21-100)	0	100	25	25	30-50	50-200				0	30-100	20-50	30-50					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	26.64	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	26.64	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0				0	16.71	0.35	0.75	-	1.26	3.68	0.28	1.44	2.49	-	-	-	-	4.35	9.64	26.2	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.88	0.02	-	-	-	-	-	-	-	-	68.93	16.71	0.35	0.75	-	1.26	3.68	0.28	1.44	2.49	-	-	-	-	4.35	9.64	26.2	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.88	0.02	-	-	-	-	-	-	-	-	68.93
H4009_001_0	2006											no maximum											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1274.61	25.57	173.46	1458.68	324.14	18005.52	18420.3	162.31	131.15	1170.52	495.41	0	25.95	293.5	8066.15	10733.77	196.95	276.49	3082.98	15910.6	205.58	955.71	0	1136.84	501.87	271.24	215.09	17.23	0	0	228.88											50 days 1 - 5	50 days 1 - 5						25		Eff. copay 20 coins.			Eff. copay 20 coins.	Eff. copay 0 20 coins.			10				Eff. copay 20 coins.	Eff. copay 0 20 coins.																				32.37	32.37	0	0	0	0	0	25	0	5.23	0	0	18.97	16.34	0	0	10	0	0	0	17.27	1.83	0	0	0	0	0	0	0	0	0											no maximum	32.37	32.37	0	0	0	0	0	25	0	5.23	0	0	18.97	16.34	0	0	10	0	0	0	17.27	1.83	0	0	0	0	0	0	0	0	0												3.44	0.07	-	-	-	-	-	0.34	-	0.51	-	-	0.04	0.4	-	-	0.16	-	-	-	0.3	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.4	3.44	0.07	-	-	-	-	-	0.34	-	0.51	-	-	0.04	0.4	-	-	0.16	-	-	-	0.3	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.4
H4009_002_0	2006											no maximum											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1327.2	26.61	180.71	1519.61	337.59	18751.38	19183.59	169.16	136.68	1240.28	516.25	0	27.05	305.94	8400.11	11178.85	205.11	287.95	3211.4	16565.57	214.3	995.35	0	1389.47	522.65	282.57	223.99	17.95	0	0	238.35											50 days 1 - 5	50 days 1 - 5						25									10																									32.37	32.37	0	0	0	0	0	25	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0											no maximum	32.37	32.37	0	0	0	0	0	25	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0												3.58	0.07	-	-	-	-	-	0.35	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.18	3.58	0.07	-	-	-	-	-	0.35	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	4.18
H4009_003_0	2006											no maximum											D	D	D	V	P	O	O	V	V	V	P	P	P	P	P	P	V	P	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1196.1	23.92	163.66	1375.94	304.88	16924.75	17316.99	153.83	124.29	1046.53	409.36	0	24.64	278.57	7013.58	9527.49	172.85	242.82	2592.82	13735.01	195.23	898.9	0	0	471.71	255.89	202.16	16.27	0	0	215.03											50 days 1 - 5	50 days 1 - 5			Eff. copay 20 coins.		Eff. copay 0 20 coins.	25	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.		Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.	Eff. copay 0 20 coins.	Eff. copay 20 coins.	Eff. copay 20 coins.																				32.37	32.37	0	0	9.84	0	0.41	25	107.14	8.99	34.36	0	18.6	40.94	9.48	8.75	34.91	5.22	13.45	3.46	16.94	1.81	0	0	0	0	0	0	0	0	0											no maximum	32.37	32.37	0	0	9.84	0	0.41	25	107.14	8.99	34.36	0	18.6	40.94	9.48	8.75	34.91	5.22	13.45	3.46	16.94	1.81	0	0	0	0	0	0	0	0	0												3.23	0.06	-	-	0.25	-	0.59	0.32	1.11	0.78	1.17	-	0.04	0.95	5.54	6.94	0.5	0.11	2.91	3.96	0.28	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.88	3.23	0.06	-	-	0.25	-	0.59	0.32	1.11	0.78	1.17	-	0.04	0.95	5.54	6.94	0.5	0.11	2.91	3.96	0.28	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.88
H4011_001_0	2006											0																	Coin	V		V					V	V	V			V																						0																																										-	0	0	0	0	0	0	1.93	376.99	0	432	0	0	0	0	6613.38	7581.91	257.77	0	0	1568.88	0	0	0	0	0	0	0	0	0	0	0																																																				0	0	0	0	0	0	0.1	25	0	7	0	0	0	0	7	7	7	0	0	7	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0.1	25	0	7	0	0	0	0	7	7	7	0	0	7	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	0.19	0.79	-	0.25	-	-	-	-	3.86	4.42	0.15	-	-	0.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.58	-	-	-	-	-	-	0.19	0.79	-	0.25	-	-	-	-	3.86	4.42	0.15	-	-	0.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.58
H4011_003_0	2006											0																	Coin	V		V					V	V	V			V																						0																																										-	0	0	0	0	0	0	1.93	376.99	0	432	0	0	0	0	6613.38	7581.91	257.77	0	0	1568.88	0	0	0	0	0	0	0	0	0	0	0																																																				0	0	0	0	0	0	0.1	25	0	7	0	0	0	0	7	7	7	0	0	7	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0.1	25	0	7	0	0	0	0	7	7	7	0	0	7	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	0.19	0.79	-	0.25	-	-	-	-	3.86	4.42	0.15	-	-	0.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.58	-	-	-	-	-	-	0.19	0.79	-	0.25	-	-	-	-	3.86	4.42	0.15	-	-	0.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.58
H4011_004_0	2006											0																	Coin	V		V					V	V	V			V				Coin																		0																																										-	0	0	0	0	0	0	1.93	376.99	0	435.03	0	0	0	0	6666.71	8179.89	259.84	0	0	1579.89	0	0	0	4.68	0	0	0	0	0	0	0																																																				0	0	0	0	0	0	0.1	25	0	5	0	0	0	0	5	5	5	0	0	5	0	0	0	0.5	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0.1	25	0	5	0	0	0	0	5	5	5	0	0	5	0	0	0	0.5	0	0	0	0	0	0	0												-	-	-	-	-	-	0.19	0.79	-	0.18	-	-	-	-	2.78	3.41	0.11	-	-	0.66	-	-	-	2.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.45	-	-	-	-	-	-	0.19	0.79	-	0.18	-	-	-	-	2.78	3.41	0.11	-	-	0.66	-	-	-	2.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.45
H4011_801_0	2006																						Coin		Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																															-	88.69	0	1.96	0	10.52	28.34	1.93	3.45	4.39	1.69	4.64	0	0	5.91	30.81	56.73	1.89	2.08	18.5	97.01	16.36	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																					0.16	0	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0												0.16	0	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0												14.48	-	0.28	-	2.45	6.6	0.45	0.8	1.02	0.39	1.08	-	-	1.38	7.18	13.22	0.44	0.49	4.31	22.6	3.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.99	14.48	-	0.28	-	2.45	6.6	0.45	0.8	1.02	0.39	1.08	-	-	1.38	7.18	13.22	0.44	0.49	4.31	22.6	3.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.99
H4011_802_0	2006																						Coin		Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																															-	88.69	0	1.96	0	10.52	28.34	1.93	3.45	4.39	1.69	4.64	0	0	5.91	30.81	56.73	1.89	2.08	18.5	97.01	16.36	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																					0.16	0	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0												0.16	0	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0												14.48	-	0.28	-	2.45	6.6	0.45	0.8	1.02	0.39	1.08	-	-	1.38	7.18	13.22	0.44	0.49	4.31	22.6	3.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.99	14.48	-	0.28	-	2.45	6.6	0.45	0.8	1.02	0.39	1.08	-	-	1.38	7.18	13.22	0.44	0.49	4.31	22.6	3.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.99
H4011_803_0	2006																						Coin		Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																															-	88.69	0	1.96	0	10.52	28.34	1.93	3.45	4.39	1.69	4.64	0	0	5.91	30.81	56.73	1.89	2.08	18.5	97.01	16.36	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																					0.16	0	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0												0.16	0	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0												14.48	-	0.28	-	2.45	6.6	0.45	0.8	1.02	0.39	1.08	-	-	1.38	7.18	13.22	0.44	0.49	4.31	22.6	3.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.99	14.48	-	0.28	-	2.45	6.6	0.45	0.8	1.02	0.39	1.08	-	-	1.38	7.18	13.22	0.44	0.49	4.31	22.6	3.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.99
H4011_804_0	2006																						Coin		Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																															-	88.69	0	1.96	0	10.52	28.34	1.93	3.45	4.39	1.69	4.64	0	0	5.91	30.81	56.73	1.89	2.08	18.5	97.01	16.36	0	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																					0.16	0	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0												0.16	0	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0												14.48	-	0.28	-	2.45	6.6	0.45	0.8	1.02	0.39	1.08	-	-	1.38	7.18	13.22	0.44	0.49	4.31	22.6	3.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.99	14.48	-	0.28	-	2.45	6.6	0.45	0.8	1.02	0.39	1.08	-	-	1.38	7.18	13.22	0.44	0.49	4.31	22.6	3.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.99
H4012_001_0	2006																													v																																																																												-								334.31																																																																																																																												25																																			-	-	-	-	-	-	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.7	-	-	-	-	-	-	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.7
H4102_001_0	2006											4200											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2156.66	170.08	1617.61	0	268.85	10.65	5.46	558.71	60.84	0	45.96	0	0.81	0.47	4127.87	3580.99	708.88	2.91	0	0	19.86	1457.52	0	0	103.38	0	215.83	0	0	0	0											250	175	125	0	100	20	20	50	20	0	0 / 20	Incl. In h.1.	20	20 /40 / 30	Oct-00	20	40 / 30	20	0	0	20	0/20			20		20			0												250	175	125		100	0.2	0.2	50	0.2	0	0.13		0.2	0.2	10	20	37.5	0.2			0.2	20			20		20																155.82	109.07	77.91	0	62.33	0.12	0.15	31.16	0.12	0	0.08	0	0.12	0.13	10	20	37.5	0.12	0	0	0.12	20	0	0	20	0	20	0	0	0	0												28	1.55	10.5	-	1.4	1.33	0.83	1.45	7.58	-	3.8	-	0.1	0.06	3.44	5.97	2.22	0.36	-	-	2.48	2.43	-	-	0.17	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.02	28	1.55	10.5	-	1.4	1.33	0.83	1.45	7.58	-	3.8	-	0.1	0.06	3.44	5.97	2.22	0.36	-	-	2.48	2.43	-	-	0.17	-	0.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.02
H4102_025_0	2006											2800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2156.66	170.08	1617.61	0	268.85	10.65	5.46	558.71	60.84	0	45.96	0	0.81	0.47	4127.87	3580.99	708.88	2.91	0	0	19.86	1457.52	0	0	103.38	0	215.83	0	0	0	0											240	175	120	0	100	20	20	50	20	0	0 / 20	Incl. In h.1.	20	20 /40 / 30	May-00	15	40 / 30	20	0	0	20	0/15			15		15			0												240	175	120		100	0.2	0.2	50	0.2	0	0.13		0.2	0.2	5	15	37.5	0.2			0.2	15			15		15																126.9	92.53	63.45	0	52.87	0.11	0.14	26.44	0.11	0	0.07	0	0.11	0.11	5	15	37.5	0.11	0	0	0.11	15	0	0	15	0	15	0	0	0	0												22.81	1.31	8.55	-	1.18	1.13	0.76	1.23	6.43	-	3.22	-	0.09	0.05	1.72	4.48	2.22	0.31	-	-	2.1	1.82	-	-	0.13	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.81	22.81	1.31	8.55	-	1.18	1.13	0.76	1.23	6.43	-	3.22	-	0.09	0.05	1.72	4.48	2.22	0.31	-	-	2.1	1.82	-	-	0.13	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.81
H4102_026_0	2006											2800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2156.66	170.08	1617.61	0	268.85	10.65	5.46	558.71	60.84	0	45.96	0	0.81	0.47	4127.87	3580.99	708.88	2.91	0	0	19.86	1457.52	0	0	103.38	0	215.83	0	0	0	0											240	175	120	0	100	20	20	50	20	0	0 / 20	Incl. In h.1.	20	20 /40 / 30	May-00	15	40 / 30	20	0	0	20	0/15			15		15			0												240	175	120		100	0.2	0.2	50	0.2	0	0.13		0.2	0.2	5	15	37.5	0.2			0.2	15			15		15																126.9	92.53	63.45	0	52.87	0.11	0.14	26.44	0.11	0	0.07	0	0.11	0.11	5	15	37.5	0.11	0	0	0.11	15	0	0	15	0	15	0	0	0	0												22.81	1.31	8.55	-	1.18	1.13	0.76	1.23	6.43	-	3.22	-	0.09	0.05	1.72	4.48	2.22	0.31	-	-	2.1	1.82	-	-	0.13	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.81	22.81	1.31	8.55	-	1.18	1.13	0.76	1.23	6.43	-	3.22	-	0.09	0.05	1.72	4.48	2.22	0.31	-	-	2.1	1.82	-	-	0.13	-	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.81
H4102_801_0	2006											3500											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2264.49	178.59	1698.49		282.3	11.2	5.73	586.64	63.88	12116.28	48.26		0.85	0.5	4334.26	3770.09	744.33	3.06			20.85	1530.4			108.55		216.57															250	17500	125		150	0	0	50	0	20	20 / 30	Incl. In h.1.	0.3	30 /40 / 30	25/0	35	40 / 30	0			0.3	0/35			35		35															250	175	125		150	0.3	0.3	50	0.3	8	0.22		0.3	0.29	25	35	37.5	0.3			0.3	35			35		35																128.22	89.75	64.11		76.93	0.15	0.21	25.64	0.15	4.1	0.11		0.15	0.16	25	35	37.5	0.15			0.15	35			35		35																24.2	1.34	9.07	-	1.81	1.72	1.18	1.25	9.83	4.14	5.35	-	0.13	0.08	9.03	11	2.33	0.47	-	-	3.21	4.46	-	-	0.32	-	0.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.54	24.2	1.34	9.07	-	1.81	1.72	1.18	1.25	9.83	4.14	5.35	-	0.13	0.08	9.03	11	2.33	0.47	-	-	3.21	4.46	-	-	0.32	-	0.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.54
H4102_802_0	2006											4200											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2264.49	178.59	1698.49	0	282.3	11.2	5.73	586.64	63.88	12116.28	48.26	0	0.85	0.5	4334.26	3770.09	744.33	3.06	0	0	20.85	1530.4	0	0	108.55	0	216.57	0														240	17500	120	0	150	0	0	50	0	10	20-Oct	Incl. In h.1.	0.3	20 /40 / 30	25/0	35	40 / 30	0	0	0	0.3	0/35			35		35			0												240	175	120		150	0.3	0.3	50	0.2	4	0.14		0.3	0.2	25	35	37.5	0.2			0.3	35			35		35																142.56	103.95	71.28	0	89.1	0.18	0.22	29.7	0.12	2.38	0.09	0	0.18	0.13	25	35	37.5	0.12	0	0	0.18	35	0	0	35	0	35	0															26.9	1.55	10.09	-	2.1	2	1.27	1.45	7.59	2.4	4.13	-	0.15	0.06	9.03	11	2.33	0.36	-	-	3.72	4.46	-	-	0.32	-	0.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.53	26.9	1.55	10.09	-	2.1	2	1.27	1.45	7.59	2.4	4.13	-	0.15	0.06	9.03	11	2.33	0.36	-	-	3.72	4.46	-	-	0.32	-	0.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.53
H4106_001_0	2006											1250											D	D	D		P	P	P	V	V	V	V	V	V	V		P	P	P																																																																		-	2261.34	519.31	871.25		304.81	2524.42	2309.35	850.39	341.03	1727.69	850.12	58.22	12.87	2212.27		2938.31	1013.33	468.02																								75/day	75/day	114/day		100	20	20	35	25	10	10	50	20	50		25	35 indiv/25 group	10																								75	75	60.08		100	27.55	26.52	35	25	10	10	50	528.44	46.38		25	32.5	14.91																									40.52	40.52	32.46		54.03	14.88	14.32	18.91	13.51	5.4	5.4	27.01	285.49	25.06		13.51	17.56	8.06																									7.64	1.75	2.36	-	1.37	3.13	2.76	1.34	0.38	0.78	0.38	0.13	0.31	4.62	-	3.31	1.48	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.05	7.64	1.75	2.36	-	1.37	3.13	2.76	1.34	0.38	0.78	0.38	0.13	0.31	4.62	-	3.31	1.48	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.05
H4152_004_0	2006	OP Facility - Emergency	Professional										Urgent Care	Routine Exams									D	D	D		T	Coin		V	P		O				V	V	V	V		V	Coin	V			V		V			O		V	V																																																			-	944.4	54.6	956.5		414	11.93		291	287.1		414				4355	6134	541	1200		10	4.94	82			271		123			552.2		219.5	426									265 per day subject to 2500 OOP Max	265 per day subject to 2500 OOP Max	75 per day subject to 2500 OOP Max																																																																																	265	265	75		75	0.2		50	175		75				10	20	20	10		10	0.06	20			20		20			10		25	10										20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12	20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12
H4152_005_0	2006	OP Facility - Emergency	Professional										Urgent Care	Routine Exams									D	D	D		T	Coin		V	P		O				V	V	V	V		V	Coin	V			V		V			O		V	V																																																			-	685.4	39.6	691.2		414	11.93		291	290.1		414				4355	6134	541	1200		10	4.94	82			271		123			552.2		219.5	426									200 per day subject to 1250 OOP Max	200 per day subject to 1250 OOP Max	75 per day subject to 1250 OOP Max																																																																																	200	200	75		75	0.2		50	125		75				10	20	20	10		10	0.06	20			20		20			10		25	10										11.42	0.66	4.32	-	2.59	2.39	-	1.21	3.02	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	46.32	11.42	0.66	4.32	-	2.59	2.39	-	1.21	3.02	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	46.32
H4152_007_0	2006	OP Facility - Emergency	Professional										Urgent Care	Routine Exams									D	D	D		T	Coin		V	P		O				V	V	V	V		V	Coin	V		Coin	V		V			O		V	V									3000																																										-	870.6	50.6	875.3		414	11.93		291	294.5		414				4355	6134	541	1200		10	4.94	82		8.36	271		123			552.2		219.5	426									50 per day subject to 500 OOP Max	50 per day subject to 500 OOP Max	25 per day subject to 500 OOP Max																																																																																	50	50	25		75	0.2		50	50		75				10	20	20	10		10	0.06	20		0.2	20		20			10		25	10										3.63	0.21	1.82	-	2.59	2.39	-	1.21	1.23	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	1.67	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	35.46	3.63	0.21	1.82	-	2.59	2.39	-	1.21	1.23	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	1.67	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	35.46
H4152_012_0	2006																						D	D	D		T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin																					28.04	0.59																																								28.63	54.04	1.07	883.29		271.45	24.66	1.72	675.4	29.69	11.61	31.55		8.8	31.24	5599.04	7073.05	326.93	408.79	28.01	123.81	18.89	2.35																																																													200.24	200.24	119.5		75	0.2	0.2	47.24	0.2	0.2	0.2		0.2	0.2	10	20	20	10	0.2	0.18	0.2	0.2																					200.24	200.24	119.5		75	0.2	0.2	47.24	0.2	0.2	0.2		0.2	0.2	10	20	20	10	0.2	0.18	0.2	0.2																					0.9	0.02	8.8	-	1.7	4.93	0.34	2.66	5.94	2.32	6.31	-	1.76	6.25	4.67	11.79	0.54	0.34	5.6	22.31	3.78	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.42	28.94	0.61	8.8	-	1.7	4.93	0.34	2.66	5.94	2.32	6.31	-	1.76	6.25	4.67	11.79	0.54	0.34	5.6	22.31	3.78	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	120.05
H4152_013_0	2006	OP Facility - Emergency	Professional										Urgent Care	Routine Exams									D	D	D		T	Coin		V	P		O				V	V	V	V		V	Coin	V			V		V			O		V	V																																																			-	944.4	54.6	956.5		414	11.93		291	287.1		414				4355	6134	541	1200		10	4.94	82			271		123			552.2		219.5	426									265 per day subject to 2500 OOP Max	265 per day subject to 2500 OOP Max	75 per day subject to 2500 OOP Max																																																																																	265	265	75		75	0.2		50	175		75				10	20	20	10		10	0.06	20			20		20			10		25	10										20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12	20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12
H4152_815_0	2006	OP Facility - Emergency	Professional										Urgent Care	Routine Exams									D	D	D		T	Coin		V	P		O				V	V	V	V		V	Coin	V			V		V			O		V	V																																																			-	944.4	54.6	956.5		414	11.93		291	287.1		414				4355	6134	541	1200		10	4.94	82			271		123			552.2		219.5	426									265 per day subject to 2500 OOP Max	265 per day subject to 2500 OOP Max	75 per day subject to 2500 OOP Max																																																																																	265	265	75		75	0.2		50	175		75				10	20	20	10		10	0.06	20			20		20			10		25	10										20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12	20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12
H4152_817_0	2006	OP Facility - Emergency	Professional										Urgent Care	Routine Exams									D	D	D		T	Coin		V	P		O				V	V	V	V		V	Coin	V			V		V			O		V	V																																																			-	944.4	54.6	956.5		414	11.93		291	287.1		414				4355	6134	541	1200		10	4.94	82			271		123			552.2		219.5	426									265 per day subject to 2500 OOP Max	265 per day subject to 2500 OOP Max	75 per day subject to 2500 OOP Max																																																																																	265	265	75		75	0.2		50	175		75				10	20	20	10		10	0.06	20			20		20			10		25	10										20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12	20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12
H4152_818_0	2006	OP Facility - Emergency	Professional										Urgent Care	Routine Exams									D	D	D		T	Coin		V	P		O				V	V	V	V		V	Coin	V			V		V			O		V	V																																																			-	944.4	54.6	956.5		414	11.93		291	287.1		414				4355	6134	541	1200		10	4.94	82			271		123			552.2		219.5	426									265 per day subject to 2500 OOP Max	265 per day subject to 2500 OOP Max	75 per day subject to 2500 OOP Max																																																																																	265	265	75		75	0.2		50	175		75				10	20	20	10		10	0.06	20			20		20			10		25	10										20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12	20.86	1.21	5.98	-	2.59	2.39	-	1.21	4.19	-	2.59	-	-	-	3.63	10.22	0.9	1	-	0.01	0.3	0.14	-	-	0.45	-	0.21	-	-	0.46	-	0.46	0.36	-	-	-	-	-	-	-	-	59.12
H4204_001_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency						5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	V	V	Coin	O	V	V	V	V	V	V	O	V	O	V	V	V	V	O							6.71	0.07	0.48	0.48	0.18	0.3	0.22	0.09	0.17	0.78	0.67	0	0	0.47	0.83	2.4	0.03	0.03	0.52	0	0	0.2	0	0	0	0	0	0	0	0	0	0.03	0.46	0.19	0.02	0	0	0	0	0	0	15.32	1356.18	27.27	779	1360.2	300.3	13.53	10.02	303.01	91.63	2956.9	1498.3	0	0	446.4	4334.8	6223.62	181	252.97	5540.2	0	3.71	912.4	0	0	0	0	0	0	0	0	0	155.29	360.57	0	157.26	1.2	0	0	0	0	0	75 for 1st 7 days	100 for 1st 7 days																minimum of 30 copay and allowed cost				30 per unit copay on blood 0 copay on pharmacy														250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	100	52.98	0	50	0.2	0.2	50	100	20	20	0	0	30	15	30	30	22.01	0	0	0.2	7.48	0	0	0	0	0	0	0	0	0	30	50	0	0	439.47	0	0	0	0	0		69.23	92.87	48.91	0	46.16	0.18	0.18	46.25	93.74	18.46	18.46	0	0	27.69	13.34	28.09	27.69	20.32	0	0	0.2	6.91	0	0	0	0	0	0	0	0	0	27.5	45.79	0	0	439.47	0	0	0	0	0	200	7.82	0.21	3.17	-	1.16	2.49	1.85	1.17	0.72	4.55	2.31	-	-	1.03	4.82	14.57	0.42	0.43	-	-	0.74	0.53	-	-	-	-	-	-	-	-	-	0.36	1.38	-	-	0.04	-	-	-	-	-	49.75	14.54	0.28	3.65	0.48	1.33	2.79	2.07	1.26	0.89	5.33	2.98	-	-	1.5	5.65	16.97	0.44	0.46	0.52	-	0.74	0.73	-	-	-	-	-	-	-	-	-	0.39	1.83	0.19	0.02	0.04	-	-	-	-	-	65.07
H4204_002_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency						5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	V	V	Coin	O	V	V	V	V	V	V	O	V	O	V	V	V	V	O							6.5	0.07	0.67	0.64	0.17	0.28	0.2	0.08	0.16	0.81	0.62	0	0	0.43	0.87	2.44	0.03	0.03	0.48	0	0	0.19	0	0	0	0	0	0	0	0	0	0.03	0.42	0.17	0.02	0	0	0	0	0	0	15.3	1375.24	27.38	1047.5	1828.4	273.4	12.14	9	251.17	75.95	2450.7	1241.8	0	0	373.83	4367.81	6303.92	186.97	261.27	5077.6	0	3.89	756.2	0	0	0	0	0	0	0	0	0	128.73	298.85	0	158.46	1.2	0	0	0	0	0	75 for 1st 7 days	100 for 1st 7 days																minimum of 30 copay and allowed cost				30 per unit copay on blood 0 copay on pharmacy														250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	100	52.98	0	50	0.2	0.2	50	100	20	20	0	0	30	15	30	30	21.79	0	0	0.2	7.49	0	0	0	0	0	0	0	0	0	30	50	0	0	439.85	0	0	0	0	0		69.44	93.13	49.06	0	46.3	0.18	0.18	46.39	93.97	18.52	18.52	0	0	27.78	13.4	28.16	27.78	20.18	0	0	0.2	6.93	0	0	0	0	0	0	0	0	0	27.59	45.95	0	0	439.85	0	0	0	0	0	200	7.96	0.21	4.28	-	1.05	2.25	1.66	0.97	0.59	3.78	1.92	-	-	0.87	4.88	14.79	0.43	0.44	-	-	0.78	0.44	-	-	-	-	-	-	-	-	-	0.3	1.14	-	-	0.04	-	-	-	-	-	48.78	14.46	0.28	4.95	0.64	1.22	2.52	1.87	1.05	0.75	4.59	2.53	-	-	1.29	5.74	17.23	0.46	0.47	0.48	-	0.78	0.62	-	-	-	-	-	-	-	-	-	0.32	1.57	0.17	0.02	0.04	-	-	-	-	-	64.09
H4204_003_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency						5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	V	V	Coin	O	V	V	V	V	V	V	O	V	O	V	V	V	V	O							6.56	0.07	0.47	0.61	0.17	0.29	0.21	0.09	0.18	0.82	0.7	0	0	0.48	0.84	2.42	0.03	0.03	0.44	0	0	0.21	0	0	0	0	0	0	0	0	0	0.03	0.48	0.19	0.02	0	0	0	0	0	0	15.33	1487.46	29.97	790	1876.6	324.8	13.65	10.11	305.45	92.36	2980.8	1510.4	0	0	450.52	4554.54	6522.2	187.88	262.53	5429.4	0	3.72	919.7	0	0	0	0	0	0	0	0	0	156.55	363.44	0	165.23	1.2	0	0	0	0	0	75 for 1st 7 days	100 for 1st 7 days																minimum of 30 copay and allowed cost				30 per unit copay on blood 0 copay on pharmacy														250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	100	52.98	0	50	0.2	0.2	50	100	20	20	0	0	30	15	30	30	22.39	0	0	0.2	7.48	0	0	0	0	0	0	0	0	0	30	50	0	0	439.47	0	0	0	0	0		68.77	92.3	48.58	0	45.85	0.18	0.18	45.95	93.24	18.34	18.34	0	0	27.51	13.2	27.94	27.51	20.53	0	0	0.2	6.86	0	0	0	0	0	0	0	0	0	27.3	45.46	0	0	439.47	0	0	0	0	0	200	8.52	0.23	3.2	-	1.24	2.5	1.85	1.17	0.72	4.56	2.31	-	-	1.03	5.01	15.19	0.43	0.45	-	-	0.74	0.53	-	-	-	-	-	-	-	-	-	0.36	1.38	-	-	0.04	-	-	-	-	-	51.45	15.08	0.3	3.67	0.61	1.42	2.79	2.07	1.26	0.9	5.38	3	-	-	1.52	5.85	17.6	0.46	0.48	0.44	-	0.74	0.73	-	-	-	-	-	-	-	-	-	0.39	1.85	0.19	0.02	0.04	-	-	-	-	-	66.79
H4204_007_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency						5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	V	V	Coin	O	V	V	V	V	V	V	O	V	O	V	V	V	V	O							6.46	0.07	0.53	0.61	0.18	0.3	0.22	0.09	0.17	0.81	0.67	0	0	0.47	0.86	2.44	0.03	0.03	0.48	0	0	0.2	0	0	0	0	0	0	0	0	0	0.03	0.46	0.19	0.02	0	0	0	0	0	0	15.31	1292.62	26.01	831.1	1799.5	284	13.27	9.84	268.36	81.15	2618.9	1327	0	0	397.24	4286.34	6150.46	178.56	249.43	5246.1	0	3.48	808.1	0	0	0	0	0	0	0	0	0	137.54	319.35	0	155.5	1.1	0	0	0	0	0	75 for 1st 7 days	100 for 1st 7 days																minimum of 30 copay and allowed cost				30 per unit copay on blood 0 copay on pharmacy														250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	100	52.98	0	50	0.2	0.2	50	100	20	20	0	0	30	15	30	30	22.45	0	0	0.2	7.49	0	0	0	0	0	0	0	0	0	30	50	0	0	439.22	0	0	0	0	0		69.59	93.31	49.16	0	46.39	0.19	0.19	46.48	94.13	18.56	18.56	0	0	27.84	13.44	28.21	27.84	20.83	0	0	0.2	6.95	0	0	0	0	0	0	0	0	0	27.66	46.05	0	0	439.22	0	0	0	0	0	200	7.5	0.2	3.4	-	1.1	2.46	1.82	1.04	0.64	4.05	2.05	-	-	0.92	4.8	14.46	0.41	0.43	-	-	0.7	0.47	-	-	-	-	-	-	-	-	-	0.32	1.23	-	-	0.04	-	-	-	-	-	48.04	13.95	0.27	3.94	0.61	1.28	2.76	2.05	1.13	0.81	4.86	2.72	-	-	1.39	5.66	16.89	0.44	0.46	0.48	-	0.7	0.67	-	-	-	-	-	-	-	-	-	0.35	1.68	0.19	0.02	0.04	-	-	-	-	-	63.35
H4204_008_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency						5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	V	V	Coin	O	V	V	V	V	V	V	O	V	O	V	V	V	V	O							6.19	0.07	0.61	0.67	0.23	0.38	0.28	0.09	0.17	0.8	0.65	0	0	0.45	0.88	2.44	0.03	0.03	0.49	0	0	0.19	0	0	0	0	0	0	0	0	0	0.03	0.44	0.18	0.02	0	0	0	0	0	0	15.3	1272.54	25.86	957.8	2119.6	313.4	16.47	12.21	234.25	70.84	2286.1	1158.3	0	0	348.42	4380.7	6207.6	171.68	239.87	5155.8	0	3.53	705.4	0	0	0	0	0	0	0	0	0	120.05	278.76	0	158.93	1.1	0	0	0	0	0	75 for 1st 7 days	100 for 1st 7 days																minimum of 30 copay and allowed cost				30 per unit copay on blood 0 copay on pharmacy														250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	100	52.98	0	50	0.2	0.2	50	100	20	20	0	0	30	15	30	30	22.48	0	0	0.2	7.49	0	0	0	0	0	0	0	0	0	30	50	0	0	439.58	0	0	0	0	0		69.52	93.22	49.11	0	46.35	0.19	0.19	46.44	94.05	18.54	18.54	0	0	27.81	13.42	28.19	27.81	20.84	0	0	0.2	6.94	0	0	0	0	0	0	0	0	0	27.63	46	0	0	439.58	0	0	0	0	0	200	7.37	0.2	3.92	-	1.21	3.05	2.26	0.91	0.56	3.53	1.79	-	-	0.81	4.9	14.58	0.4	0.42	-	-	0.71	0.41	-	-	-	-	-	-	-	-	-	0.28	1.07	-	-	0.04	-	-	-	-	-	48.4	13.57	0.27	4.53	0.67	1.44	3.43	2.54	0.99	0.72	4.33	2.44	-	-	1.26	5.78	17.02	0.42	0.45	0.49	-	0.71	0.6	-	-	-	-	-	-	-	-	-	0.31	1.51	0.18	0.02	0.04	-	-	-	-	-	63.7
H4205_001_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Other Medicare Part B	Other Medicare Part B				5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Vision	Hearing				D	D	D	Coin	T	Coin	Coin	V	Coin	V	Coin			V	V	V	V	P	P		Coin				V	V	V					V	Coin	Coin	V	O	V	V					0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0		0				0	0	0					0	0	0	0	0	0	0				-	1307.16	26.08	978.9	23.73	278.7	12.55	9.3	252.56	35.3	2437.8	27.73			18.74	4239.63	5364.5	178.56	252.37	4825.7		3.62				408.9	349.1	175.3					129.44	18.94	7.69	43.8	1.1	655.1	93.5				150/day for days 1-7	150/day for days 1-7 5/day for days 8-90 10/day for days 91-190	10/day for days 1-10 100/day for days 11-100				30 coinsurance on prosthetics 12 copay on diabetes monitoring supplies																			25 copay for most lenses 75 for progressive lenses 100 allowance for frames and contacts										250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						150	153.08	54.84	0.1	100	0.3	0.25	50	0.13	35	0.15			35	25	34.55	35	20	0		0.2				25	25	0					25	0.15	0.15	25	439.6	25	35					126.36	129.1	46.2	0.08	84.24	0.26	0.21	42.62	0.11	29.48	0.13			35	20.31	29.68	29.48	16.85	0		0.2				21.06	21.06	0					20.08	0.13	0.13	21.06	439.6	20.44	33.15				0	13.76	0.28	3.77	2	1.96	3.21	1.94	0.9	3.73	5.99	3.5	-	-	0.05	7.18	13.27	0.44	0.35	-	-	0.72	-	-	-	0.72	0.61	-	-	-	-	-	0.22	2.39	0.97	0.08	0.04	1.12	0.26	-	-	-	69.46	13.76	0.28	3.77	2	1.96	3.21	1.94	0.9	3.73	5.99	3.5	-	-	0.05	7.18	13.27	0.44	0.35	-	-	0.72	-	-	-	0.72	0.61	-	-	-	-	-	0.22	2.39	0.97	0.08	0.04	1.12	0.26	-	-	-	69.46
H4205_002_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Other Medicare Part B	Other Medicare Part B				5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Vision	Hearing				D	D	D	Coin	T	Coin	Coin	V	Coin	V	Coin			V	V	V	V	P	P		Coin				V	V	V					V	Coin	Coin	V	O	V	V					0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0		0				0	0	0					0	0	0	0	0	0	0				-	1456.6	28.38	1014.5	28.24	272.4	11.98	8.87	275.77	36.33	2662	28.54			19.91	4329.09	5530.97	189.69	268.07	5405.6		3.66				417.6	364.8	179					141.33	19.49	7.92	44.7	1.2	668.8	95.4				150/day for days 1-7	150/day for days 1-7 5/day for days 8-90 10/day for days 91-190	10/day for days 1-10 100/day for days 11-100				30 coinsurance on prosthetics 12 copay on diabetes monitoring supplies																			25 copay for most lenses 75 for progressive lenses 100 allowance for frames and contacts										250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						150	153.08	54.84	0.1	100	0.3	0.25	50	0.13	35	0.15			35	25	34.53	35	20	0		0.2				25	25	0					25	0.15	0.15	25	439.6	25	35					124.66	127.37	45.58	0.08	83.11	0.25	0.21	42.09	0.11	29.09	0.12			35	19.98	29.31	29.09	16.62	0		0.2				20.78	20.78	0					19.73	0.12	0.12	20.78	439.6	20.06	33.02				0	15.13	0.3	3.85	2.35	1.89	3.02	1.82	0.97	3.82	6.45	3.56	-	-	0.06	7.21	13.51	0.46	0.37	-	-	0.73	-	-	-	0.72	0.63	-	-	-	-	-	0.23	2.43	0.99	0.08	0.04	1.12	0.26	-	-	-	72.01	15.13	0.3	3.85	2.35	1.89	3.02	1.82	0.97	3.82	6.45	3.56	-	-	0.06	7.21	13.51	0.46	0.37	-	-	0.73	-	-	-	0.72	0.63	-	-	-	-	-	0.23	2.43	0.99	0.08	0.04	1.12	0.26	-	-	-	72.01
H4206_001_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	Coin	V	O	V	V					6.08	0.07	0.68	0.61	0.19	0.31	0.23	0.09	0.17	0.76	0.67		0	0.65	0.81	2.22	0.02	0.03	0.44		0	0.2										0.03	0.46	0.18	0.01	0	0.06	0.03				15	1221.34	24.81	1001.33	1653.27	289.25	12.34	8.91	261.27	81.69	2647.87	1335.88		0.03	397.69	4162.08	4725.25	158.8	224.46	4740.97		3.45	813.44										133.9	321.44	0	151	1.07	691.9	450.08				1-7:  75/Day	1-7:  100/Day	1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	100	52.98	0	50	0.2	0.12	50	100	20	20		0	30	15	29.95	30	30	0		0.2	0										50	50	0	0	439.54	30	30				5000	69.7	93.25	49.12	0	46.36	0.18	0.11	45.9	94.07	18.54	18.59		0	25.72	13.43	28.24	27.82	28.49	0		0.2	0										47.26	46.01	0	0	439.54	27.82	27.86				200	7.09	0.19	4.1	-	1.12	2.24	1	1	0.64	4.09	2.07	-	-	0.85	4.66	11.12	0.37	0.53	-	-	0.69	-	-	-	-	-	-	-	-	-	-	0.53	1.23	-	-	0.04	1.6	1.05	-	-	-	46.21	13.18	0.26	4.78	0.61	1.3	2.55	1.23	1.09	0.81	4.86	2.74	-	0	1.5	5.46	13.34	0.39	0.56	0.44	-	0.69	0.2	-	-	-	-	-	-	-	-	-	0.56	1.69	0.18	0.01	0.04	1.66	1.07	-	-	-	61.21
H4206_002_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V				2500	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0										0	0	0	0	0	0	0				-	356.48	5.14	1001.23	1654.04	289.25	12.92	9.58	284.69	81.71	2730.06	1377.3		0	410.48	4478.71	5051.46	167.52	224.46	4771.04		3.76	813.54										141.53	321.52	0	157.79	1.07	707.71	460.65						1-10: 10/Day 11-100: 100/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						0	0	53	0	50	0.2	0.12	50	50	10	10		0	20	10	20	20	20	0		0	0										20	25	0	0	439.54	20	20				2500	0	0	47.59	0	44.9	0.18	0.11	45.56	45.85	9	9.01		0	18.02	8.58	18.46	18.02	17.96	0		0	0										16.95	22.21	0	0	439.54	17.96	17.96				0	-	-	3.97	-	1.08	2.29	1.05	1.08	0.31	2.05	1.03	-	-	0.62	3.2	7.77	0.25	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	0.2	0.6	-	-	0.04	1.06	0.69	-	-	-	27.62	-	-	3.97	-	1.08	2.29	1.05	1.08	0.31	2.05	1.03	-	-	0.62	3.2	7.77	0.25	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	0.2	0.6	-	-	0.04	1.06	0.69	-	-	-	27.62
H4206_005_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V					6.66	0.07	0.4	0.46	0.17	0.28	0.21	0.08	0.17	0.74	0.65		0	0.45	0.79	2.22	0.02	0.03	0.51		0	0.19										0.03	0.44	0.18	0.02	0	0.06	0.03				14.86	1312.82	26.45	666.1	1296.11	290.61	12.55	9.3	281.67	88.08	2842.1	1440.06		0.15	429.44	4180.4	4746.91	177.59	250.91	5483.7		3.38	876.98										144.36	346.58	0	151.66	1.16	773.48	503.14						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	92.72	52.98	0	50	0.2	0.12	50	100	20	20		0.2	30	15	29.94	30	21.24	0		0.2	-0.01										50	50	0	0	439.44	30	30				5000	73.99	85.8	49.03	0	46.27	0.18	0.11	45.8	93.93	18.5	18.55		0.2	27.76	13.39	28.19	27.76	19.66	0		0.2	-0.01										47.2	45.92	0	0	439.44	27.76	27.76				200	8.09	0.19	2.72	-	1.12	2.28	1.04	1.07	0.69	4.38	2.23	-	0.03	0.99	4.66	11.15	0.41	0.41	-	-	0.68	0	-	-	-	-	-	-	-	-	-	0.57	1.33	-	-	0.04	1.79	1.16	-	-	-	47.05	14.75	0.26	3.12	0.46	1.29	2.56	1.25	1.16	0.86	5.12	2.87	-	0.03	1.44	5.46	13.37	0.44	0.44	0.51	-	0.68	0.19	-	-	-	-	-	-	-	-	-	0.6	1.77	0.18	0.02	0.04	1.85	1.19	-	-	-	61.91
H4206_006_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V				2500	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0										0	0	0	0	0	0	0				-	364.04	5.24	665.03	1288.74	290.52	12.71	9.42	297.45	88.02	2840.35	1439.19		0.15	429.57	4361.34	4920.01	181.63	250.91	5517.94		3.72	876.4										152.44	346.35	0	158.4	1.16	791.04	514.97						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						0	0	53	0	50	0.2	0.12	50	50	10	10		0.2	20	10	19.97	20	20	0		0.1	0										20	25	0	0	439.44	20	20				2500	0	0	47.58	0	44.89	0.18	0.11	45.41	45.84	8.96	9.01		0.2	17.95	8.53	18.37	17.95	17.95	0		0.1	0										16.94	22.2	0	0	439.44	17.95	17.95				0	-	-	2.64	-	1.09	2.25	1.03	1.13	0.34	2.12	1.08	-	0.03	0.64	3.1	7.53	0.27	0.38	-	-	0.37	-	-	-	-	-	-	-	-	-	-	0.22	0.64	-	-	0.04	1.18	0.77	-	-	-	26.85	-	-	2.64	-	1.09	2.25	1.03	1.13	0.34	2.12	1.08	-	0.03	0.64	3.1	7.53	0.27	0.38	-	-	0.37	-	-	-	-	-	-	-	-	-	-	0.22	0.64	-	-	0.04	1.18	0.77	-	-	-	26.85
H4206_007_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V					6.25	0.07	0.42	0.68	0.2	0.32	0.24	0.08	0.17	0.81	0.64		0	0.45	0.85	2.17	0.03	0.03	0.53		0	0.19										0.03	0.44	0.18	0.01	0	0.06	0.03				14.88	1318.7	25.88	742.15	2464.96	331.55	15.67	11.61	198.81	62.15	2005.96	1016.37		0.16	310.65	4707.98	5345.89	197.34	278.81	5825.72		3.51	618.96										101.89	244.56	0	170.8	1.16	859.42	559.01						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	92.73	52.98	0	50	0.2	0.12	50	100	20	20		0.2	30	15	29.48	30	20.83	0		0.2	-0.01										50	50	0	0	439.88	30	30				5000	73.96	85.76	49	0	46.24	0.18	0.11	45.76	93.87	18.48	18.54		0.2	27.74	13.37	27.75	27.74	19.26	0		0.2	-0.01										47.17	45.88	0	0	439.88	27.74	27.78				200	8.13	0.18	3.03	-	1.28	2.85	1.3	0.76	0.49	3.09	1.57	-	0.03	0.72	5.25	12.36	0.46	0.45	-	-	0.7	0	-	-	-	-	-	-	-	-	-	0.4	0.94	-	-	0.04	1.99	1.29	-	-	-	47.3	14.37	0.25	3.45	0.68	1.47	3.17	1.54	0.84	0.65	3.9	2.22	-	0.04	1.17	6.1	14.53	0.48	0.48	0.53	-	0.7	0.19	-	-	-	-	-	-	-	-	-	0.43	1.38	0.18	0.01	0.04	2.05	1.32	-	-	-	62.18
H4206_008_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V				2500	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0										0	0	0	0	0	0	0				-	344.35	4.95	742.34	2465.16	331.64	15.84	11.74	210.1	62.15	2005.77	1016.37		0.16	311.12	4914.27	5543.68	201.82	278.78	5862.29		3.83	618.86										107.67	244.56	0	178.48	1.16	878.92	572.11						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						0	0	53	0	50	0.2	0.12	50	50	10	10		0.2	20	10	19.97	20	20	0		0.1	0										20	25	0	0	439.88	20	20				2500	0	0	47.23	0	44.55	0.18	0.11	45.11	45.57	8.89	8.94		0.2	17.82	8.43	18.27	17.82	17.82	0		0.1	0										16.74	22.02	0	0	439.88	17.82	17.82				0	-	-	2.92	-	1.23	2.79	1.28	0.79	0.24	1.49	0.76	-	0.03	0.46	3.45	8.44	0.3	0.41	-	-	0.38	-	-	-	-	-	-	-	-	-	-	0.15	0.45	-	-	0.04	1.31	0.85	-	-	-	27.77	-	-	2.92	-	1.23	2.79	1.28	0.79	0.24	1.49	0.76	-	0.03	0.46	3.45	8.44	0.3	0.41	-	-	0.38	-	-	-	-	-	-	-	-	-	-	0.15	0.45	-	-	0.04	1.31	0.85	-	-	-	27.77
H4206_009_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V					5.83	0.06	0.67	0.63	0.3	0.5	0.37	0.08	0.16	0.73	0.62		0	0.43	0.84	2.17	0.02	0.03	0.49		0	0.19										0.03	0.42	0.17	0.02	0	0.06	0.03				14.82	1222.69	24.68	1028.39	2010.71	371.8	20.68	15.33	199.45	62.37	2012.65	1019.86		0.12	307.36	4551.13	4475.39	156.78	221.55	5070		3.32	620.99										102.22	245.41	0	165.12	1.16	682.98	444.26						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	92.7	52.98	0	50	0.2	0.12	50	100	20	20		0.2	30	15	29.95	30	20.4	0		0.2	-0.01										50	50	0	0	439.7	30	30				5000	73.93	85.92	49.1	0	46.34	0.18	0.11	45.87	94.04	18.53	18.58		0.2	27.8	13.42	28.3	27.8	18.91	0		0.2	-0.01										47.25	45.99	0	0	439.7	27.8	27.88				200	7.53	0.18	4.21	-	1.44	3.76	1.72	0.76	0.49	3.11	1.58	-	0.02	0.71	5.09	10.56	0.36	0.35	-	-	0.66	0	-	-	-	-	-	-	-	-	-	0.4	0.94	-	-	0.04	1.58	1.03	-	-	-	46.53	13.36	0.24	4.88	0.63	1.74	4.26	2.09	0.84	0.65	3.83	2.2	-	0.03	1.14	5.93	12.72	0.39	0.38	0.49	-	0.66	0.18	-	-	-	-	-	-	-	-	-	0.43	1.36	0.17	0.02	0.04	1.64	1.06	-	-	-	61.35
H4206_010_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V				2500	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0										0	0	0	0	0	0	0				-	345.61	4.95	1028.59	2009.74	371.9	21	15.56	210.61	62.33	2011.1	1018.99		0.13	307.54	4750.54	4650.9	160.3	221.52	5101.23		3.63	620.51										107.94	245.26	0	172.55	1.16	698.4	454.64						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						0	0	53	0	50	0.2	0.12	50	50	10	10		0.2	20	10	19.97	20	20	0		0.1	0										20	25	0	0	439.7	20	20				2500	0	0	47.07	0	44.41	0.18	0.11	44.98	45.45	8.86	8.92		0.2	17.76	8.39	18.3	17.76	17.76	0		0.1	0										16.65	21.94	0	0	439.7	17.76	17.76				0	-	-	4.03	-	1.38	3.69	1.69	0.79	0.24	1.49	0.76	-	0.03	0.46	3.32	7.09	0.24	0.33	-	-	0.36	-	-	-	-	-	-	-	-	-	-	0.15	0.45	-	-	0.04	1.03	0.67	-	-	-	28.23	-	-	4.03	-	1.38	3.69	1.69	0.79	0.24	1.49	0.76	-	0.03	0.46	3.32	7.09	0.24	0.33	-	-	0.36	-	-	-	-	-	-	-	-	-	-	0.15	0.45	-	-	0.04	1.03	0.67	-	-	-	28.23
H4206_013_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	Coin	V	O	V	V					6.08	0.07	0.68	0.61	0.19	0.31	0.23	0.09	0.17	0.76	0.67		0	0.65	0.81	2.22	0.02	0.03	0.44		0	0.2										0.03	0.46	0.18	0.01	0	0.06	0.03				15	1221.31	24.81	1001.53	1652.59	289.25	12.34	8.91	261.21	81.69	2647.58	1335.69		0.03	397.69	4161.98	4725.06	158.8	224.46	4740.68		3.45	813.35										133.87	321.44	0	150.99	1.07	691.9	450.08				1-7:  75/Day	1-7:  100/Day	1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	100	52.98	0	50	0.2	0.12	50	100	20	20		0	30	15	29.95	30	30	0		0.2	0										50	50	0	0	439.54	30	30				5000	69.7	93.25	49.12	0	46.36	0.18	0.11	45.9	94.07	18.54	18.59		0	25.72	13.43	28.24	27.82	28.49	0		0.2	0										47.26	46.01	0	0	439.54	27.82	27.86				200	7.09	0.19	4.1	-	1.12	2.24	1	1	0.64	4.09	2.07	-	-	0.85	4.66	11.12	0.37	0.53	-	-	0.69	-	-	-	-	-	-	-	-	-	-	0.53	1.23	-	-	0.04	1.6	1.05	-	-	-	46.21	13.18	0.26	4.78	0.61	1.3	2.55	1.23	1.08	0.81	4.86	2.74	-	0	1.5	5.46	13.34	0.39	0.56	0.44	-	0.69	0.2	-	-	-	-	-	-	-	-	-	0.56	1.69	0.18	0.01	0.04	1.66	1.07	-	-	-	61.21
H4206_014_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V				2500	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0										0	0	0	0	0	0	0				-	356.48	5.14	1001.33	1653.66	289.25	12.92	9.58	284.69	81.69	2729.96	1377.2		0	410.48	4478.66	5051.41	167.52	224.46	4770.95		3.76	813.54										141.53	321.44	0	157.79	1.07	707.71	460.65						1-10: 10/Day 11-100: 100/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						0	0	53	0	50	0.2	0.12	50	50	10	10		0	20	10	20	20	20	0		0	0										20	25	0	0	439.54	20	20				2500	0	0	47.59	0	44.9	0.18	0.11	45.56	45.85	9	9.01		0	18.02	8.58	18.46	18.02	17.96	0		0	0										16.94	22.21	0	0	439.54	17.96	17.96				0	-	-	3.97	-	1.08	2.29	1.05	1.08	0.31	2.05	1.03	-	-	0.62	3.2	7.77	0.25	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	0.2	0.59	-	-	0.04	1.06	0.69	-	-	-	27.62	-	-	3.97	-	1.08	2.29	1.05	1.08	0.31	2.05	1.03	-	-	0.62	3.2	7.77	0.25	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	0.2	0.59	-	-	0.04	1.06	0.69	-	-	-	27.62
H4206_017_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V					6.66	0.07	0.4	0.46	0.17	0.28	0.21	0.08	0.17	0.74	0.64		0	0.45	0.79	2.22	0.02	0.03	0.51		0	0.19										0.03	0.44	0.18	0.02	0	0.06	0.03				14.85	1311.79	26.45	665.03	1289.23	290.42	12.54	9.3	281.41	88	2839.97	1439		0.15	429.14	4177.83	4743.96	177.5	250.87	5482.63		3.39	876.3										144.22	346.27	0	151.56	1.16	773.38	503.04						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	92.72	52.98	0	50	0.2	0.12	50	100	20	20		0.2	30	15	29.94	30	21.24	0		0.2	-0.01										50	50	0	0	439.44	30	30				5000	73.99	85.81	49.04	0	46.28	0.18	0.11	45.8	93.94	18.5	18.56		0.2	27.77	13.39	28.2	27.77	19.66	0		0.2	-0.01										47.2	45.93	0	0	439.44	27.77	27.77				200	8.09	0.19	2.72	-	1.12	2.28	1.04	1.07	0.69	4.38	2.23	-	0.03	0.99	4.66	11.15	0.41	0.41	-	-	0.68	0	-	-	-	-	-	-	-	-	-	0.57	1.33	-	-	0.04	1.79	1.16	-	-	-	47.02	14.74	0.26	3.12	0.46	1.29	2.56	1.25	1.16	0.86	5.12	2.87	-	0.03	1.44	5.45	13.37	0.44	0.44	0.51	-	0.68	0.19	-	-	-	-	-	-	-	-	-	0.6	1.77	0.18	0.02	0.04	1.85	1.19	-	-	-	61.87
H4206_018_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V				2500	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0										0	0	0	0	0	0	0				-	364.14	5.24	665.42	1291.07	290.52	12.71	9.42	297.57	88.04	2841.03	1439.48		0.15	429.67	4362.24	4921.07	181.63	250.94	5518.33		3.72	876.59										152.51	346.43	0	158.43	1.16	791.13	514.97						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						0	0	53	0	50	0.2	0.12	50	50	10	10		0.2	20	10	19.97	20	20	0		0.1	0										20	25	0	0	439.44	20	20				2500	0	0	47.58	0	44.89	0.18	0.11	45.41	45.84	8.96	9.01		0.2	17.95	8.53	18.37	17.95	17.95	0		0.1	0										16.94	22.2	0	0	439.44	17.95	17.95				0	-	-	2.64	-	1.09	2.25	1.03	1.13	0.34	2.12	1.08	-	0.03	0.64	3.1	7.53	0.27	0.38	-	-	0.37	-	-	-	-	-	-	-	-	-	-	0.22	0.64	-	-	0.04	1.18	0.77	-	-	-	26.85	-	-	2.64	-	1.09	2.25	1.03	1.13	0.34	2.12	1.08	-	0.03	0.64	3.1	7.53	0.27	0.38	-	-	0.37	-	-	-	-	-	-	-	-	-	-	0.22	0.64	-	-	0.04	1.18	0.77	-	-	-	26.85
H4206_019_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V					6.25	0.07	0.42	0.68	0.2	0.32	0.24	0.08	0.17	0.81	0.65		0	0.45	0.85	2.17	0.03	0.03	0.53		0	0.19										0.03	0.44	0.18	0.01	0	0.06	0.03				14.89	1318.7	25.88	742.15	2464.96	331.55	15.67	11.61	198.81	62.15	2005.96	1016.37		0.16	310.65	4708.08	5345.97	197.34	278.81	5825.82		3.51	618.96										101.89	244.56	0	170.8	1.16	859.42	559.01						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						75	92.73	52.98	0	50	0.2	0.12	50	100	20	20		0.2	30	15	29.48	30	20.83	0		0.2	-0.01										50	50	0	0	439.88	30	30				5000	73.96	85.76	49	0	46.24	0.18	0.11	45.76	93.87	18.48	18.54		0.2	27.74	13.37	27.75	27.74	19.26	0		0.2	-0.01										47.17	45.88	0	0	439.88	27.74	27.78				200	8.13	0.18	3.03	-	1.28	2.85	1.3	0.76	0.49	3.09	1.57	-	0.03	0.72	5.25	12.36	0.46	0.45	-	-	0.7	0	-	-	-	-	-	-	-	-	-	0.4	0.94	-	-	0.04	1.99	1.29	-	-	-	47.3	14.38	0.25	3.45	0.68	1.47	3.17	1.54	0.84	0.65	3.9	2.22	-	0.04	1.17	6.1	14.53	0.48	0.48	0.53	-	0.7	0.19	-	-	-	-	-	-	-	-	-	0.43	1.38	0.18	0.01	0.04	2.05	1.32	-	-	-	62.19
H4206_020_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V				2500	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0										0	0	0	0	0	0	0				-	344.35	4.95	742.24	2465.06	331.64	15.84	11.74	210.1	62.15	2005.77	1016.27		0.16	311.12	4914.22	5543.64	201.82	278.78	5862.29		3.83	618.86										107.67	244.56	0	178.48	1.16	878.92	572.11						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						0	0	53	0	50	0.2	0.12	50	50	10	10		0.2	20	10	19.97	20	20	0		0.1	0										20	25	0	0	439.88	20	20				2500	0	0	47.23	0	44.55	0.18	0.11	45.11	45.57	8.89	8.94		0.2	17.82	8.43	18.27	17.82	17.82	0		0.1	0										16.74	22.02	0	0	439.88	17.82	17.82				0	-	-	2.92	-	1.23	2.79	1.28	0.79	0.24	1.49	0.76	-	0.03	0.46	3.45	8.44	0.3	0.41	-	-	0.38	-	-	-	-	-	-	-	-	-	-	0.15	0.45	-	-	0.04	1.31	0.85	-	-	-	27.77	-	-	2.92	-	1.23	2.79	1.28	0.79	0.24	1.49	0.76	-	0.03	0.46	3.45	8.44	0.3	0.41	-	-	0.38	-	-	-	-	-	-	-	-	-	-	0.15	0.45	-	-	0.04	1.31	0.85	-	-	-	27.77
H4206_022_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	P	P		Coin	O										V	V	V	V	O	V	V				2500	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0										0	0	0	0	0	0	0				-	345.61	4.95	1028.59	2009.84	371.9	21	15.56	210.61	62.33	2011.2	1019.08		0.13	307.54	4750.59	4650.95	160.3	221.52	5101.33		3.63	620.51										107.94	245.26	0	172.55	1.16	698.4	454.64						1-5: 0/Day 6-100: 75/Day				20 coin on prosthetics 0 copay on diabetic supplies																													250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						0	0	53	0	50	0.2	0.12	50	50	10	10		0.2	20	10	19.97	20	20	0		0.1	0										20	25	0	0	439.7	20	20				2500	0	0	47.07	0	44.41	0.18	0.11	44.98	45.45	8.86	8.92		0.2	17.76	8.39	18.3	17.76	17.76	0		0.1	0										16.65	21.94	0	0	439.7	17.76	17.76				0	-	-	4.03	-	1.38	3.69	1.69	0.79	0.24	1.49	0.76	-	0.03	0.46	3.32	7.09	0.24	0.33	-	-	0.36	-	-	-	-	-	-	-	-	-	-	0.15	0.45	-	-	0.04	1.03	0.67	-	-	-	28.23	-	-	4.03	-	1.38	3.69	1.69	0.79	0.24	1.49	0.76	-	0.03	0.46	3.32	7.09	0.24	0.33	-	-	0.36	-	-	-	-	-	-	-	-	-	-	0.15	0.45	-	-	0.04	1.03	0.67	-	-	-	28.23
H4207_001_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	Coin	P		Coin	Coin			Coin						V	V	V	Coin	V	O	V	V				5000	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0			0						0	0	0	0	0	0	0	0				-	1305.21	25.22	1002.11	25.73	264.42	11.04	8.18	227.16	6.76	34.96	25.94		0.04	18.17	4403.01	5737.97	178.64	1.57	4838.65		3.48	7.84			2.73						1284.43	116.42	17.88	7.24	158.68	1.16	778.23	506.19				1-7:  200/Day	1-11:  225/Day equivalent to 283/Day for days 1-7	1-24: 75/Day																																	250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						200	282.91	62.11	0	100	0.2	0.2	50	0.2	0.09	0.2		0.2	0.11	10	25	42	0.15			0.2	0.2			0.2						30	50	100	0.15	10	439.6	20	20				5000	170.43	244.66	52.93	0	85.22	0.16	0.18	41.67	0.18	0.09	0.2		0.2	0.11	7.52	22.4	35.79	0.13			0.2	0.17			0.17						22.61	44.44	99.98	0.12	7.55	439.6	16.3	16.3				0	18.54	0.51	4.42	-	1.88	1.81	1.44	0.79	1.2	3.08	5.19	-	0.01	1.94	2.76	10.71	0.53	0.2	-	-	0.7	1.34	-	-	0.47	-	-	-	-	-	2.42	0.43	0.15	0.87	0.1	0.04	1.06	0.69	-	-	-	63.27	18.54	0.51	4.42	-	1.88	1.81	1.44	0.79	1.2	3.08	5.19	-	0.01	1.94	2.76	10.71	0.53	0.2	-	-	0.7	1.34	-	-	0.47	-	-	-	-	-	2.42	0.43	0.15	0.87	0.1	0.04	1.06	0.69	-	-	-	63.27
H4207_002_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	Coin	P		Coin	Coin			Coin						V	V	V	Coin	V	O	V	V				4000	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0			0						0	0	0	0	0	0	0	0				-	1305.21	25.6	1023.25	25.73	264.42	11.04	8.18	232.29	6.76	35.01	25.94		0.04	18.17	4448.93	5870.93	178.64	1.57	4849.9		3.48	7.84			2.73						1299.27	119.05	17.88	7.24	160.4	1.16	787.11	512.16				1-7:  150/Day	1-11:  175/Day equivalent to 220/Day for days 1-7	1-24: 50/Day														30 copay per group visit 35 copay per individual visit																			250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						150	220.04	41.41	0	75	0.15	0.15	50	0.15	0.07	0.15		0.15	0.14	10	20	34	0.15	0		0.2	0.15			0.2						25	35	75	0.15	10	439.6	20	20				4000	128.07	190.85	35.35	0	64.04	0.12	0.13	42.6	0.13	0.06	0.13		0.15	0.13	7.88	17.84	29.03	0.13	0		0.2	0.13			0.17						18.42	30.06	74.98	0.13	7.91	439.6	16.71	16.71				0	13.93	0.41	3.01	-	1.41	1.35	1.08	0.82	0.9	1.98	3.32	-	0.01	2.37	2.92	8.73	0.43	0.2	-	-	0.7	1	-	-	0.47	-	-	-	-	-	1.99	0.3	0.11	0.93	0.11	0.04	1.1	0.71	-	-	-	50.34	13.93	0.41	3.01	-	1.41	1.35	1.08	0.82	0.9	1.98	3.32	-	0.01	2.37	2.92	8.73	0.43	0.2	-	-	0.7	1	-	-	0.47	-	-	-	-	-	1.99	0.3	0.11	0.93	0.11	0.04	1.1	0.71	-	-	-	50.34
H4207_003_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional					Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	V	Coin	P		Coin	Coin			Coin						V	V	V	Coin	V	O	V	V				3000	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0			0						0	0	0	0	0	0	0	0				-	1318.54	25.73	1033.73	25.73	264.42	11.04	8.18	237.48	6.76	35.3	25.94		0.04	18.17	4681.53	6076.86	178.64	1.6	4914.02		3.48	7.84			2.73						1314.06	121.71	17.88	7.24	169.02	1.16	795.93	518.13				1-7:  100/Day	1-11:  125/Day equivalent to 220/Day for days 1-7	1-24: 25/Day																																							100	157.17	20.7	0	50	0.15	0.15	50	0.1	0.04	0.1		0.1	0.1	5	10	25	0.1	0		0.2	0.1			0.2						25	25	50	0.1	5	439.6	20	20				3000	87.18	139.16	18.05	0	43.59	0.13	0.13	44	0.09	0.04	0.09		0.1	0.09	4.07	8.89	21.79	0.09	0		0.2	0.09			0.18						19.87	21	49.99	0.09	4.08	439.6	17.44	17.44				0	9.58	0.3	1.55	-	0.96	1.38	1.09	0.87	0.61	1.37	2.26	-	0	1.62	1.59	4.5	0.32	0.14	-	-	0.7	0.68	-	-	0.48	-	-	-	-	-	2.18	0.21	0.07	0.63	0.06	0.04	1.16	0.75	-	-	-	35.12	9.58	0.3	1.55	-	0.96	1.38	1.09	0.87	0.61	1.37	2.26	-	0	1.62	1.59	4.5	0.32	0.14	-	-	0.7	0.68	-	-	0.48	-	-	-	-	-	2.18	0.21	0.07	0.63	0.06	0.04	1.16	0.75	-	-	-	35.12
H4208_001_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	V	V	V	V	V	V	P	V	Coin	V	T	P	V	P	V	P	O	V	V																																																					-	893.13	14.14	0	0	242.1	18.19	1.31	364.6	358.6	9.09	42.89	0	169.69	661.6	0	0	214.8	856.7	0	11259.4	6.62	736.5	0	0	494.1	0	211.7	0	0	0	0											100 / day up to 3 days.	100 / day up to 3 days.	0 / day	0 copay	50 copay	20 coinsurance	20 coinsurance	50 ER copay 30 Urgent Care copay	25 ASC copay 75 Hosp copay	0 Preferred lab 20 Non-preferred lab	20 Radiation Therapy copay		20 copay	10 PT/OT/ST copay			20 copay	10 copay		10 PCP copay / 20 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	10 Vision Exams copay			10 copay		10 copay															100	100	0	0	50	0.18	0.2	43.22	35	0.02	20	0	20	10	0	0	20	10	0	15.12	0.2	10	0	0	10	0	10	0	0	0	0												100	100	0	0	50	0.18	0.2	43.22	35	0.02	20	0	20	10	0	0	20	10	0	15.12	0.2	10	0	0	10	0	10	0	0	0	0												7.44	0.12	-	-	1.01	3.24	0.26	1.31	1.05	0.18	0.07	-	0.28	0.55	-	-	0.36	0.71	-	14.19	1.32	0.61	-	-	0.41	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.3	7.44	0.12	-	-	1.01	3.24	0.26	1.31	1.05	0.18	0.07	-	0.28	0.55	-	-	0.36	0.71	-	14.19	1.32	0.61	-	-	0.41	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.3
H4208_002_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	V	V	V	V	V	V	P	V	Coin	V	T	P	V	P	V	P	O	V	V																																																					-	1028.97	17.16	1136.4	0	242.1	18.19	1.31	360.7	358.6	9.09	42.89	0	167.88	661.6	0	0	209.9	829.8	0	10941.5	6.62	713.4	0	0	478.6	0	205.1	0	0	0	0											400 / day up to 4 days.	400 / day up to 4 days.	50 / day	0 copay	50 copay	30 coinsurance	30 coinsurance	50 ER copay 40 Urgent Care copay	50 ASC copay 150 Hosp copay	0 Preferred lab 20 Non-preferred lab	25 Radiation Therapy copay		25 copay	15 PT/OT/ST copay			40 copay	15 copay		15 PCP copay / 25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	15 Vision Exams copay			15 copay		15 copay															400	400	50	0	50	0.26	0.3	46.61	70	0.02	25	0	25	15	0	0	40	15	0	20.01	0.2	15	0	0	15	0	15	0	0	0	0												400	400	50	0	50	0.26	0.3	46.61	70	0.02	25	0	25	15	0	0	40	15	0	20.01	0.2	15	0	0	15	0	15	0	0	0	0												34.3	0.57	4.74	-	1.01	4.77	0.39	1.4	2.09	0.18	0.09	-	0.35	0.83	-	-	0.7	1.04	-	18.24	1.32	0.89	-	-	0.6	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.76	34.3	0.57	4.74	-	1.01	4.77	0.39	1.4	2.09	0.18	0.09	-	0.35	0.83	-	-	0.7	1.04	-	18.24	1.32	0.89	-	-	0.6	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.76
H4208_801_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	V	V	V	V	V	V	P	V	Coin	V	T	P	V	P	V	P	O	V	V																																																					-	934.87	16.1	822.3	0	246.3	18.05	1.26	374.8	372.9	9.46	44.48	0	145.94	691.1	0	0	181.4	719.3	0	9617.5	6.95	631.4	0	0	395.5	0	169.5	0	0	0	0											400 / day up to 4 days.	400 / day up to 4 days.	50 / day	0 copay	50 copay	30 coinsurance	30 coinsurance	50 ER copay 30 Urgent Care copay	25 ASC copay 75 Hosp copay	0 Preferred lab 20 Non-preferred lab	20 Radiation Therapy copay		25 copay	15 PT/OT/ST copay			40 copay	15 copay		15 PCP copay / 25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	15 Vision Exams copay			15 copay		15 copay															400	400	50	0	50	0.26	0.3	46.61	70	0.02	25	0	25	15	0	0	40	15	0	19.99	0.2	15	0	0	15	0	15	0	0	0	0												400	400	50	0	50	0.26	0.3	46.61	70	0.02	25	0	25	15	0	0	40	15	0	19.99	0.2	15	0	0	15	0	15	0	0	0	0												31.16	0.54	3.43	-	1.03	4.73	0.38	1.46	2.18	0.18	0.09	-	0.3	0.86	-	-	0.6	0.9	-	16.02	1.39	0.79	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.74	31.16	0.54	3.43	-	1.03	4.73	0.38	1.46	2.18	0.18	0.09	-	0.3	0.86	-	-	0.6	0.9	-	16.02	1.39	0.79	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.74
H4208_802_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	V	V	V	V	V	V	P	V	Coin	V	T	P	V	P	V	P	O	V	V																																																					-	934.87	16.1	822.3	0	246.3	18.05	1.26	374.8	372.9	9.46	44.48	0	145.94	691.1	0	0	181.4	719.3	0	9617.5	6.95	631.4	0	0	395.5	0	169.5	0	0	0	0											400 / day up to 4 days.	400 / day up to 4 days.	50 / day	0 copay	50 copay	30 coinsurance	30 coinsurance	50 ER copay 30 Urgent Care copay	25 ASC copay 75 Hosp copay	0 Preferred lab 20 Non-preferred lab	20 Radiation Therapy copay		25 copay	15 PT/OT/ST copay			40 copay	15 copay		15 PCP copay / 25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	15 Vision Exams copay			15 copay		15 copay															400	400	50	0	50	0.26	0.3	46.61	70	0.02	25	0	25	15	0	0	40	15	0	19.99	0.2	15	0	0	15	0	15	0	0	0	0												400	400	50	0	50	0.26	0.3	46.61	70	0.02	25	0	25	15	0	0	40	15	0	19.99	0.2	15	0	0	15	0	15	0	0	0	0												31.16	0.54	3.43	-	1.03	4.73	0.38	1.46	2.18	0.18	0.09	-	0.3	0.86	-	-	0.6	0.9	-	16.02	1.39	0.79	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.74	31.16	0.54	3.43	-	1.03	4.73	0.38	1.46	2.18	0.18	0.09	-	0.3	0.86	-	-	0.6	0.9	-	16.02	1.39	0.79	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.74
H4208_803_0	2006											0											D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	V	V	V	V	V	V	P	V	Coin	V	T	P	V	P	V	P	O	V	V																																																					-	934.87	16.1	822.3	0	246.3	18.05	1.26	374.8	372.9	9.46	44.48	0	145.94	691.1	0	0	181.4	719.3	0	9617.5	6.95	631.4	0	0	395.5	0	169.5	0	0	0	0											400 / day up to 4 days.	400 / day up to 4 days.	50 / day	0 copay	50 copay	30 coinsurance	30 coinsurance	50 ER copay 30 Urgent Care copay	25 ASC copay 75 Hosp copay	0 Preferred lab 20 Non-preferred lab	20 Radiation Therapy copay		25 copay	15 PT/OT/ST copay			40 copay	15 copay		15 PCP copay / 25 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	15 Vision Exams copay			15 copay		15 copay															400	400	50	0	50	0.26	0.3	46.61	70	0.02	25	0	25	15	0	0	40	15	0	19.99	0.2	15	0	0	15	0	15	0	0	0	0												400	400	50	0	50	0.26	0.3	46.61	70	0.02	25	0	25	15	0	0	40	15	0	19.99	0.2	15	0	0	15	0	15	0	0	0	0												31.16	0.54	3.43	-	1.03	4.73	0.38	1.46	2.18	0.18	0.09	-	0.3	0.86	-	-	0.6	0.9	-	16.02	1.39	0.79	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.74	31.16	0.54	3.43	-	1.03	4.73	0.38	1.46	2.18	0.18	0.09	-	0.3	0.86	-	-	0.6	0.9	-	16.02	1.39	0.79	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.74
H4209_001_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional				10000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	Coin	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	V	P	P		Coin	Coin			V	V						V	Coin	V	V	O	V	V					0	0	0	0	0	0	0	0	0.59	0	0		0	0.82	0.07	1.38	0	0	0		0	0.69			0	0						0	1.56	0	0	0	0	0				5.1	1259.97	25.24	980.86	22.31	270.34	10.48	7.77	236.2	5.61	2279.99	26.62		0.15	8.76	4261.04	5644.1	178.03	251.52	4691.41		3.69	7.23			405.65	341.25						121.05	16.44	316.61	153.39	1.07	775.32	504.3				1-7:  150/Day	1-7:  150/Day	1-10: 10/Day 11-100: 100/Day				25 coin on prosthetics 12 copay on diabetic supplies				25 copay for X-Rays; 10 coinsurance for Radiation Therapy																									250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						150	150	54.84	0.1	50	0.25	0.22	50	0.2	25	0.13		0.2	0.1	25	35	35	20	0		0.2	0.1			25	25						25	0.1	20	20	439.92	35	35					144.04	144.04	52.67	0.1	48.01	0.23	0.21	48.14	0.3	24	0.13		0.2	0.19	24.03	36.78	33.61	19.21	0		0.2	0.19			24.01	24.01						20.13	0.19	19.21	18.85	439.92	33.61	33.82				100	15.12	0.3	4.3	2.14	1.08	2.44	1.64	0.95	1.68	4.56	3.4	-	0.03	1.64	8.53	17.3	0.5	0.4	-	-	0.74	1.38	-	-	0.81	0.68	-	-	-	-	-	0.2	3.13	0.51	0.24	0.04	2.17	1.42	-	-	-	77.34	15.12	0.3	4.3	2.14	1.08	2.44	1.64	0.95	2.27	4.56	3.4	-	0.03	2.46	8.6	18.67	0.5	0.4	-	-	0.74	2.06	-	-	0.81	0.68	-	-	-	-	-	0.2	4.69	0.51	0.24	0.04	2.17	1.42	-	-	-	82.44
H4209_002_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional				10000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	Coin	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	V	P	P		Coin	Coin			V	V						V	Coin	V	V	O	V	V					0	0	0	0	0	0	0	0	0.56	0	0		0	0.78	0.07	1.38	0	0	0		0	0.65			0	0						0	1.48	0	0	0	0	0				4.92	1391.24	27.04	1040.91	26.37	257.34	9.78	7.25	252.04	5.53	2432.86	26.07		0.15	8.61	4145.25	5585.91	182.24	257.5	5200.36		3.64	7.1			393.04	343.96						129.17	16.15	337.85	149.08	1.16	793.75	516.33				1-7:  150/Day	1-7:  150/Day	1-10: 10/Day 11-100: 100/Day				25 coin on prosthetics 12 copay on diabetic supplies				25 copay for X-Rays; 10 coinsurance for Radiation Therapy																									250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						150	150	54.84	0.1	50	0.25	0.22	50	0.2	25	0.14		0.2	0.1	25	35	35	20	0		0.2	0.1			25	25						25	0.1	20	20	439.93	35	35					143.62	143.62	52.51	0.1	47.87	0.23	0.21	48.01	0.3	23.93	0.13		0.2	0.18	23.98	37.14	33.51	19.15	0		0.2	0.19			23.94	23.94						19.79	0.19	19.15	18.77	439.93	33.51	33.76				100	16.65	0.32	4.56	2.52	1.03	2.27	1.52	1.01	1.64	4.85	3.45	-	0.03	1.58	8.28	17.29	0.51	0.41	-	-	0.73	1.33	-	-	0.78	0.69	-	-	-	-	-	0.21	3.02	0.54	0.23	0.04	2.22	1.45	-	-	-	79.17	16.65	0.32	4.56	2.52	1.03	2.27	1.52	1.01	2.2	4.85	3.45	-	0.03	2.36	8.35	18.67	0.51	0.41	-	-	0.73	1.98	-	-	0.78	0.69	-	-	-	-	-	0.21	4.51	0.54	0.23	0.04	2.22	1.45	-	-	-	84.09
H4209_003_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional				10000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	Coin	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	V	P	P		Coin	Coin			V	V						V	Coin	V	V	O	V	V					0	0	0	0	0	0	0	0	0.63	0	0		0	0.88	0.07	1.38	0	0	0		0	0.73			0	0						0	1.67	0	0	0	0	0				5.36	1813.34	36.46	583.26	25.78	367.92	13.95	10.34	309.76	7.3	2989.83	33.58		0.16	11.19	4282.5	5658.35	200.76	283.69	5889.84		4.39	9.25			415.45	365.01						158.75	21.03	415.16	154.18	1.16	874.55	568.81				1-7:  150/Day	1-7:  150/Day	1-10: 10/Day 11-100: 100/Day				25 coin on prosthetics 12 copay on diabetic supplies				25 copay for X-Rays; 10 coinsurance for Radiation Therapy																									250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						150	150	54.84	0.1	50	0.25	0.22	50	0.2	25	0.13		0.2	0.1	25	35	35	20	0		0.2	0.1			25	25						25	0.1	20	20	438.73	35	35					141.92	141.92	51.89	0.09	47.31	0.23	0.21	47.48	0.28	23.65	0.13		0.2	0.17	23.6	36.07	33.12	18.92	0		0.2	0.17			23.65	23.65						18.4	0.17	18.92	18.44	438.73	33.12	33.47				100	21.45	0.43	2.52	2.44	1.45	3.2	2.16	1.23	2.04	5.89	4.23	-	0.03	1.9	8.42	17.01	0.55	0.45	-	-	0.88	1.6	-	-	0.82	0.72	-	-	-	-	-	0.24	3.65	0.65	0.24	0.04	2.41	1.59	-	-	-	88.25	21.45	0.43	2.52	2.44	1.45	3.2	2.16	1.23	2.68	5.89	4.23	-	0.03	2.78	8.49	18.38	0.55	0.45	-	-	0.88	2.34	-	-	0.82	0.72	-	-	-	-	-	0.24	5.32	0.65	0.24	0.04	2.41	1.59	-	-	-	93.61
H4209_004_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional				5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	Coin	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	V	P	P		Coin	Coin			V	V						V	Coin	V	V	O	V	V					0	0	0	0	0	0	0	0	0.59	0	0		0	0.82	0.07	1.38	0	0	0		0	0.69			0	0						0	1.56	0	0	0	0	0				5.1	1260.05	25.27	980.77	22.31	270.34	10.48	7.77	236.33	6.2	2280.96	29.92		0.15	17.62	4354.29	5722.31	178.03	251.55	4713.04		3.78	7.23			405.75	341.34						121.12	16.45	316.71	156.89	1.07	775.52	504.4				1-7:  150/Day	1-7:  150/Day	1-10: 10/Day 11-100: 100/Day				25 coin on prosthetics 12 copay on diabetic supplies				15 copay for X-Rays; 10 coinsurance for Radiation Therapy																									250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						150	150	54.84	0.1	50	0.25	0.22	50	0.2	15	0.1		0.2	0.1	15	25	25	20	0		0.2	0.1			25	25						25	0.1	20	15	439.92	25	25					133.54	133.54	48.83	0.09	44.51	0.22	0.2	44.86	0.28	13.34	0.09		0.2	0.14	13.06	25.55	22.26	17.81	0		0.2	0.18			22.26	22.26						21.57	0.18	17.81	12.9	439.92	22.26	22.26				100	14.02	0.28	3.99	1.99	1	2.27	1.56	0.88	1.75	2.54	2.69	-	0.03	2.43	4.74	12.18	0.33	0.37	-	-	0.76	1.32	-	-	0.75	0.63	-	-	-	-	-	0.22	3	0.47	0.17	0.04	1.44	0.94	-	-	-	62.79	14.02	0.28	3.99	1.99	1	2.27	1.56	0.88	2.34	2.54	2.69	-	0.03	3.25	4.8	13.56	0.33	0.37	-	-	0.76	2.01	-	-	0.75	0.63	-	-	-	-	-	0.22	4.56	0.47	0.17	0.04	1.44	0.94	-	-	-	67.88
H4209_005_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional				5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	Coin	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	V	P	P		Coin	Coin			V	V						V	Coin	V	V	O	V	V					0	0	0	0	0	0	0	0	0.56	0	0		0	0.78	0.07	1.38	0	0	0		0	0.65			0	0						0	1.48	0	0	0	0	0				4.92	1391.48	27.04	1041.59	26.38	257.24	9.78	7.25	251.98	6.09	2431.98	29.29		0.15	17.27	4235.34	5661.71	182.24	257.5	5224.23		3.74	7.1			393.04	343.96						129.14	16.14	337.75	152.47	1.16	793.85	516.33				1-7:  150/Day	1-7:  150/Day	1-10: 10/Day 11-100: 100/Day				25 coin on prosthetics 12 copay on diabetic supplies				15 copay for X-Rays; 10 coinsurance for Radiation Therapy																									250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						150	150	54.84	0.1	50	0.25	0.22	50	0.2	15	0.1		0.2	0.1	15	25	25	20	0		0.2	0.1			25	25						25	0.1	20	15	439.93	25	25					132.47	132.47	48.44	0.09	44.16	0.21	0.2	44.53	0.28	13.23	0.09		0.2	0.14	12.95	25.81	22.08	17.66	0		0.2	0.18			22.08	22.08						21.35	0.18	17.66	12.76	439.93	22.08	22.08				100	15.36	0.3	4.2	2.33	0.95	2.1	1.45	0.94	1.7	2.68	2.66	-	0.03	2.35	4.57	12.18	0.34	0.38	-	-	0.75	1.27	-	-	0.72	0.63	-	-	-	-	-	0.23	2.89	0.5	0.16	0.04	1.46	0.95	-	-	-	64.11	15.36	0.3	4.2	2.33	0.95	2.1	1.45	0.94	2.26	2.68	2.66	-	0.03	3.13	4.64	13.55	0.34	0.38	-	-	0.75	1.92	-	-	0.72	0.63	-	-	-	-	-	0.23	4.37	0.5	0.16	0.04	1.46	0.95	-	-	-	69.03
H4209_006_0	2006	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Other Non-Covered	OP Facility - Emergency	Professional	Professional				5000	Urgent Care Clinic	ASC Based	Cardiovascular	Physical Exams	Foreign Travel	Podiatrist	Chiropractor				D	D	D	Coin	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	V	P	P		Coin	Coin			V	V						V	Coin	V	V	O	V	V					0	0	0	0	0	0	0	0	0.63	0	0		0	0.88	0.07	1.38	0	0	0		0	0.73			0	0						0	1.67	0	0	0	0	0				5.36	1813.34	36.46	583.26	25.78	367.92	13.95	10.34	309.76	7.93	2989.83	37.73		0.16	22.34	4375.81	5736.72	200.76	283.69	5917.58		4.51	9.25			415.45	365.01						158.75	21.03	415.16	157.68	1.16	874.55	568.81				1-7:  150/Day	1-7:  150/Day	1-10: 10/Day 11-100: 100/Day				25 coin on prosthetics 12 copay on diabetic supplies				15 copay for X-Rays; 10 coinsurance for Radiation Therapy																									250 Annual Deductible + 20 Coinsurance.  Coverage Limited to 25000 each year.						150	150	54.84	0.1	50	0.25	0.22	50	0.2	15	0.1		0.2	0.1	15	25	25	20	0		0.2	0.1			25	25						25	0.1	20	15	438.73	25	25					128.25	128.25	46.89	0.09	42.75	0.21	0.2	43.21	0.26	12.81	0.08		0.2	0.13	12.35	24.48	21.37	17.1	0		0.2	0.16			21.37	21.37						20.47	0.16	17.1	12.22	438.73	21.37	21.37				100	19.38	0.39	2.28	2.2	1.31	2.9	2.02	1.12	2.09	3.19	3.14	-	0.03	2.87	4.5	11.7	0.36	0.4	-	-	0.9	1.51	-	-	0.74	0.65	-	-	-	-	-	0.27	3.44	0.59	0.16	0.04	1.56	1.01	-	-	-	70.78	19.38	0.39	2.28	2.2	1.31	2.9	2.02	1.12	2.72	3.19	3.14	-	0.03	3.75	4.57	13.08	0.36	0.4	-	-	0.9	2.25	-	-	0.74	0.65	-	-	-	-	-	0.27	5.11	0.59	0.16	0.04	1.56	1.01	-	-	-	76.13
H4209_809_0	2006											10000											D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	coin	V	V	V	V	coin	V	coin	O	T	P	V	P	V	P	O	O	V											10000	0	0	0	0	0	0	0	0	2.27	0	0	0	0	0.86	0.08	1.72	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.94	1233.34	17.44	830.61	22.34	263.81	8.87	8.55	375.32	24.86	2388.5	26.68	0	0.14	25.86	4008.2	5798.98	167.29	236.36	18.95	241.56	7.21	677.37	0	0	11992.25	98.94	165.46	0	0	0	0											Per Day: 1-7	Per Day: 1-7	Days: 1-10 10/Day; Days 11-100 100/Day			25 DME; 25 Prosthetics; 12 Diabetes Monitoring Supplies	25 DME; 25 Prosthetics; 12 Diabetes Monitoring Supplies	50 ER / 25 UC			25 X-Rays; 10 Rad Ther			35 OP SA / 20 Cardiac Rehab10 Surgical Supplies	25 PCP	35 SCP / 35 Chiro / 35 Podiatrist	35 MH	20 Therapy	10 Rad Therapy; 0 Other Rad	35 Hearing / 0 Preventive		25 Vision			25 Copay + Employer Group Placeholder																	150	150	54.84	0.1	50	0.24	0.24	42.76	0.1	25	0.14	0	0.2	0.08	24.95	33.62	35	20	0.01	12.41	0.2	23.64	0	0	0.73	25	35	0	0	0	0											20000	146.42	146.42	53.54	0.1	48.81	0.23	0.23	41.74	0.1	24.4	0.14	0	0.19	0.08	24.36	32.82	34.17	19.52	0.01	12.16	0.2	23.08	0	0	0.73	25	34.17	0	0	0	0											100	15.05	0.21	3.71	2.18	1.07	2.06	2	1.31	2.43	4.86	3.69	-	0.03	2.08	8.14	15.86	0.48	0.38	0.13	0.24	1.41	1.3	-	-	0.73	0.21	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.02	15.05	0.21	3.71	2.18	1.07	2.06	2	1.31	4.69	4.86	3.69	-	0.03	2.94	8.22	17.58	0.48	0.38	0.13	0.24	1.41	1.3	-	-	0.73	0.21	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.95
H4209_810_0	2006											10000											D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	coin	V	V	V	V	coin	V	coin	O	T	P	V	P	V	P	O	O	V											10000	0	0	0	0	0	0	0	0	2.27	0	0	0	0	0.86	0.08	1.72	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.94	1233.41	17.44	830.81	22.35	263.81	8.87	8.55	375.42	24.86	2388.9	26.68	0	0.14	25.86	4007.58	5798.41	167.29	236.33	18.95	241.53	7.21	677.27	0	0	11992.19	98.94	165.46	0	0	0	0											Per Day: 1-7	Per Day: 1-7	Days: 1-10 10/Day; Days 11-100 100/Day			25 DME; 25 Prosthetics; 12 Diabetes Monitoring Supplies	25 DME; 25 Prosthetics; 12 Diabetes Monitoring Supplies	50 ER / 25 UC			25 X-Rays; 10 Rad Ther			35 OP SA / 20 Cardiac Rehab10 Surgical Supplies	25 PCP	35 SCP / 35 Chiro / 35 Podiatrist	35 MH	20 Therapy	10 Rad Therapy; 0 Other Rad	35 Hearing / 0 Preventive		25 Vision			25 Copay + Employer Group Placeholder																	150	150	54.84	0.1	50	0.24	0.24	42.76	0.1	25	0.14	0	0.2	0.08	24.95	33.62	35	20	0.01	12.42	0.2	23.64	0	0	0.73	25	35	0	0	0	0											20000	146.42	146.42	53.54	0.1	48.81	0.23	0.23	41.74	0.1	24.4	0.14	0	0.19	0.08	24.36	32.81	34.17	19.52	0.01	12.16	0.2	23.08	0	0	0.73	25	34.17	0	0	0	0											100	15.05	0.21	3.71	2.18	1.07	2.06	2	1.31	2.43	4.86	3.69	-	0.03	2.08	8.13	15.86	0.48	0.38	0.13	0.24	1.41	1.3	-	-	0.73	0.21	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.02	15.05	0.21	3.71	2.18	1.07	2.06	2	1.31	4.69	4.86	3.69	-	0.03	2.94	8.22	17.58	0.48	0.38	0.13	0.24	1.41	1.3	-	-	0.73	0.21	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.95
H4209_811_0	2006											10000											D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	coin	V	V	V	V	coin	V	coin	O	T	P	V	P	V	P	O	O	V											10000	0	0	0	0	0	0	0	0	2.27	0	0	0	0	0.86	0.08	1.72	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.94	1233.34	17.44	830.61	22.34	263.81	8.87	8.55	375.32	24.86	2388.5	26.68	0	0.14	25.86	4008.2	5798.98	167.29	236.36	18.95	241.56	7.21	677.37	0	0	11992.25	98.94	165.46	0	0	0	0											Per Day: 1-7	Per Day: 1-7	Days: 1-10 10/Day; Days 11-100 100/Day			25 DME; 25 Prosthetics; 12 Diabetes Monitoring Supplies	25 DME; 25 Prosthetics; 12 Diabetes Monitoring Supplies	50 ER / 25 UC			25 X-Rays; 10 Rad Ther			35 OP SA / 20 Cardiac Rehab10 Surgical Supplies	25 PCP	35 SCP / 35 Chiro / 35 Podiatrist	35 MH	20 Therapy	10 Rad Therapy; 0 Other Rad	35 Hearing / 0 Preventive		25 Vision			25 Copay + Employer Group Placeholder																	150	150	54.84	0.1	50	0.24	0.24	42.76	0.1	25	0.14	0	0.2	0.08	24.95	33.62	35	20	0.01	12.41	0.2	23.64	0	0	0.73	25	35	0	0	0	0											20000	146.42	146.42	53.54	0.1	48.81	0.23	0.23	41.74	0.1	24.4	0.14	0	0.19	0.08	24.36	32.82	34.17	19.52	0.01	12.16	0.2	23.08	0	0	0.73	25	34.17	0	0	0	0											100	15.05	0.21	3.71	2.18	1.07	2.06	2	1.31	2.43	4.86	3.69	-	0.03	2.08	8.14	15.86	0.48	0.38	0.13	0.24	1.41	1.3	-	-	0.73	0.21	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.02	15.05	0.21	3.71	2.18	1.07	2.06	2	1.31	4.69	4.86	3.69	-	0.03	2.94	8.22	17.58	0.48	0.38	0.13	0.24	1.41	1.3	-	-	0.73	0.21	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.95
H4209_812_0	2006											10000											D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	coin	V	V	V	V	coin	V	coin	O	T	P	V	P	V	P	O	O	V											10000	0	0	0	0	0	0	0	0	2.27	0	0	0	0	0.86	0.08	1.72	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.94	1233.41	17.44	830.81	22.35	263.81	8.87	8.55	375.42	24.86	2388.9	26.68	0	0.14	25.86	4007.58	5798.41	167.29	236.33	18.95	241.53	7.21	677.27	0	0	11992.19	98.94	165.46	0	0	0	0											Per Day: 1-7	Per Day: 1-7	Days: 1-10 10/Day; Days 11-100 100/Day			25 DME; 25 Prosthetics; 12 Diabetes Monitoring Supplies	25 DME; 25 Prosthetics; 12 Diabetes Monitoring Supplies	50 ER / 25 UC			25 X-Rays; 10 Rad Ther			35 OP SA / 20 Cardiac Rehab10 Surgical Supplies	25 PCP	35 SCP / 35 Chiro / 35 Podiatrist	35 MH	20 Therapy	10 Rad Therapy; 0 Other Rad	35 Hearing / 0 Preventive		25 Vision			25 Copay + Employer Group Placeholder																	150	150	54.84	0.1	50	0.24	0.24	42.76	0.1	25	0.14	0	0.2	0.08	24.95	33.62	35	20	0.01	12.42	0.2	23.64	0	0	0.73	25	35	0	0	0	0											20000	146.42	146.42	53.54	0.1	48.81	0.23	0.23	41.74	0.1	24.4	0.14	0	0.19	0.08	24.36	32.81	34.17	19.52	0.01	12.16	0.2	23.08	0	0	0.73	25	34.17	0	0	0	0											100	15.05	0.21	3.71	2.18	1.07	2.06	2	1.31	2.43	4.86	3.69	-	0.03	2.08	8.13	15.86	0.48	0.38	0.13	0.24	1.41	1.3	-	-	0.73	0.21	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.02	15.05	0.21	3.71	2.18	1.07	2.06	2	1.31	4.69	4.86	3.69	-	0.03	2.94	8.22	17.58	0.48	0.38	0.13	0.24	1.41	1.3	-	-	0.73	0.21	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	74.95
H4406_001_0	2006											3100											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V	T		V	V	V			V																																																						-	1678.57	80.26	916.69	0	179.12	14.54	16.45	338.89	38.89	0	21.28	1.64	0.32	17.5	4531	5173.78	196.64	1.72	20.27	380.15	26.36	0	0		124	266.8	222			0												250	17500	125	0	150	30	30	50	25	0	25 / 0	25	30	25 / 40 / 30	15 / 0	35	40 / 30	25	25 / 0	0 / 35	30	0	0		35	15	35			0												250	175	125	0	150	0.3	0.3	50	0.25	0	0.21	0.25	0.3	0.24	15	32.67	37.5	0.25	0.13	0.4	0.3	0	0		35	15	35			0													141.58	99.11	70.79	0	84.95	0.17	0.17	28.32	0.14	0	0.12	0.14	0.17	0.14	15	32.67	37.5	0.14	0.08	0.4	0.17	0	0		35	15	35			0													19.8	0.66	5.41	-	1.27	2.47	2.8	0.8	5.51	-	2.56	0.23	0.05	2.39	5.66	14.09	0.61	0.24	1.54	0.01	4.48	-	-	-	0.36	0.33	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.94	19.8	0.66	5.41	-	1.27	2.47	2.8	0.8	5.51	-	2.56	0.23	0.05	2.39	5.66	14.09	0.61	0.24	1.54	0.01	4.48	-	-	-	0.36	0.33	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.94
H4406_003_0	2006											2200											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V	T		V	V	V			V																																																						-	1678.57	80.26	916.69	0	179.12	14.54	16.45	338.89	38.89	0	21.28	1.64	0.32	17.5	4531.01	5173.8	196.64	1.72	20.27	380.15	26.36	0	0		124	266.8	222			0												195	17500	95	0	150	20	20	50	15	0	15 / 0	15	20	15 / 40 / 30	Oct-00	30	40 / 30	15	15 / 0	0 / 30	20	0	0		30	15	30			0												195	175	95	0	150	0.2	0.2	50	0.15	0	0.13	0.15	0.2	0.15	10	28.01	37.5	0.15	0.08	0.25	0.2	0	0		30	15	30			0													109.54	98.31	53.37	0	84.26	0.11	0.11	28.09	0.08	0	0.07	0.08	0.11	0.08	10	28.01	37.5	0.08	0.05	0.25	0.11	0	0		30	15	30			0													15.32	0.66	4.08	-	1.26	1.63	1.85	0.79	3.28	-	1.53	0.14	0.04	1.43	3.78	12.07	0.61	0.15	0.92	0.01	2.96	-	-	-	0.31	0.33	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.69	15.32	0.66	4.08	-	1.26	1.63	1.85	0.79	3.28	-	1.53	0.14	0.04	1.43	3.78	12.07	0.61	0.15	0.92	0.01	2.96	-	-	-	0.31	0.33	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.69
H4406_004_0	2006											600											D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	V	V		V																																																						-	1945.65	92	900.64		219.07	17.79	20.12	569.54	692.35		935.31	49.27	0.54	1311.44	8941.36	6049.5	254.53	240.78	5215.95	442.86	31.97				124		323.29															25	25	15		100	20	20	40	15		0 / 10	15	20	15 / 10 / 8 / 4	Feb-00	4	04-Aug	10	0 / 10	0 / 4	20				05-Apr		4															25	25	15		100	0.2	0.2	40	15		9.49	15	0.2	13.23	1.4	3.74	7	10	5.36	0.35	0.2				4.95		4																15.25	15.25	9.15		61	0.12	0.12	24.4	9.15		5.79	9.15	0.12	8.07	1.4	3.74	7	6.1	3.27	0.35	0.12				4.95		4																2.47	0.12	0.69	-	1.11	2.17	2.46	1.16	0.53	-	0.45	0.04	0.07	0.88	1.04	1.88	0.15	0.12	1.42	0.01	3.9	-	-	-	0.05	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.83	2.47	0.12	0.69	-	1.11	2.17	2.46	1.16	0.53	-	0.45	0.04	0.07	0.88	1.04	1.88	0.15	0.12	1.42	0.01	3.9	-	-	-	0.05	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.83
H4406_801_0	2006											4650											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V			V		V			V																																																						-	1759.24	77.96	946.12	0	183.43	14.86	16.93	348.18	41.92	1217.24	25.29	1.77	0.25	18.62	4833.33	5580.2	198.17	1.87	21.81	410.95	28.49	0			133.3		238.65			0												250	175	125	0	150	30	30	50	25	0	25 / 0	25	30	25 / 40 / 30	15 / 0	35	40 / 30	25	25 / 0	0 / 35	30	0	0		35	15	35			0												250	175	125	0	150	0.3	0.3	50	0.3	10	0.24	0.3	0.3	0.29	35	32.7	37.5	0.3	0.22	0.3	0.3	0			35		35			0													159.07	111.35	79.54	0	95.44	0.19	0.19	31.81	0.19	6.36	0.15	0.19	0.19	0.18	35	32.7	37.5	0.19	0.14	0.3	0.19	0			35		35			0													23.32	0.72	6.27	-	1.46	2.84	3.23	0.92	8	0.65	3.86	0.34	0.05	3.43	14.1	15.21	0.62	0.36	3.12	0.01	5.44	-	-	-	0.39	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.02	23.32	0.72	6.27	-	1.46	2.84	3.23	0.92	8	0.65	3.86	0.34	0.05	3.43	14.1	15.21	0.62	0.36	3.12	0.01	5.44	-	-	-	0.39	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.02
H4407_001_0	2006	Ambulance										2000	Air										D		D		T	Coin		P	P		P	O			V	V	V				Coin	O	T		V							T										0																																										-	1017.15		1031.36		86.06	6.09		269.09	265.26		387.01	24			6747	1625	225				25.02	22	342.86		160							2.5										150/D first 10 Days; 2K OP		0/D (0-10 Days); 25 (11-90 Days)		100 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	250 CP / Surg		75 CP / (MRI CT Test)	150/D first 10 Days; 2K OP			15 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	150/D first 10 Days; 2K OP	3.50 / Trip		30 CP / Visit							250 CP / Trip										150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250										2000	150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05	12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05
H4407_002_0	2006																						D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	1440.66		375.25		96.28	7.66		226.07	212.18					830.62	7710.77	2570.26					16.99	0.63				159.66																100 per day for 1st 10 days	100 per day for 1st 10 days	25 for days 1 to 100		160 per trip	20 coinsurance	20 coinsurance	50 per visit	225 per visit		30 per service		30 per visit	30 per visit	10 per visit	30 per visit	30 per visit	30 per visit	30 per visit	30 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		30 per visit	100 limit on eyewear																100	100	25		160	0.2	0.2	50	225		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100																	100	100	25		160	0.2	0.2	50	225		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100																	12.01	-	0.78	-	1.28	1.53	-	0.94	3.98	-	-	-	-	2.08	6.43	6.43	-	-	-	-	1.7	0.06	-	-	-	1.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.54	12.01	-	0.78	-	1.28	1.53	-	0.94	3.98	-	-	-	-	2.08	6.43	6.43	-	-	-	-	1.7	0.06	-	-	-	1.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.54
H4407_003_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4407_004_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4407_005_0	2006	Ambulance											Air										D		D		T	Coin		P	P		P	P			V	V	V				Coin	V	T		V							T																																																				-	1017.15		1031.36		86.06	6.09		269.09	265.26		387.01	24			6747	1625	225				25.02	22	342.86		160							2.5										150/D first 10 Days; 2K OP		0/D (0-10 Days); 25 (11-90 Days)		100 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	250 CP / Surg		75 CP / (MRI CT Test)	150/D first 10 Days; 2K OP			15 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	150/D first 10 Days; 2K OP	3.50 / Trip		30 CP / Visit							250 CP / Trip										150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05	12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05
H4407_006_0	2006																						D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	1444.43		376.23		96.53	7.68		226.66	212.73					832.79	7730.94	2576.98					17.03	0.63				160.08																100 per day for 1st 10 days	100 per day for 1st 10 days	25 for days 1 to 100		100 per trip	20 coinsurance	20 coinsurance	50 per visit	200 per visit		30 per service		30 per visit	30 per visit	10 per visit	30 per visit	30 per visit	30 per visit	30 per visit	30 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		30 per visit	100 limit on eyewear																100	100	25		100	0.2	0.2	50	200		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100																	100	100	25		100	0.2	0.2	50	200		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100																	12.04	-	0.78	-	0.8	1.54	-	0.94	3.55	-	-	-	-	2.08	6.44	6.44	-	-	-	-	1.7	0.06	-	-	-	1.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.72	12.04	-	0.78	-	0.8	1.54	-	0.94	3.55	-	-	-	-	2.08	6.44	6.44	-	-	-	-	1.7	0.06	-	-	-	1.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.72
H4407_007_0	2006	Ambulance											Air										D		D		T	Coin		P	P		P	O			V	V	V				Coin	O	T		V							T																																																				-	2169.08		2199.38		183.52	12.98		573.83	565.68		825.31	51.18			14387.98	3465.31	479.81				53.35	46.92	731.14		160							5.33										150/D first 10 Days; 2K OP		0/D (0-10 Days); 20 (11-90 Days)		100 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	150 CP / Surg		50 CP / (MRI CT Test)	100/D first 10 Days; 2K OP			15 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	150/D first 10 Days; 2K OP	3.50 / Trip		30 CP / Visit							250 CP / Trip										150		20		100	0.2		50	150		50	100			15	30	30				0.2	150	3.5		30							250											150		20		100	0.2		50	150		50	100			15	30	30				0.2	150	3.5		30							250											27.11	-	3.67	-	1.53	2.6	-	2.39	7.07	-	3.44	0.43	-	-	17.98	8.66	1.2	-	-	-	10.67	0.59	0.21	-	0.4	-	-	-	-	-	-	0.11	-	-	-	-	-	-	-	-	-	88.06	27.11	-	3.67	-	1.53	2.6	-	2.39	7.07	-	3.44	0.43	-	-	17.98	8.66	1.2	-	-	-	10.67	0.59	0.21	-	0.4	-	-	-	-	-	-	0.11	-	-	-	-	-	-	-	-	-	88.06
H4407_008_0	2006																						D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	2819.77		734.47		188.44	15		442.49	415.29					1625.75	15092.14	5030.71					33.25	1.23				312.06																100 per day for 1st 10 days	100 per day for 1st 10 days	25 for days 1 to 100		100 per trip	20 coinsurance	20 coinsurance	50 per visit	200 per visit		30 per service		30 per visit	30 per visit	5.50 per visit	30 per visit	30 per visit	30 per visit	30 per visit	30 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		30 per visit	100 limit on eyewear																100	100	25		100	0.2	0.2	50	200		30		30	30	5.5	30	30	30	30	30	0.1	0.1			30	100																	100	100	25		100	0.2	0.2	50	200		30		30	30	5.5	30	30	30	30	30	0.1	0.1			30	100																	23.5	-	1.53	-	1.57	3	-	1.84	6.92	-	-	-	-	4.06	6.92	12.58	-	-	-	-	3.32	0.12	-	-	-	2.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.97	23.5	-	1.53	-	1.57	3	-	1.84	6.92	-	-	-	-	4.06	6.92	12.58	-	-	-	-	3.32	0.12	-	-	-	2.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.97
H4407_009_0	2006	Ambulance											Air										D		D		T	Coin		P	P		P	P			V	V	V				Coin	V	T		V							T																																																				-	1017.15		1031.36		86.06	6.09		269.09	265.26		387.01	24			6747	1625	225				25.02	22	342.86		160							2.5										150/D first 10 Days; 2K OP		0/D (0-10 Days); 25 (11-90 Days)		100 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	250 CP / Surg		75 CP / (MRI CT Test)	150/D first 10 Days; 2K OP			15 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	150/D first 10 Days; 2K OP	3.50 / Trip		30 CP / Visit							250 CP / Trip										150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05	12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05
H4407_010_0	2006																						D	D	D	V	T	Coin	Coin	V	P	O	V	O	V	O	V	V	V	V	V	V	Coin	Coin	T	V	V	V				O	V																																																					-	1444.43		376.23		96.53	7.68		226.66	212.73					832.79	7730.94	2576.98					17.03	0.63				160.08																100 per day for 1st 10 days	100 per day for 1st 10 days	25 for days 1 to 100		100 per trip	20 coinsurance	20 coinsurance	50 per visit	200 per visit		30 per service		30 per visit	30 per visit	10 per visit	30 per visit	30 per visit	30 per visit	30 per visit	30 per visit	10 per Script	10 per Script	0 Co-pay 20 Trips per year		30 per visit	100 limit on eyewear																100	100	25		100	0.2	0.2	50	200		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100																	100	100	25		100	0.2	0.2	50	200		30		30	30	10	30	30	30	30	30	0.1	0.1			30	100																	12.04	-	0.78	-	0.8	1.54	-	0.94	3.55	-	-	-	-	2.08	6.44	6.44	-	-	-	-	1.7	0.06	-	-	-	1.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.72	12.04	-	0.78	-	0.8	1.54	-	0.94	3.55	-	-	-	-	2.08	6.44	6.44	-	-	-	-	1.7	0.06	-	-	-	1.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.72
H4407_802_0	2006	Ambulance											Air										D		D		T	Coin		P	P		P	P			V	V	V				Coin	V	T		V							T																																																				-	1017.15		376.23		96.53	7.68		226.66	265.26		387.01	24			6747	1625	225				25.02	22	342.86		160							2.5										150/D first 10 Days; 2K OP		95/D (0-10 Days); 25 (11-90 Days)		150 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	250 CP / Surg		75 CP / (MRI CT Test)	150/D first 10 Days; 2K OP			20 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	150/D first 10 Days; 2K OP	3.50 / Trip		30 CP / Visit							250 CP / Trip										150		95		150	0.2		50	250		75	150			20	30	30				0.2	150	3.5		30							250											150		95		150	0.2		50	250		75	150			20	30	30				0.2	150	3.5		30							250											12.71	-	2.98	-	1.21	1.54	-	0.94	5.53	-	2.42	0.3	-	-	11.25	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	49.33	12.71	-	2.98	-	1.21	1.54	-	0.94	5.53	-	2.42	0.3	-	-	11.25	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	49.33
H4408_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1079.35	22.86	564.98	526.69	147.65	19.19	1.44	416.05	329.63				17.97	2031.23	6516.49	11364.48					4.45			0	0		0					56.81	1.2	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-75	Oct-50	35-50					20			0								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.89	10.78	35.29					20			0	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.89	10.78	35.29					20			0	0		0					119.04	119.04	0	0	0	0	0				0	10.71	0.23	1.11	0.44	1.23	3.84	0.29	1.41	3.2	-	-	-	-	8.45	5.86	33.43	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.56	0.01	-	-	-	-	-	-	-	-	71.64	10.71	0.23	1.11	0.44	1.23	3.84	0.29	1.41	3.2	-	-	-	-	8.45	5.86	33.43	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.56	0.01	-	-	-	-	-	-	-	-	71.64
H4408_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1068.9	22.64	559.5	521.59	146.21	18.35	1.38	412.01	326.44				17.8	2011.55	6453.35	11254.37					4.45			0	0		0					56.26	1.19	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-75	Oct-50	35-50					20			0								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.84	10.78	35.29					20			0	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	23.59	10	100	0.2	0.2	40.7	116.5				0	49.84	10.78	35.29					20			0	0		0					119.04	119.04	0	0	0	0	0				0	10.6	0.22	1.1	0.43	1.22	3.67	0.28	1.4	3.17	-	-	-	-	8.35	5.8	33.1	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.56	0.01	-	-	-	-	-	-	-	-	70.81	10.6	0.22	1.1	0.43	1.22	3.67	0.28	1.4	3.17	-	-	-	-	8.35	5.8	33.1	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.56	0.01	-	-	-	-	-	-	-	-	70.81
H4408_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	259.02	5.89	1162.98	542.08	151.96	19.81	1.49	428.2	339.27				18.5	2090.59	6706.91	11696.57					4.45			0	0		0					13.63	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.89	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.89	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.95	0.29	0.85	0.45	1.27	4.95	0.37	1.61	5.65	-	-	-	-	6.08	14.08	34.12	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	84.27	12.95	0.29	0.85	0.45	1.27	4.95	0.37	1.61	5.65	-	-	-	-	6.08	14.08	34.12	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	84.27
H4408_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	259.02	5.89	1162.97	542.08	151.96	19.81	1.49	428.2	339.26				18.5	2090.58	6706.88	11696.52					4.45			0	0		0					13.63	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.89	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.89	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.95	0.29	0.85	0.45	1.27	4.95	0.37	1.61	5.65	-	-	-	-	6.08	14.08	34.11	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	84.27	12.95	0.29	0.85	0.45	1.27	4.95	0.37	1.61	5.65	-	-	-	-	6.08	14.08	34.11	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	84.27
H4408_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	259.02	5.89	1162.98	542.08	151.96	19.81	1.49	428.2	339.27				18.5	2090.59	6706.91	11696.57					4.45			0	0		0					13.63	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.89	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.89	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.95	0.29	0.85	0.45	1.27	4.95	0.37	1.61	5.65	-	-	-	-	6.08	14.08	34.12	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	84.27	12.95	0.29	0.85	0.45	1.27	4.95	0.37	1.61	5.65	-	-	-	-	6.08	14.08	34.12	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	84.27
H4408_805_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	259.02	5.89	1162.97	542.08	151.96	19.81	1.49	428.2	339.26				18.5	2090.58	6706.88	11696.52					4.45			0	0		0					13.63	0.31	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.89	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.89	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.95	0.29	0.85	0.45	1.27	4.95	0.37	1.61	5.65	-	-	-	-	6.08	14.08	34.11	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	84.27	12.95	0.29	0.85	0.45	1.27	4.95	0.37	1.61	5.65	-	-	-	-	6.08	14.08	34.11	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.68	0.02	-	-	-	-	-	-	-	-	84.27
H4454_002_0	2006	Ambulance										2000	Air										D		D		T	Coin		P	P		P				V	V	V				Coin	O	T		V							T										0																																										-	1017.15		1031.36		86.06	6.09		269.09	265.26		387.01	24			6747	1625	225				25.02	22	342.86		160							2.5										150/D first 10 Days; 2K OP		0/D (0-10 Days); 25 (11-90 Days)		100 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	250 CP / Surg		75 CP / (MRI CT Test)	150/D first 10 Days; 2K OP			15 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	150/D first 10 Days; 2K OP	3.50 / Trip		30 CP / Visit							250 CP / Trip										150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250										2000	150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05	12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05
H4454_007_0	2006																													P															T																																																													-								309															342.86																										50 Copay per Visit															3.50 per trip																										50															3.5																											50															3.5																				-	-	-	-	-	-	-	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.39	-	-	-	-	-	-	-	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.39
H4454_008_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4454_012_0	2006	Ambulance											Air										D		D		T	Coin		P	P		P	P			V	V	V				Coin	V	T		V							T																																																				-	1017.15		1031.36		86.06	6.09		269.09	265.26		387.01	24			6747	1625	225				25.02	22	342.86		160							2.5										150/D first 10 Days; 2K OP		0/D (0-10 Days); 25 (11-90 Days)		100 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	250 CP / Surg		75 CP / (MRI CT Test)	150/D first 10 Days; 2K OP			15 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	150/D first 10 Days; 2K OP	3.50 / Trip		30 CP / Visit							250 CP / Trip										150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05	12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05
H4454_013_0	2006	Ambulance											Air										D		D		T	Coin		P	P		P	O			V	V	V				Coin	O	T		V							T																																																				-	2169.08		2199.38		183.52	12.98		573.83	565.68		825.31	51.18			14387.98	3465.31	479.81				53.35	46.92	731.14		160							5.33										150/D first 10 Days; 2K OP		0/D (0-10 Days); 20 (11-90 Days)		100 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	150 CP / Surg		50 CP / (MRI CT Test)	100/D first 10 Days; 2K OP			15 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	150/D first 10 Days; 2K OP	3.50 / Trip		30 CP / Visit							250 CP / Trip										150		20		100	0.2		50	150		50	100			15	30	30				0.2	150	3.5		30							250											150		20		100	0.2		50	150		50	100			15	30	30				0.2	150	3.5		30							250											27.11	-	3.67	-	1.53	2.6	-	2.39	7.07	-	3.44	0.43	-	-	17.98	8.66	1.2	-	-	-	10.67	0.59	0.21	-	0.4	-	-	-	-	-	-	0.11	-	-	-	-	-	-	-	-	-	88.06	27.11	-	3.67	-	1.53	2.6	-	2.39	7.07	-	3.44	0.43	-	-	17.98	8.66	1.2	-	-	-	10.67	0.59	0.21	-	0.4	-	-	-	-	-	-	0.11	-	-	-	-	-	-	-	-	-	88.06
H4454_803_0	2006	Ambulance											Air										D		D		T	Coin		P	P		P	P			V	V	V				Coin	V	T		V							T																																																				-	1017.15		1031.36		86.06	6.09		269.09	265.26		387.01	24			6747	1625	225				25.02	22	342.86		160							2.5										150/D first 10 Days; 2K OP		0/D (0-10 Days); 25 (11-90 Days)		100 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	250 CP / Surg		75 CP / (MRI CT Test)	150/D first 10 Days; 2K OP			15 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	150/D first 10 Days; 2K OP	3.50 / Trip		30 CP / Visit							250 CP / Trip										150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											150		25		100	0.2		50	250		75	150			15	30	30				0.2	150	3.5		30							250											12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05	12.71	-	2.15	-	0.72	1.22	-	1.12	5.53	-	2.42	0.3	-	-	8.43	4.06	0.56	-	-	-	5	0.28	0.1	-	0.4	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	-	-	45.05
H4456_005_0	2006											Unlimited											A					Coin		V	V						V	V	V	V		V					V	P																																																										-	275.47					15.19		237.24	625.52						4818.35	3212.24	36.59	854.66		712.5					200	45																																																																																																			250					0.2		50	50						20	20	20	20		6.67					20	100																	5.74	-	-	-	-	3.04	-	0.99	2.61	-	-	-	-	-	8.03	5.35	0.06	1.42	-	0.4	-	-	-	-	0.33	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.34	5.74	-	-	-	-	3.04	-	0.99	2.61	-	-	-	-	-	8.03	5.35	0.06	1.42	-	0.4	-	-	-	-	0.33	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.34
H4456_006_0	2006											Unlimited																Coin		V							V	V	V	V		V					V	P																																																										-						15.78		273.8							5071.95	3381.3	38.51	899.64		750					200	45																																																																																																								0.2		50							15	15	15	15		5					15	100																	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97
H4456_008_0	2006																											Coin		V							V	V	V	V		V					V	P																																																										-						15.78		273.8							5071.95	3381.3	38.51	899.64		750					200	45																																																																																																								0.2		50							15	15	15	15		5					15	100																	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97
H4456_009_0	2006																						A					Coin		V	V						V	V	V	V		V					V	P																																																										-	275.47					15.19		237.24	625.52						4818.35	3212.24	36.59	854.66		712.5					200	45																																																																																																			250					0.2		50	50						20	20	20	20		6.67					20	100																	5.74	-	-	-	-	3.04	-	0.99	2.61	-	-	-	-	-	8.03	5.35	0.06	1.42	-	0.4	-	-	-	-	0.33	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.34	5.74	-	-	-	-	3.04	-	0.99	2.61	-	-	-	-	-	8.03	5.35	0.06	1.42	-	0.4	-	-	-	-	0.33	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.34
H4456_010_0	2006											Unlimited											A		D	Coin	Coin	Coin		V	Coin	Coin					V	V	V	V	Coin	V					V	P																																																										-	275.34		170	13.29	7.95	14.2		246.42	54.22	58.66					4564.76	3043.17	34.66	809.68	57.44	675					200	45																																																																																																			500		75	0.1	0.1	0.2		50	0.1	0.1					25	25	25	25	0.1	8.33					25	100																	11.47	-	1.06	1.33	0.79	2.84	-	1.03	5.42	5.87	-	-	-	-	9.51	6.34	0.07	1.69	5.74	0.47	-	-	-	-	0.42	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.43	11.47	-	1.06	1.33	0.79	2.84	-	1.03	5.42	5.87	-	-	-	-	9.51	6.34	0.07	1.69	5.74	0.47	-	-	-	-	0.42	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.43
H4456_011_0	2006											Unlimited																											V								V	P																																																										-																	40.44								200	45																																																																																																																			15								15	100																	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68
H4456_013_0	2006											Unlimited											A		D	Coin	Coin	Coin		V	Coin	Coin					V	V	V	V	Coin	V					V	P																																																										-	275.34		170	13.29	7.95	14.2		246.42	67.34	58.66					4564.76	3043.17	34.66	809.68	57.44	675					200	45																																																																																																			500		75	0.1	0.1	0.2		50	0.1	0.1					25	25	25	25	0.1	8.33					25	100																	11.47	-	1.06	1.33	0.79	2.84	-	1.03	6.73	5.87	-	-	-	-	9.51	6.34	0.07	1.69	5.74	0.47	-	-	-	-	0.42	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.74	11.47	-	1.06	1.33	0.79	2.84	-	1.03	6.73	5.87	-	-	-	-	9.51	6.34	0.07	1.69	5.74	0.47	-	-	-	-	0.42	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.74
H4456_014_0	2006											Unlimited																											V								V	P																																																										-																	40.44								200	45																																																																																																																			15								15	100																	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68
H4456_015_0	2006																											Coin		V							V	V	V	V		V					V	P																																																										-						15.78		273.8							5071.95	3381.3	38.51	899.64		750					200	45																																																																																																								0.2		50							15	15	15	15		5					15	100																	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97
H4456_016_0	2006																											Coin		V							V	V	V	V		V					V	P																																																										-						15.78		273.8							5071.95	3381.3	38.51	899.64		750					200	45																																																																																																								0.2		50							15	15	15	15		5					15	100																	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97
H4456_017_0	2006											Unlimited																											V								V	P																																																										-																	40.44								200	45																																																																																																																			15								15	100																	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68
H4456_018_0	2006											Unlimited																											V								V	P																																																										-																	40.44								200	45																																																																																																																			15								15	100																	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68
H4456_019_0	2006											Unlimited																Coin		V							V	V	V	V		V					V	P																																																										-						15.78		273.8							5071.95	3381.3	38.51	899.64		750					200	45																																																																																																								0.2		50							15	15	15	15		5					15	100																	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97
H4456_020_0	2006											Unlimited																Coin		V							V	V	V	V		V					V	P																																																										-						15.78		273.8							5071.95	3381.3	38.51	899.64		750					200	45																																																																																																								0.2		50							15	15	15	15		5					15	100																	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97	-	-	-	-	-	3.16	-	1.14	-	-	-	-	-	-	6.34	4.23	0.05	1.12	-	0.31	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.97
H4456_021_0	2006											Unlimited																											V								V	P																																																										-																	40.44								200	45																																																																																																																			15								15	100																	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68
H4456_022_0	2006											Unlimited																											V								V	P																																																										-																	40.44								200	45																																																																																																																			15								15	100																	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.05	-	-	-	-	-	-	-	0.25	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.68
H4456_801_0	2006																						A		D	Coin	Coin	Coin		V	Coin	Coin					V	V	V	V	Coin	V																																																																-	296.43		170	19.69	14.08	18.28		307.6	93.23	63.29					5469	3646	32.65	1119	67.77	1070.6																																																																																																									500		75	0.1	0.1	0.2		50	0.1	0.1					25	25	25	25	0.1	8.33																							12.35	-	1.06	1.97	1.41	3.66	-	1.28	9.32	6.33	-	-	-	-	11.39	7.6	0.07	2.33	6.78	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.29	12.35	-	1.06	1.97	1.41	3.66	-	1.28	9.32	6.33	-	-	-	-	11.39	7.6	0.07	2.33	6.78	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.29
H4456_805_0	2006																						A		D	Coin	Coin	Coin		V	Coin	Coin					V	V	V	V	Coin	V																																																																-	296.43		170	19.69	14.08	18.28		307.6	93.23	63.29					5469	3646	32.65	1119	67.77	1070.6																																																																																																									500		75	0.1	0.1	0.2		50	0.1	0.1					25	25	25	25	0.1	8.33																							12.35	-	1.06	1.97	1.41	3.66	-	1.28	9.32	6.33	-	-	-	-	11.39	7.6	0.07	2.33	6.78	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.29	12.35	-	1.06	1.97	1.41	3.66	-	1.28	9.32	6.33	-	-	-	-	11.39	7.6	0.07	2.33	6.78	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.29
H4456_806_0	2006											Unlimited											A		D	Coin	Coin	Coin		V	Coin	Coin					V	V	V	V	Coin	V																																																																-	296.43		170	19.69	14.08	18.28		307.6	74.77	63.29					5469	3646	32.65	1119	67.77	1070.6																																																																																																									500		75	0.1	0.1	0.2		50	0.1	0.1					25	25	25	25	0.1	8.33																							12.35	-	1.06	1.97	1.41	3.66	-	1.28	7.48	6.33	-	-	-	-	11.39	7.6	0.07	2.33	6.78	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.44	12.35	-	1.06	1.97	1.41	3.66	-	1.28	7.48	6.33	-	-	-	-	11.39	7.6	0.07	2.33	6.78	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.44
H4456_807_0	2006											Unlimited											A		D	Coin	Coin	Coin		V	Coin	Coin					V	V	V	V	Coin	V																																																																-	296.43		170	19.69	14.08	18.28		307.6	74.77	63.29					5469	3646	32.65	1119	67.77	1070.6																																																																																																									500		75	0.1	0.1	0.2		50	0.1	0.1					25	25	25	25	0.1	8.33																							12.35	-	1.06	1.97	1.41	3.66	-	1.28	7.48	6.33	-	-	-	-	11.39	7.6	0.07	2.33	6.78	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.44	12.35	-	1.06	1.97	1.41	3.66	-	1.28	7.48	6.33	-	-	-	-	11.39	7.6	0.07	2.33	6.78	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.44
H4461_001_0	2006																											coin	coin																																																																													-						7.46	0.34	314.91	0	0	0	0	0	3393.91	0	0	211.39	0	0	28220.58	0	1125.17	0	0	217.2	0	53.96	0	0																																																																																																					0.2	0.2	28.55	0	0	0	0	0	1.24	0	0	20	0	0	3.35	0	13.17	0	0	10	0	0	0	0														-	-	-	-	-	1.49	0.07	0.75	-	-	-	-	-	0.35	-	-	0.35	-	-	7.87	-	1.24	-	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.3	-	-	-	-	-	1.49	0.07	0.75	-	-	-	-	-	0.35	-	-	0.35	-	-	7.87	-	1.24	-	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.3
H4461_004_0	2006																											coin	coin																																																																													-						7.46	0.34	314.91	0	0	0	0	0	3393.91	0	0	211.39	0	0	28220.58	0	1125.17	0	0	217.2	0	53.96	0	0																																																																																																					0.2	0.2	28.55	0	0	0	0	0	1.24	0	0	20	0	0	3.35	0	13.17	0	0	10	0	0	0	0														-	-	-	-	-	1.49	0.07	0.75	-	-	-	-	-	0.35	-	-	0.35	-	-	7.87	-	1.24	-	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.3	-	-	-	-	-	1.49	0.07	0.75	-	-	-	-	-	0.35	-	-	0.35	-	-	7.87	-	1.24	-	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.3
H4461_007_0	2006																											Coin	Coin																																																																													-						7.77	0.1	357.45	291.74	0	0	0	13.82	3317.35	0	0	340.34	0	3529.04	26496.5	0	1545.78	131.89	0	125.4	228.87	0	0	0	0																																																																																																				0.2	0.2	26.81	0	0	0	0	0	1.01	0	0	20	0	0	3.61	0	0.53	0	0	10	0	0	0	0	0													-	-	-	-	-	1.55	0.02	0.8	-	-	-	-	-	0.28	-	-	0.57	-	-	7.97	-	0.07	-	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.36	-	-	-	-	-	1.55	0.02	0.8	-	-	-	-	-	0.28	-	-	0.57	-	-	7.97	-	0.07	-	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.36
H4461_011_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4461_012_0	2006																											coin	coin																																																																													-						7.77	0.1	357.45	291.74	0	0	0	13.82	3317.35	0	0	340.34	0	3529.04	26496.5	0	1545.78	131.89	0	125.4	228.87	0	0	0	0																																																																																																				0.2	0.2	26.81	0	0	0	0	0	1.01	0	0	20	0	0	3.61	0	0.53	0	0	10	0	0	0	0	0													-	-	-	-	-	1.55	0.02	0.8	-	-	-	-	-	0.28	-	-	0.57	-	-	7.97	-	0.07	-	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.36	-	-	-	-	-	1.55	0.02	0.8	-	-	-	-	-	0.28	-	-	0.57	-	-	7.97	-	0.07	-	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.36
H4461_802_0	2006																											coin	coin																																																																													-						8.14	0.34	330.38						3463.24			202.84			29438		1125.17			214.94		53.37																																																																																																							0.2	0.2	28.7						1.23			20			3.26		13.17			10		10																-	-	-	-	-	1.63	0.07	0.79	-	-	-	-	-	0.36	-	-	0.34	-	-	8.01	-	1.24	-	-	0.18	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.65	-	-	-	-	-	1.63	0.07	0.79	-	-	-	-	-	0.36	-	-	0.34	-	-	8.01	-	1.24	-	-	0.18	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.65
H4506_003_0	2006	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Inpatient Facility						cardiac stress tests	radiation therapy	MRI/MRA/CT Scan	PET Scan	IMRT	Transplants					a	a	coin		t	coin	coin	v	v				v		p	p	p	v			coin				p							v	v	v	v	v	coin																																															-	313.12	0.33	14.09		283.24	11.23	4.3	325.92	696.35				9.73		4542.02	4808.67	237.52	129.96			13.78				105.73							15.58	45	154.02	19.24	58.71	1					300/stay	300/stay	FFS cost sharing		50/trip	0	0	50	100				50/session		5	25	35 individual 20 group	25			0.2				25							25	benchmarks	125	300	200	FFS cost sharing																																															300	300	0.16		50	0.1	0.2	50	100				50		5	25	31.25	25			0.2				25							25	50	125	300	200	0.01						7.83	0.01	2.25	-	1.18	1.12	0.86	1.36	5.8	-	-	-	0.04	-	1.89	10.02	0.62	0.27	-	-	2.76	-	-	-	0.22	-	-	-	-	-	-	0.03	0.19	1.6	0.48	0.98	0.01	-	-	-	-	39.53	7.83	0.01	2.25	-	1.18	1.12	0.86	1.36	5.8	-	-	-	0.04	-	1.89	10.02	0.62	0.27	-	-	2.76	-	-	-	0.22	-	-	-	-	-	-	0.03	0.19	1.6	0.48	0.98	0.01	-	-	-	-	39.53
H4506_004_0	2006	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Inpatient Facility						cardiac stress tests	radiation therapy	MRI/MRA/CT Scan	PET Scan	IMRT	Transplants					a	a	coin		t	coin	coin	v	v				v			p	p	v			coin				p							v	v	v	v	v	coin																																															-	230.27	1.03	8.06		648.48	26.13	3.37	488.53	429.34				43.06			4550.58	242.61	300.98			8.93				276.79							24.53	45	175.78	7.9	62.14	1					300/stay	300/stay	FFS cost sharing		50/trip	0	0	50	100				50/session			25	35 individual 20 group	25			0.2				25							25	benchmarks	125	300	200	FFS cost sharing																																															300	300	0.16		50	0.1	0.2	50	100				50			25	31.25	25			0.2				25							25	50	125	300	200	0.01						5.76	0.03	1.29	-	2.7	2.61	0.67	2.04	3.58	-	-	-	0.18	-	-	9.48	0.63	0.63	-	-	1.79	-	-	-	0.58	-	-	-	-	-	-	0.05	0.19	1.83	0.2	1.04	0.01	-	-	-	-	35.27	5.76	0.03	1.29	-	2.7	2.61	0.67	2.04	3.58	-	-	-	0.18	-	-	9.48	0.63	0.63	-	-	1.79	-	-	-	0.58	-	-	-	-	-	-	0.05	0.19	1.83	0.2	1.04	0.01	-	-	-	-	35.27
H4506_005_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4506_006_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4506_010_0	2006	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Inpatient Facility						cardiac stress tests	radiation therapy	MRI/MRA/CT Scan	PET Scan	IMRT	Transplants					a	a	coin		t	coin	coin	v	v				v			p	p	v			coin				p							v	v	v	v	v	coin																																															-	309.76	0.32	13.94		280.2	11.11	4.26	322.42	688.87				9.73			4808.67	237.52	129.96			13.63				104.59							15.58	45	154.02	19.24	58.71	1					300/stay	300/stay	FFS cost sharing		50/trip	10	20	50	100				50/session			25	35 individual 20 group	25			20				25							25	benchmarks	125	300	200	FFS cost sharing																																															300	300	0.16		50	0.1	0.2	50	100				50			25	31.25	25			0.2				25							25	50	125	300	200	0.01						7.74	0.01	2.23	-	1.17	1.11	0.85	1.34	5.74	-	-	-	0.04	-	-	10.02	0.62	0.27	-	-	2.73	-	-	-	0.22	-	-	-	-	-	-	0.03	0.19	1.6	0.48	0.98	0.01	-	-	-	-	37.38	7.74	0.01	2.23	-	1.17	1.11	0.85	1.34	5.74	-	-	-	0.04	-	-	10.02	0.62	0.27	-	-	2.73	-	-	-	0.22	-	-	-	-	-	-	0.03	0.19	1.6	0.48	0.98	0.01	-	-	-	-	37.38
H4506_011_0	2006	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Inpatient Facility						cardiac stress tests	radiation therapy	MRI/MRA/CT Scan	PET Scan	IMRT	Transplants					a	a	coin		t	coin	coin	v	v				v			p	p	v			coin				p							v	v	v	v	v	coin																																															-	222.05	0.99	7.78		625.33	25.2	3.25	471.09	414.01				43.06			4550.58	242.61	300.98			8.61				266.91							24.53	45	175.78	7.9	62.14	1					300/stay	300/stay	FFS cost sharing		50/trip	10	20	50	100				50/session			25	35 individual 20 group	25			20				25							25	benchmarks	125	300	200	FFS cost sharing																																															300	300	0.16		50	0.1	0.2	50	100				50			25	31.25	25			0.2				25							25	50	125	300	200	0.01						5.55	0.02	1.24	-	2.61	2.52	0.65	1.96	3.45	-	-	-	0.18	-	-	9.48	0.63	0.63	-	-	1.72	-	-	-	0.56	-	-	-	-	-	-	0.05	0.19	1.83	0.2	1.04	0.01	-	-	-	-	34.52	5.55	0.02	1.24	-	2.61	2.52	0.65	1.96	3.45	-	-	-	0.18	-	-	9.48	0.63	0.63	-	-	1.72	-	-	-	0.56	-	-	-	-	-	-	0.05	0.19	1.83	0.2	1.04	0.01	-	-	-	-	34.52
H4506_012_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	520.73	52.78	52.24		18.43	60.26	22.35	20.78	26.52	22.55	20.09	2.07	5.73	32.64	28.33	37.31	11.39	4.69	25.67	132.02	30.33	0.26																				FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share	FFS Cost Share											0.07	0.07	0.19		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.19		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	33.9	3.44	9.67	-	4.29	14.04	5.21	4.84	6.18	5.25	4.68	0.48	1.33	7.61	6.6	8.69	2.65	1.09	5.98	30.76	7.07	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	163.83	33.9	3.44	9.67	-	4.29	14.04	5.21	4.84	6.18	5.25	4.68	0.48	1.33	7.61	6.6	8.69	2.65	1.09	5.98	30.76	7.07	0.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	163.83
H4506_801_0	2006																						coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	267.92	0.05	14.09	0.16	5.29	11.23	4.3	4.86	17.94	60.82					229.66						13.78	8.77																				FFS cost sharing																																																																																			0.06	0.06	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					17.39	0	2.6	-	1.23	2.62	1	1.13	4.18	14.17	-	-	-	-	53.51	-	-	-	-	-	3.21	2.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.09	17.39	0	2.6	-	1.23	2.62	1	1.13	4.18	14.17	-	-	-	-	53.51	-	-	-	-	-	3.21	2.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.09
H4506_802_0	2006																						coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	209.71	0.79	8.06	0	14.53	26.13	3.37	11.09	38.52	57.53					283.54						8.93	6.19																				FFS cost sharing																																																																																			0.07	0.07	0.21	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					14.85	0.06	1.71	-	3.39	6.09	0.79	2.58	8.98	13.4	-	-	-	-	66.07	-	-	-	-	-	2.08	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.42	14.85	0.06	1.71	-	3.39	6.09	0.79	2.58	8.98	13.4	-	-	-	-	66.07	-	-	-	-	-	2.08	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.42
H4506_806_0	2006																						coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	267.92	0.05	14.09	0.16	5.29	11.23	4.3	4.86	17.94	60.82					229.66						13.78	8.77																				FFS cost sharing																																																																																			0.06	0.06	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					17.39	0	2.6	-	1.23	2.62	1	1.13	4.18	14.17	-	-	-	-	53.51	-	-	-	-	-	3.21	2.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.09	17.39	0	2.6	-	1.23	2.62	1	1.13	4.18	14.17	-	-	-	-	53.51	-	-	-	-	-	3.21	2.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.09
H4506_807_0	2006																						coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	209.71	0.79	8.06	0	14.53	26.13	3.37	11.09	38.52	57.53					283.54						8.93	6.19																				FFS cost sharing																																																																																			0.07	0.07	0.21	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					14.85	0.06	1.71	-	3.39	6.09	0.79	2.58	8.98	13.4	-	-	-	-	66.07	-	-	-	-	-	2.08	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.42	14.85	0.06	1.71	-	3.39	6.09	0.79	2.58	8.98	13.4	-	-	-	-	66.07	-	-	-	-	-	2.08	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.42
H4506_808_0	2006																						coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	267.92	0.05	14.09	0.16	5.29	11.23	4.3	4.86	17.94	60.82					229.66						13.78	8.77																				FFS cost sharing																																																																																			0.06	0.06	0.18	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					17.39	0	2.6	-	1.23	2.62	1	1.13	4.18	14.17	-	-	-	-	53.51	-	-	-	-	-	3.21	2.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.09	17.39	0	2.6	-	1.23	2.62	1	1.13	4.18	14.17	-	-	-	-	53.51	-	-	-	-	-	3.21	2.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.09
H4506_809_0	2006																						coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																														-	209.71	0.79	8.06	0	14.53	26.13	3.37	11.09	38.52	57.53					283.54						8.93	6.19																				FFS cost sharing																																																																																			0.07	0.07	0.21	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					14.85	0.06	1.71	-	3.39	6.09	0.79	2.58	8.98	13.4	-	-	-	-	66.07	-	-	-	-	-	2.08	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.42	14.85	0.06	1.71	-	3.39	6.09	0.79	2.58	8.98	13.4	-	-	-	-	66.07	-	-	-	-	-	2.08	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.42
H4510_012_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				3250	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1868.56	13.09	693.99	2222.39	394.8	1.42	0.11	476.48	424.17				0	458.58	7007.34	7454.06					4.45			10.35	0		0					0	0	32070.2	0	0	0	0				65 per day (1-5)	65 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	30-50	40-50				0	0-100	5-100	20-100					20			25	0							0 per day (0-0)	0 per day (0-0)	0	0	0	0	0				44.21	44.21	22.01	0	100	0.2	0.2	46	43.3				0	17.01	6.86	21.57					20			0.35	0		0					0	0	0	0	0	0	0					36.45	44.21	18.15	0	82.44	0.16	0.16	37.92	35.7				0	14.02	5.66	17.78					20			0.35	0		0					0	0	0	0	0	0	0				0	5.68	0.05	1.05	-	2.71	0.23	0.02	1.51	1.26	-	-	-	-	0.54	3.3	11.05	-	-	-	-	0.89	-	-	3.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.93	5.68	0.05	1.05	-	2.71	0.23	0.02	1.51	1.26	-	-	-	-	0.54	3.3	11.05	-	-	-	-	0.89	-	-	3.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.93
H4510_015_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				3750	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	Coin	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	2057.74	13.2	1141.14	2186.52	434.57	1.23	0.09	859.83	811.04				0	1042.45	9287.87	6208.28					4.45			10.35	0		0					108.3	0.69	25.73	0	0	0	0				65 per day (1-5)	65 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	50	20	20	35-50	40-50				0	0-100	5-100	20-100					20			25	0							65 per day (1-5)	65 per day (1-5)	20	0	0	0	0				44.21	44.21	22.01	0	50	0.2	0.2	47	43.3				0	21.6	6.86	21.57					20			0.35	0		0					44.21	44.21	0.2	0	0	0	0					35.77	44.21	17.81	0	40.45	0.16	0.16	38.02	35.03				0	17.48	5.55	17.45					20			0.35	0		0					35.77	44.21	0.16	0	0	0	0				0	6.13	0.05	1.69	-	1.46	0.2	0.01	2.72	2.37	-	-	-	-	1.52	4.3	9.03	-	-	-	-	0.89	-	-	3.65	-	-	-	-	-	-	-	0.32	0	4.16	-	-	-	-	-	-	-	38.52	6.13	0.05	1.69	-	1.46	0.2	0.01	2.72	2.37	-	-	-	-	1.52	4.3	9.03	-	-	-	-	0.89	-	-	3.65	-	-	-	-	-	-	-	0.32	0	4.16	-	-	-	-	-	-	-	38.52
H4510_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1950.1	12.51	2162.9	2003.22	403.92	1.29	0.1	799.18	753.84				0	968.92	8509.24	5687.82					4.45			0	0		0					102.64	0.66	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.08	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.08	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	33.16	0.21	1.98	-	3.37	0.26	0.02	3.08	12.56	-	-	-	-	3.96	15.99	17.66	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.75	0.01	-	-	-	-	-	-	-	-	94.91	33.16	0.21	1.98	-	3.37	0.26	0.02	3.08	12.56	-	-	-	-	3.96	15.99	17.66	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.75	0.01	-	-	-	-	-	-	-	-	94.91
H4510_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1950.1	12.51	2162.9	2003.22	403.92	1.29	0.1	799.18	753.84				0	968.92	8509.24	5687.82					4.45			0	0		0					102.64	0.66	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.08	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.08	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	33.16	0.21	1.98	-	3.37	0.26	0.02	3.08	12.56	-	-	-	-	3.96	15.99	17.66	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.75	0.01	-	-	-	-	-	-	-	-	94.91	33.16	0.21	1.98	-	3.37	0.26	0.02	3.08	12.56	-	-	-	-	3.96	15.99	17.66	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.75	0.01	-	-	-	-	-	-	-	-	94.91
H4510_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1950.1	12.51	2162.9	2003.22	403.92	1.29	0.1	799.18	753.84				0	968.92	8509.24	5687.82					4.45			0	0		0					102.64	0.66	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.08	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.08	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	33.16	0.21	1.98	-	3.37	0.26	0.02	3.08	12.56	-	-	-	-	3.96	15.99	17.66	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.75	0.01	-	-	-	-	-	-	-	-	94.91	33.16	0.21	1.98	-	3.37	0.26	0.02	3.08	12.56	-	-	-	-	3.96	15.99	17.66	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.75	0.01	-	-	-	-	-	-	-	-	94.91
H4510_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1950.1	12.51	2162.9	2003.22	403.92	1.29	0.1	799.18	753.84				0	968.92	8509.24	5687.82					4.45			0	0		0					102.64	0.66	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	35-50	200				0	35-100	20-150	35-150					20											300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.08	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	11.01	0	100	0.2	0.2	46.3	200				0	49.08	22.55	37.26					20			0	0		0					204.06	204.06	0	0	0	0	0				0	33.16	0.21	1.98	-	3.37	0.26	0.02	3.08	12.56	-	-	-	-	3.96	15.99	17.66	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.75	0.01	-	-	-	-	-	-	-	-	94.91	33.16	0.21	1.98	-	3.37	0.26	0.02	3.08	12.56	-	-	-	-	3.96	15.99	17.66	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.75	0.01	-	-	-	-	-	-	-	-	94.91
H4513_001_0	2006											3000											D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T		V	V																0																																										-	1180	50	182.4	2100.84	67.2	6.8	2.3	273.6	164.8	480.22	315.74	27.36	119.88	197.82	4060.64	6206.24	225.6	254.16	2097.08	0	2.63	0	0		158.4	278.24																100 per Day	100 per Day	Days 1-10 0 per day; Days 11-100 25 per day	No Cost Sharing	50 per trip unless being admitted for same condition w/in 3 days	10 Coinsurance	10 Coinsurance	50 per visit	225 per visit	25 copay	25 copay	No Cost Sharing	25 copay	25 copay	10 copay	25 copay	25 copay	25 copay	25 copay	25 copay	15 copay	No Cost Sharing	No Cost Sharing		25 copay	1 pair of eyeglasses after cataract surgery																100	100	25	0	50	0.1	0.1	50	225	25	25	0	25	25	10	25	25	25	25	25	0.15	0	0		25	0																3000	100	100	25	0	50	0.1	0.1	50	225	25	25	0	25	25	10	25	25	25	25	25	0.09	0	0		25	0																	9.83	0.42	0.38	-	0.28	0.68	0.23	1.14	3.09	1	0.66	-	0.25	0.41	3.38	12.93	0.47	0.53	4.37	-	0.24	-	-	-	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.62	9.83	0.42	0.38	-	0.28	0.68	0.23	1.14	3.09	1	0.66	-	0.25	0.41	3.38	12.93	0.47	0.53	4.37	-	0.24	-	-	-	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.62
H4513_006_0	2006											3000											D	D	D		T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T		V	V																0																																										-	1188	48.04	189.06	1381.53	64.23	6.06	2.05	212.32	149.63	464.03	305.1	26.44	115.84	191.15	3605.6	5510.75	200.32	225.68	1862.08	0	0.63	0	0		158.4	278.24																150 per Day	150 per Day	Days 1-10 0 per day; Days 11-100 25 per day	No Cost Sharing	50 per trip unless being admitted for same condition w/in 3 days	10 Coinsurance	10 Coinsurance	50 per visit	150 per visit	30 copay	30 copay	No Cost Sharing	30 copay	30 copay	10 copay	30 copay	30 copay	30 copay	30 copay	30 copay	No Cost Sharing	No Cost Sharing	No Cost Sharing		30 copay	1 pair of eyeglasses after cataract surgery																150	150	25	0	50	0.1	0.1	50	150	30	30	0	30	30	10	30	30	30	30	30	0.15	0	0		30	0																3000	150	150	25	0	50	0.1	0.1	50	150	30	30	0	30	30	10	30	30	30	30	30	0.09	0	0		30	0																	14.85	0.6	0.39	-	0.27	0.61	0.2	0.88	1.87	1.16	0.76	-	0.29	0.48	3	13.78	0.5	0.56	4.66	-	0.06	-	-	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.32	14.85	0.6	0.39	-	0.27	0.61	0.2	0.88	1.87	1.16	0.76	-	0.29	0.48	3	13.78	0.5	0.56	4.66	-	0.06	-	-	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.32
H4513_009_0	2006											3000											D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	V	V	V	O	O	O											0																																										-	658.17	21.06	136.8	1575.63	50.4	5.1	1.73	205.2	123.6	360.16	236.81	20.52	89.91	148.37	2977.72	4551.12	165.44	186.38	1537.82	0	1.97	0	0		158.4	278.24																150 per Day	150 per Day	25 per Day	No Cost Sharing	50 per trip	10 Coinsurance	10 Coinsurance	50 per trip	150 copay	30 copay	30 copay	No Cost Sharing	30 copay	30 copay	10 copay	30 copay	30 copay	30 copay	30 copay	30 copay	No Cost Sharing	No Cost Sharing	No Cost Sharing		30 copay	1 pair of eyeglasses after cataract surgery																150	150	25	0	50	0.1	0.1	50	150	30	30	0	30	30	10	30	30	30	30	30	0.15	0	0	0	30																	3000	150	150	25	0	50	0.1	0.1	50	150	30	30	0	30	30	10	30	30	30	30	30	0.09	0	0	0	30																		8.23	0.26	0.29	-	0.21	0.51	0.17	0.86	1.55	0.9	0.59	-	0.22	0.37	2.48	11.38	0.41	0.47	3.84	-	0.18	-	-	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.31	8.23	0.26	0.29	-	0.21	0.51	0.17	0.86	1.55	0.9	0.59	-	0.22	0.37	2.48	11.38	0.41	0.47	3.84	-	0.18	-	-	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.31
H4513_010_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H4513_014_0	2006											3000											D	D	D		T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T		V	V																0																																										-	658.17	21.06	189.06	1381.53	64.23	6.06	2.05	212.32	149.63	464.03	305.1	26.44	115.84	191.15	3605.6	5510.75	200.32	225.68	1862.08	0	0.63	0	0		158.4	278.24																150 per Day	150 per Day	25 per Day	No Cost Sharing	50 per trip	10 Coinsurance	10 Coinsurance	50 per trip	150 copay	30 copay	30 copay	No Cost Sharing	30 copay	30 copay	10 copay	30 copay	30 copay	30 copay	30 copay	30 copay	No Cost Sharing	No Cost Sharing	No Cost Sharing		30 copay	1 pair of eyeglasses after cataract surgery																150	150	25	0	50	0.1	0.1	50	150	30	30	0	30	30	10	30	30	30	30	30	0.15	0	0		30	0																3000	150	150	25	0	50	0.1	0.1	50	150	30	30	0	30	30	10	30	30	30	30	30	0.09	0	0		30	0																	8.23	0.26	0.39	-	0.27	0.61	0.2	0.88	1.87	1.16	0.76	-	0.29	0.48	3	13.78	0.5	0.56	4.66	-	0.06	-	-	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.36	8.23	0.26	0.39	-	0.27	0.61	0.2	0.88	1.87	1.16	0.76	-	0.29	0.48	3	13.78	0.5	0.56	4.66	-	0.06	-	-	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.36
H4513_015_0	2006											3000											A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T		V	V																0																																										-	452.95	9.6	364.8	4201.68	134.4	13.6	4.6	547.2	329.6	960.44	631.48	54.72	239.76	395.64	8121.29	12412.49	451.2	508.32	4194.17	0	5.26	0	0		316.8	556.49																275 per admit	275 per admit up to 190 days annually	Days 1-10 0 per day; Days 11-100 25 per day	No Cost Sharing	50 per trip unless being admitted for same condition w/in 3 days	10 Coinsurance	10 Coinsurance	50 per visit	150 per visit	25 copay	25 copay	No Cost Sharing	25 copay	25 copay	10 copay	25 copay	25 copay	25 copay	25 copay	25 copay	15 copay	No Cost Sharing	No Cost Sharing		25 copay	1 pair of eyeglasses after cataract surgery																275	275	25	0	50	0.1	0.1	50	150	25	25	0	25	25	10	25	25	25	25	25	0.15	0	0		25	0																3000	275	275	25	0	50	0.1	0.1	50	150	25	25	0	25	25	10	25	25	25	25	25	0.09	0	0		25	0																	10.38	0.22	0.76	-	0.56	1.36	0.46	2.28	4.12	2	1.32	-	0.5	0.82	6.77	25.86	0.94	1.06	8.74	-	0.48	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.29	10.38	0.22	0.76	-	0.56	1.36	0.46	2.28	4.12	2	1.32	-	0.5	0.82	6.77	25.86	0.94	1.06	8.74	-	0.48	-	-	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.29
H4513_802_0	2006											3000											D	D	D		T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T		V	V																0																																										-	1205.4	38.43	182.4	2100.84	67.2	6.8	2.3	273.6	164.8	480.22	315.74	27.36	119.88	197.82	4060.64	6206.24	225.6	254.16	2097.08	0	2.63	0	323.12		158.4	278.24																150 per Day	150 per Day	25 per Day	No Cost Sharing	50 per trip	10 Coinsurance	10 Coinsurance	50 per trip	150 copay	30 copay	30 copay	No Cost Sharing	30 copay	30 copay	20 copay	30 copay	30 copay	30 copay	30 copay	30 copay	15 Coinsurance	No Cost Sharing	3.50 per trip		30 copay	1 pair of eyeglasses after cataract surgery																150	150	25	0	50	0.1	0.1	50	150	30	30	0	30	30	20	30	30	30	30	30	0.15	0	3.5		30	0																3000	150	150	25	0	50	0.1	0.1	50	150	30	30	0	30	30	20	30	30	30	30	30	0.09	0	3.5		30	0																	15.07	0.48	0.38	-	0.28	0.68	0.23	1.14	2.06	1.2	0.79	-	0.3	0.49	6.77	15.52	0.56	0.64	5.24	-	0.24	-	0.09	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.56	15.07	0.48	0.38	-	0.28	0.68	0.23	1.14	2.06	1.2	0.79	-	0.3	0.49	6.77	15.52	0.56	0.64	5.24	-	0.24	-	0.09	-	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.56
H4514_001_0	2006											2100											D	D	D	P	P	Coin	Coin	V	V	V	V	V	Coin	V	P	P	P	P		P	S	V	P		P	P	P																																																									-	3664.19	14.42			1597.33	37.5	4.71	962.33	138.27	1762.32	782.71	41.97	0.2	1820.08		16150.35	3247.68	549.69		289.16																						125/day	125/day			50/trip	20	20	50	30	30	30	30	20	30		30	35/25 Grp/Ind	30		30																						125	125			50	0.2	0.2	50	30	30	30	30	0.2	30		30	30	30		30																							86.01	86.01			34.41	0.14	0.14	34.41	20.64	20.64	20.64	20.64	0.14	20.64		20.64	20.64	20.64		20.64																							26.26	0.1	-	-	4.58	5.16	0.65	2.76	0.24	3.03	1.35	0.07	0.03	3.13	-	27.78	5.59	0.95	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.18	26.26	0.1	-	-	4.58	5.16	0.65	2.76	0.24	3.03	1.35	0.07	0.03	3.13	-	27.78	5.59	0.95	-	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.18
H4514_002_0	2006											4000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-	1735.74	88.27			169	15.8	17.47	351.98	426.4	1681.81	794.18	52.61	0.52	1218.96	4962.79	6492.48	315.09	987.07																								125	12500			50	20	20	50	50	30	30	50	20	50	10	30	35 indiv/25 group	30																								125	125			50	0.2	0.2	50	50	30	30	50	0.2	45.96	10	30	32.5	30																									98.54	98.54			39.42	0.16	0.16	39.42	39.42	23.65	23.65	39.42	0.16	36.23	7.88	23.65	25.62	23.65																									14.25	0.72	-	-	0.56	2.49	2.75	1.16	1.4	3.31	1.57	0.17	0.08	3.68	3.26	12.8	0.67	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.82	14.25	0.72	-	-	0.56	2.49	2.75	1.16	1.4	3.31	1.57	0.17	0.08	3.68	3.26	12.8	0.67	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.82
H4514_003_0	2006											4000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-	1651.07	83.96			160.75	15.03	16.61	334.81	405.6	1599.77	755.44	50.05	0.5	1159.5	4720.71	6175.77	299.72	938.92																								125	12500			50	20	20	50	50	30	30	50	20	50	10	30	35 indiv/25 group	30																								125	125			50	0.2	0.2	50	50	30	30	50	0.2	45.96	10	30	32.5	30																									99.76	99.76			39.9	0.16	0.16	39.9	39.9	23.94	23.94	39.9	0.16	36.68	7.98	23.94	25.94	23.94																									13.73	0.7	-	-	0.53	2.4	2.65	1.11	1.35	3.19	1.51	0.17	0.08	3.54	3.14	12.32	0.65	1.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.94	13.73	0.7	-	-	0.53	2.4	2.65	1.11	1.35	3.19	1.51	0.17	0.08	3.54	3.14	12.32	0.65	1.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.94
H4520_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1045.08	22.14	1094.08	509.97	142.96	18.08	1.36	402.84	319.17				17.4	1966.74	6309.58	11003.65					4.45			6.21	0		0					55	1.17	0	0	0	0	0				75 per day (1-5)	75 per day (1-5)	0 per day (1-20) 125 per day (21-100)	0	100	20	20	30-50	50-75				0	0-100	15-100	30-100					0.2			25 - 75								75 per day (1-5)	75 per day (1-5)	0	0	0	0	0				51.02	51.02	11.01	0	100	0.2	0.2	40.6	58.25				0	45.67	16.67	31.37					0.2			0.35	0		0					51.02	51.02	0	0	0	0	0					51.02	51.02	11.01	0	100	0.2	0.2	40.6	58.25				0	45.67	16.67	31.37					0.2			0.35	0		0					51.02	51.02	0	0	0	0	0				0	4.44	0.09	1	-	1.19	3.62	0.27	1.36	1.55	-	-	-	-	7.49	8.76	28.77	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.23	0	-	-	-	-	-	-	-	-	61.87	4.44	0.09	1	-	1.19	3.62	0.27	1.36	1.55	-	-	-	-	7.49	8.76	28.77	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.23	0	-	-	-	-	-	-	-	-	61.87
H4520_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V				5000	0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1114.06	23.6	1166.29	543.62	152.39	20.8	1.57	429.42	340.23				18.55	2096.54	6726.01	11729.88					4.45			6.21	0		0					58.63	1.24	0	0	0	0	0				100 per day (1-5)	100 per day (1-5)	0 per day (1-20) 100 per day (21-100)	0	100	20	20	30-50	100				0	0-100	15-100	30-100					0.2			25 - 75								100 per day (1-5)	100 per day (1-5)	0	0	0	0	0				68.02	68.02	8.81	0	100	0.2	0.2	40.6	100				0	57.66	16.67	31.37					0.2			0.35	0		0					68.02	68.02	0	0	0	0	0					68.02	68.02	8.81	0	100	0.2	0.2	40.6	100				0	57.66	16.67	31.37					0.2			0.35	0		0					68.02	68.02	0	0	0	0	0				0	6.31	0.13	0.86	-	1.27	4.16	0.31	1.45	2.84	-	-	-	-	10.07	9.34	30.67	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.33	0.01	-	-	-	-	-	-	-	-	70.84	6.31	0.13	0.86	-	1.27	4.16	0.31	1.45	2.84	-	-	-	-	10.07	9.34	30.67	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.33	0.01	-	-	-	-	-	-	-	-	70.84
H4520_003_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1087.14	23.03	1138.1	530.49	148.71	18.37	1.38	419.05	332.01				18.1	2045.88	6563.48	11446.43					4.45			6.21	0		0					57.22	1.21	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-100	10-100	35-100					0.2			25 - 75								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	36.03	11.77	36.28					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	36.03	11.77	36.28					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0				0	10.78	0.23	1.12	0.44	1.24	3.67	0.28	1.42	3.22	-	-	-	-	6.14	6.44	34.6	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.57	0.01	-	-	-	-	-	-	-	-	73.25	10.78	0.23	1.12	0.44	1.24	3.67	0.28	1.42	3.22	-	-	-	-	6.14	6.44	34.6	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.57	0.01	-	-	-	-	-	-	-	-	73.25
H4520_005_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1151.94	24.4	1205.95	562.11	157.57	22.35	1.68	444.03	351.8				19.18	2167.83	6954.73	12128.77					4.45			6.21	0		0					60.63	1.28	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-100	10-100	35-100					0.2			25 - 75								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	36.32	11.77	36.28					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	36.32	11.77	36.28					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0				0	11.43	0.24	1.19	0.47	1.31	4.47	0.34	1.51	3.42	-	-	-	-	6.56	6.82	36.66	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.6	0.01	-	-	-	-	-	-	-	-	78.1	11.43	0.24	1.19	0.47	1.31	4.47	0.34	1.51	3.42	-	-	-	-	6.56	6.82	36.66	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.6	0.01	-	-	-	-	-	-	-	-	78.1
H4520_006_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1106.37	23.44	1158.24	539.87	151.34	20.37	1.53	426.46	337.88				18.42	2082.06	6679.57	11648.9					4.45			6.21	0		0					58.23	1.23	0	0	0	0	0				125 per day (1-5)	125 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-125				0	0-100	10-100	35-100					0.2			25 - 75								125 per day (1-5)	125 per day (1-5)	0	0	0	0	0				85.03	85.03	11.79	10	100	0.2	0.2	40.7	108.25				0	36.12	11.77	36.28					0.2			0.35	0		0					85.03	85.03	0	0	0	0	0					85.03	85.03	11.79	10	100	0.2	0.2	40.7	108.25				0	36.12	11.77	36.28					0.2			0.35	0		0					85.03	85.03	0	0	0	0	0				0	7.84	0.17	1.14	0.45	1.26	4.07	0.31	1.45	3.05	-	-	-	-	6.27	6.55	35.21	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.41	0.01	-	-	-	-	-	-	-	-	71.26	7.84	0.17	1.14	0.45	1.26	4.07	0.31	1.45	3.05	-	-	-	-	6.27	6.55	35.21	-	-	-	-	0.89	-	-	2.19	-	-	-	-	-	-	-	0.41	0.01	-	-	-	-	-	-	-	-	71.26
H4520_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	272.03	6.18	1196.19	557.56	156.3	21.6	1.63	440.43	348.96				19.03	2150.3	6898.48	12030.66					4.45			0	0		0					14.32	0.33	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.03	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.03	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13.6	0.31	0.88	0.46	1.3	5.4	0.41	1.66	5.82	-	-	-	-	6.28	14.48	35.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	87.31	13.6	0.31	0.88	0.46	1.3	5.4	0.41	1.66	5.82	-	-	-	-	6.28	14.48	35.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	87.31
H4520_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	272.02	6.18	1196.18	557.56	156.3	21.6	1.63	440.43	348.95				19.03	2150.28	6898.43	12030.57					4.45			0	0		0					14.32	0.33	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.03	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.03	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13.6	0.31	0.88	0.46	1.3	5.4	0.41	1.66	5.82	-	-	-	-	6.28	14.48	35.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	87.31	13.6	0.31	0.88	0.46	1.3	5.4	0.41	1.66	5.82	-	-	-	-	6.28	14.48	35.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	87.31
H4520_805_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	272.03	6.18	1196.19	557.56	156.3	21.6	1.63	440.43	348.96				19.03	2150.3	6898.48	12030.66					4.45			0	0		0					14.32	0.33	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.03	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.03	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13.6	0.31	0.88	0.46	1.3	5.4	0.41	1.66	5.82	-	-	-	-	6.28	14.48	35.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	87.31	13.6	0.31	0.88	0.46	1.3	5.4	0.41	1.66	5.82	-	-	-	-	6.28	14.48	35.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	87.31
H4520_806_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	272.02	6.18	1196.18	557.56	156.3	21.6	1.63	440.43	348.95				19.03	2150.28	6898.43	12030.57					4.45			0	0		0					14.32	0.33	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.03	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	35.03	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	13.6	0.31	0.88	0.46	1.3	5.4	0.41	1.66	5.82	-	-	-	-	6.28	14.48	35.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	87.31	13.6	0.31	0.88	0.46	1.3	5.4	0.41	1.66	5.82	-	-	-	-	6.28	14.48	35.09	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.72	0.02	-	-	-	-	-	-	-	-	87.31
H4521_001_0	2006											2960											D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1460.84	45.31	0	0	258.65	0	0	209.36	256.46	0	0	0	0	0.4	4151.94	4370.25	183.32	670.87	0	1410.96	39.49	0	0	0	124	0	222	0	0	0	0											100 per adm	100 per adm			50			50	25						10	20	20	20			20				20		20															17.21	12.03	0	0	50	0	0	45	25	0	0	0	0	20	10	20	19.69	20	0	19.98	0.2	0	0	0	20	0	20	0	0	0	0												17.21	12.03	0	0	50	0	0	45	25	0	0	0	0	20	10	20	19.69	20	0	19.98	0.2	0	0	0	20	0	20	0	0	0	0												2.1	0.05	-	-	1.08	-	-	0.79	0.53	-	-	-	-	0	3.46	7.28	0.3	1.12	-	2.35	7.9	-	-	-	0.21	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.52	2.1	0.05	-	-	1.08	-	-	0.79	0.53	-	-	-	-	0	3.46	7.28	0.3	1.12	-	2.35	7.9	-	-	-	0.21	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.52
H4521_002_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	2834.83	161.66	865.88	0	545.79	2643.6	2998.84	394.34	288.22	19430.25	525.6	34.07	17.32	783.66	8584.31	6781.4	490.28	1444.35	43.94	23095.92	38.19	124.83	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				123.02	40.84	77	0	50.92	35.69	23.46	95.7	298.02	4.29	77.01	308.59	635.97	39.13	14.81	18.19	14.34	21.61	0.23	18.62	0.23	13.86	0	0	0	0	0	0	0	0	0												123.02	40.84	77	0	50.92	35.69	23.46	95.7	298.02	4.29	77.01	308.59	635.97	39.13	14.81	18.19	14.34	21.61	0.23	18.62	0.23	13.86	0	0	0	0	0	0	0	0	0												29.06	0.55	5.56	-	2.32	7.86	5.86	3.14	7.16	6.95	3.37	0.88	0.92	2.56	10.6	10.28	0.59	2.6	10.24	35.84	8.9	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	155.37	29.06	0.55	5.56	-	2.32	7.86	5.86	3.14	7.16	6.95	3.37	0.88	0.92	2.56	10.6	10.28	0.59	2.6	10.24	35.84	8.9	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	155.37
H4521_003_0	2006											2960											D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1460.84	45.31	0	0	258.65	0	0	209.36	256.46	0	0	0	0	0.4	4151.94	4370.25	183.32	670.87	0	1410.96	39.49	0	0	0	124	0	222	0	0	0	0											100 per adm	100 per adm			50			50	25						10	20	20	20			20				20		20															17.21	12.03	0	0	50	0	0	45	25	0	0	0	0	20	10	20	19.69	20	0	19.98	0.2	0	0	0	20	0	20	0	0	0	0												17.21	12.03	0	0	50	0	0	45	25	0	0	0	0	20	10	20	19.69	20	0	19.98	0.2	0	0	0	20	0	20	0	0	0	0												2.1	0.05	-	-	1.08	-	-	0.79	0.53	-	-	-	-	0	3.46	7.28	0.3	1.12	-	2.35	7.9	-	-	-	0.21	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.52	2.1	0.05	-	-	1.08	-	-	0.79	0.53	-	-	-	-	0	3.46	7.28	0.3	1.12	-	2.35	7.9	-	-	-	0.21	-	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.52
H4521_801_0	2006											2960											D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1460.84	45.31	425.17	0	258.65	1303.72	1144	209.36	272.16	11596.45	434.41	32.61	0	496.01	4269.19	5205.89	183.32	766.77	33.7	15641.74	39.49	79.17	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				148.01	46.46	71.87	0	59.72	26.62	29.86	113.95	354.02	5.91	88.44	324.2	0	50.72	15.05	18.16	17.93	22.7	0.23	18.92	0.23	14.54	0	0	0	0	0	0	0	0	0												148.01	46.46	71.87	0	59.72	26.62	29.86	113.95	354.02	5.91	88.44	324.2	0	50.72	15.05	18.16	17.93	22.7	0.23	18.92	0.23	14.54	0	0	0	0	0	0	0	0	0												18.02	0.18	2.55	-	1.29	2.89	2.85	1.99	8.03	5.71	3.2	0.88	-	2.1	5.35	7.88	0.27	1.45	7.85	24.66	9.2	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	106.44	18.02	0.18	2.55	-	1.29	2.89	2.85	1.99	8.03	5.71	3.2	0.88	-	2.1	5.35	7.88	0.27	1.45	7.85	24.66	9.2	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	106.44
H4522_001_0	2006											2600											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1198.56	40.01	574.1		90.33	9.43	22.86	324.78	33.61		12.59	1.73	0.08	30.58	3678.97	4235.3	201.01	2.93	18.25	233.95	14.1				117.8		210.9															250	25000	125		150	30	30	50	30		0/30	30	30	30/40/30	Oct-00	30	40/30	30	0/30	0/30	30				30		30															250	250	125		150	0.3	0.3	50	0.3		0.26	0.3	0.3	0.29	10	28.31	37.5	0.3	0.16	0.55	0.3				30		30																144.5	139.1	69.55		83.46	0.17	0.17	27.82	0.17		0.15	0.17	0.17	0.16	10	28.31	37.5	0.17	0.09	0.55	0.17				30		30																14.43	0.46	3.33	-	0.63	1.57	3.82	0.75	5.61	-	1.83	0.29	0.01	4.97	3.07	9.99	0.63	0.5	1.63	0.01	2.35	-	-	-	0.29	-	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.71	14.43	0.46	3.33	-	0.63	1.57	3.82	0.75	5.61	-	1.83	0.29	0.01	4.97	3.07	9.99	0.63	0.5	1.63	0.01	2.35	-	-	-	0.29	-	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.71
H4522_003_0	2006											3000											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1123.82	37.52	538.33		84.7	8.63	20.91	304.57	30.75		11.52	1.58	0.07	27.98	3453.89	3975.7	188.48	2.68	16.69	219.36	12.9				117.8		210.9															295	29500	150		150	30	30	50	30		0/30	30	30	30/40/30	Oct-00	25	40/30	30	0/30	0/25	30				25		25															295	295	150		150	0.3	0.3	50	0.3		0.26	0.3	0.3	0.29	10	23.31	37.5	0.3	0.16	0.55	0.3				25		25																180.92	175.09	89.03		89.03	0.18	0.18	29.68	0.18		0.16	0.18	0.18	0.17	10	23.31	37.5	0.18	0.1	0.55	0.18				25		25																16.94	0.55	3.99	-	0.63	1.54	3.72	0.75	5.48	-	1.79	0.28	0.01	4.85	2.88	7.72	0.59	0.48	1.59	0.01	2.3	-	-	-	0.25	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.79	16.94	0.55	3.99	-	0.63	1.54	3.72	0.75	5.48	-	1.79	0.28	0.01	4.85	2.88	7.72	0.59	0.48	1.59	0.01	2.3	-	-	-	0.25	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.79
H4522_005_0	2006											2400											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1198.56	40.01	574.1	0	90.33	9.43	22.86	324.78	33.61	0	12.59	1.73	0.08	30.58	3678.97	4235.3	201.01	2.93	18.25	233.95	14.1	0	0	0	117.8	0	210.9	0	0	0	0											195	195	95	0	150	20	20	50	20	0	0/20	20	20	20/40/30	Oct-00	20	40/30	20	0/20	0/20	20	0			20		20															195	195	95	0	150	0.2	0.2	50	0.2	0	0.17	0.2	0.2	0.2	10	18.87	37.5	0.2	0.11	0.18	0.2	0	0	0	20	0	20	0	0	0	0												123.92	120.29	58.6	0	92.53	0.12	0.12	30.84	0.12	0	0.11	0.12	0.12	0.12	10	18.87	37.5	0.12	0.07	0.18	0.12	0	0	0	20	0	20	0	0	0	0												12.38	0.4	2.8	-	0.7	1.16	2.82	0.83	4.15	-	1.36	0.21	0.01	3.69	3.07	6.66	0.63	0.37	1.21	0	1.74	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.73	12.38	0.4	2.8	-	0.7	1.16	2.82	0.83	4.15	-	1.36	0.21	0.01	3.69	3.07	6.66	0.63	0.37	1.21	0	1.74	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.73
H4522_006_0	2006											2400											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1123.71	37.51	538.28	0	84.69	8.62	20.91	304.54	30.74	0	11.52	1.58	0.07	27.97	3453.55	3975.31	188.46	2.68	16.69	219.34	12.9	0	0	0	117.8	0	210.9	0	0	0	0											265	265	125	0	150	20	20	50	20	0	0/20	20	20	20/40/30	Oct-00	20	40/30	20	0/20	0/20	20	0			20		20															265	265	125	0	150	0.2	0.2	50	0.2	0	0.17	0.2	0.2	0.2	10	18.87	37.5	0.2	0.11	0.55	0.2	0	0	0	20	0	20	0	0	0	0												164.11	158.95	74.98	0	89.97	0.12	0.12	29.99	0.12	0	0.1	0.12	0.12	0.12	10	18.87	37.5	0.12	0.06	0.55	0.12	0	0	0	20	0	20	0	0	0	0												15.37	0.5	3.36	-	0.63	1.03	2.51	0.76	3.69	-	1.21	0.19	0.01	3.28	2.88	6.25	0.59	0.33	1.07	0.01	1.55	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.76	15.37	0.5	3.36	-	0.63	1.03	2.51	0.76	3.69	-	1.21	0.19	0.01	3.28	2.88	6.25	0.59	0.33	1.07	0.01	1.55	-	-	-	0.2	-	0.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.76
H4522_007_0	2006											600											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	P	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1395.65	48.66	593.48		123.61	12.97	31.44	542.84	56.5		22.87	2.9	0.13	51.6	7832.21	5527.75	290.87	375.17	26.4	304.68	18.46				117.8		309.72															25	25	15		100	20	20	40	15		0/10	15	20	15/10/8/4	Feb-00	4	04-Aug	10	0/10	0/4	20				4.00/5.00		4															25	25	15		100	0.2	0.2	40	0.01		0.02	0.04	0.2	0.07	1.29	3.77	7	10	0.07	0.55	0.2				4		4																16	15.54	9.32		62.17	0.12	0.12	24.87	0.01		0.01	0.02	0.12	0.04	1.29	3.77	7	6.29	0.05	0.55	0.12				4		4																1.86	0.06	0.46	-	0.64	1.61	3.91	1.12	0.47	-	0.34	0.07	0.02	2.15	0.84	1.74	0.17	0.2	1.2	0.01	2.29	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.31	1.86	0.06	0.46	-	0.64	1.61	3.91	1.12	0.47	-	0.34	0.07	0.02	2.15	0.84	1.74	0.17	0.2	1.2	0.01	2.29	-	-	-	0.04	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.31
H4522_801_0	2006											2500											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	P	Coin	P	Coin	P	T	P	P	P	P	P	P	P	P																																																					-	1243.99	34.6	587.12		93.47	9.44	23.78	333.9	36.06	1429.47	16.9	1.85		31.62	3872.19	4513.9	200.68	307.27	19.48	251.03	15.21				126.64		226.72															195	175	125		150	30	30	50	30	20	20/30	30	30	30/40/30	25/0	35	40/30	30	0/30	0/35	30				35		35															195	175	124.99		150	0.3	0.3	50	0.3	20	0.24	0.3		0.29	25.19	33.04	10.5	36.76	0.29	0.48	0.3				35		35																140.75	123.75	88.39		106.07	0.21	0.21	35.36	0.21	14.14	0.17	0.21		0.21	25.19	33.04	10.5	26.15	0.2	0.48	0.21				35		35																14.59	0.36	4.32	-	0.83	2	5.05	0.98	7.65	1.68	2.84	0.39	-	6.5	8.13	12.43	0.18	0.67	3.98	0.01	3.23	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.85	14.59	0.36	4.32	-	0.83	2	5.05	0.98	7.65	1.68	2.84	0.39	-	6.5	8.13	12.43	0.18	0.67	3.98	0.01	3.23	-	-	-	0.37	-	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.85
H4523_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1422.01383	0.14508865	1232.2655	767.270526	163.202931	2.41457747	0.02438967	143.298355	30.0906528	261.100638	217.962603	0.31626748	216.010688	17.3630846	3007.48436	6692.85372	3.13035992	792.137266	171.89343		245.309894	703.665982																				200/d 5	200/d 5	0/d 1-20 101.5+																																							121.34	121.34	40.75	0	50	0.2	0.2	50	205	0	34.2	30	25	25	10	25	30	25	25		45	25			0		0			0													121.34	121.34	40.75	0	50	0.2	0.2	50	205	0	34.2	30	25	25	10	25	30	25	25		45	25			0		0			0													14.38	0	4.18	-	0.68	0.48	0	0.6	0.51	-	0.62	0	0.45	0.04	2.51	13.94	0.01	1.65	0.36	-	0.92	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.8	14.38	0	4.18	-	0.68	0.48	0	0.6	0.51	-	0.62	0	0.45	0.04	2.51	13.94	0.01	1.65	0.36	-	0.92	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.8
H4523_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1582.09	15.98	1217.06	1188.29	213.77	1.97	0.02	223.17	45.27	834.13	255.39		61.59	38.93	2462.7	9342.36	0.38	635.59	567.17		272.9	676.94																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	18.94	0.19	10.14	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.09	-	0.18	0.11	7.18	27.25	0	1.85	1.65	-	1.54	1.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.91	18.94	0.19	10.14	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.09	-	0.18	0.11	7.18	27.25	0	1.85	1.65	-	1.54	1.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.91
H4523_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1582.09	15.98	1217.06	1188.29	213.77	1.97	0.02	223.17	45.27	834.13	255.39		61.59	38.93	2462.7	9342.36	0.38	635.59	567.17		272.9	676.94																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	18.94	0.19	10.14	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.09	-	0.18	0.11	7.18	27.25	0	1.85	1.65	-	1.54	1.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.91	18.94	0.19	10.14	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.09	-	0.18	0.11	7.18	27.25	0	1.85	1.65	-	1.54	1.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.91
H4523_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1582.09	15.98	1217.06	1188.29	213.77	1.97	0.02	223.17	45.27	834.13	255.39		61.59	38.93	2462.7	9342.36	0.38	635.59	567.17		272.9	676.94																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	18.94	0.19	10.14	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.09	-	0.18	0.11	7.18	27.25	0	1.85	1.65	-	1.54	1.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.91	18.94	0.19	10.14	3.47	2.67	0.59	0.01	0.93	0.57	0.56	2.09	-	0.18	0.11	7.18	27.25	0	1.85	1.65	-	1.54	1.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.91
H4524_001_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												3000																																										-	1428.63	14.43	1238	770.84	163.96	16.99	1.27	143.96	30.23	262.31	218.98	0.32	217.02	17.44	3021.47	6723.98	3.14	795.82	172.69		246.45	706.94																				200/d 5	200/d 5	0/d 1-20 101.5+																																							121.34	121.34	0	0	50	0.2	0.2	50	205	0	50	30	25	25	10	25	30	25	25		45	25			0		0			0													121.34	121.34	0	0	50	0.2	0.2	50	205	0	50	30	25	25	10	25	30	25	25		45	25			0		0			0												0	14.45	0.15	-	-	0.68	3.4	0.25	0.6	0.52	-	0.91	0	0.45	0.04	2.52	14.01	0.01	1.66	0.36	-	0.92	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.39	14.45	0.15	-	-	0.68	3.4	0.25	0.6	0.52	-	0.91	0	0.45	0.04	2.52	14.01	0.01	1.66	0.36	-	0.92	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.39
H4524_002_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												3000																																										-	1428.63	14.43	1238	770.84	163.96	16.99	1.27	143.96	30.23	262.31	218.98	0.32	217.02	17.44	3021.47	6723.98	3.14	795.82	172.69		246.45	706.94																				200/d 5	200/d 5	0/d 1-20 101.5+																																							121.34	121.34	0	0	50	0.2	0.2	50	205	0	50	30	25	25	10	25	30	25	25		45	25			0		0			0													121.34	121.34	0	0	50	0.2	0.2	50	205	0	50	30	25	25	10	25	30	25	25		45	25			0		0			0												0	14.45	0.15	-	-	0.68	3.4	0.25	0.6	0.52	-	0.91	0	0.45	0.04	2.52	14.01	0.01	1.66	0.36	-	0.92	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.39	14.45	0.15	-	-	0.68	3.4	0.25	0.6	0.52	-	0.91	0	0.45	0.04	2.52	14.01	0.01	1.66	0.36	-	0.92	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.39
H4524_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P																																																						-	1392.24	14.06	1071.01	1045.69	188.12	1.74	0.02	196.39	39.84	734.03	224.74		54.2	34.25	2167.17	8221.28	0.33	559.32	499.11	0	240.15	595.7																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35	0	67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	16.67	0.17	8.93	3.05	2.35	0.52	0.01	0.82	0.5	0.5	1.84	-	0.16	0.1	6.32	23.98	0	1.63	1.46	-	1.35	1.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.08	16.67	0.17	8.93	3.05	2.35	0.52	0.01	0.82	0.5	0.5	1.84	-	0.16	0.1	6.32	23.98	0	1.63	1.46	-	1.35	1.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.08
H4524_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1392.24	14.06	1071.01	1045.69	188.12	1.74	0.02	196.39	39.84	734.03	224.74		54.2	34.25	2167.17	8221.28	0.33	559.32	499.11		240.15	595.7																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	16.67	0.17	8.93	3.05	2.35	0.52	0.01	0.82	0.5	0.5	1.84	-	0.16	0.1	6.32	23.98	0	1.63	1.46	-	1.35	1.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.08	16.67	0.17	8.93	3.05	2.35	0.52	0.01	0.82	0.5	0.5	1.84	-	0.16	0.1	6.32	23.98	0	1.63	1.46	-	1.35	1.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.08
H4524_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1392.24	14.06	1071.01	1045.69	188.12	1.74	0.02	196.39	39.84	734.03	224.74		54.2	34.25	2167.17	8221.28	0.33	559.32	499.11		240.15	595.7																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0												0	16.67	0.17	8.93	3.05	2.35	0.52	0.01	0.82	0.5	0.5	1.84	-	0.16	0.1	6.32	23.98	0	1.63	1.46	-	1.35	1.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.08	16.67	0.17	8.93	3.05	2.35	0.52	0.01	0.82	0.5	0.5	1.84	-	0.16	0.1	6.32	23.98	0	1.63	1.46	-	1.35	1.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.08
H4525_001_0	2006											2960											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1957.12	85.32	555.71	0	150.65	17.25	2.19	277.48	142.9	0	596.05	0	0	10.38	3264.82	3356.05	243.74	315.7	0	734.5	22.63	0	0	0	0	0	0	0	0	0	0											75 per day max 30 days		25/day 1-20 150/day 21-100		100	0	0	50 Emerg./25 Urg. Care	100		10 except 75 MRI CT Ultrasound PET Stress and 20 radiation therapy				15	25	15 I/25 G visits 1-20 50 visits 21+	20																								66.75	66.75	75	0	100	0.2	0.2	45	100	0	39.25	0	0	24.16	15	24.74	24.16	24.46	0	24.98	0.2	0	0	0	0	0	0	0	0	0	0												66.75	66.75	75	0	100	0.2	0.2	45	100	0	39.25	0	0	24.16	15	24.74	24.16	24.46	0	24.98	0.2	0	0	0	0	0	0	0	0	0	0												10.89	0.47	3.47	-	1.26	3.45	0.44	1.04	1.19	-	1.95	-	-	0.02	4.08	6.92	0.49	0.64	-	1.53	4.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.37	10.89	0.47	3.47	-	1.26	3.45	0.44	1.04	1.19	-	1.95	-	-	0.02	4.08	6.92	0.49	0.64	-	1.53	4.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.37
H4525_002_0	2006											2960											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	2072.02	36.12	832.16	0	98.22	17.32	2.19	321.43	177.93	0	777.42	0	0	0	3053.27	4123.7	219.82	321.26	0	881.83	19.32	0	0	0	0	0	0	0	0	0	0											75 per day max 30 days		25/day 1-20 150/day 21-100		100	0	0	50 Emerg./25 Urg. Care	100		10 except 75 MRI CT Ultrasound PET Stress and 20 radiation therapy				15	25	15 I/25 G visits 1-20 50 visits 21+	20																								66.75	66.75	75	0	100	0.2	0.2	45	100	0	39.25	0	0	0	15	24.85	24.16	24.75	0	25	0.2	0	0	0	0	0	0	0	0	0	0												66.75	66.75	75	0	100	0.2	0.2	45	100	0	39.25	0	0	0	15	24.85	24.16	24.75	0	25	0.2	0	0	0	0	0	0	0	0	0	0												11.53	0.2	5.2	-	0.82	3.46	0.44	1.21	1.48	-	2.54	-	-	-	3.82	8.54	0.44	0.66	-	1.84	3.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.04	11.53	0.2	5.2	-	0.82	3.46	0.44	1.21	1.48	-	2.54	-	-	-	3.82	8.54	0.44	0.66	-	1.84	3.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.04
H4525_003_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	3667.4	505.99	1122.35	0	406.96	3290.18	2694.94	766.6	308.39	11912.16	773.44	62.08	17.11	2041.08	5305.49	5236.17	1025.6	536.91	28.55	17119.12	27.49	54.5	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing											120.38	53.44	72.91	0	75.91	46.89	28.66	88.63	296.44	5.71	78.3	160.17	689.31	43.97	15.02	18.42	17.47	20.75	0.23	20.1	0.23	14.94	0	0	0	0	0	0	0	0	0												120.38	53.44	72.91	0	75.91	46.89	28.66	88.63	296.44	5.71	78.3	160.17	689.31	43.97	15.02	18.42	17.47	20.75	0.23	20.1	0.23	14.94	0	0	0	0	0	0	0	0	0												36.79	2.25	6.82	-	2.57	12.86	6.44	5.66	7.62	5.66	5.05	0.83	0.98	7.48	6.64	8.04	1.49	0.93	6.65	28.68	6.41	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	159.92	36.79	2.25	6.82	-	2.57	12.86	6.44	5.66	7.62	5.66	5.05	0.83	0.98	7.48	6.64	8.04	1.49	0.93	6.65	28.68	6.41	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	159.92
H4525_004_0	2006											2960											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1957.12	85.32	555.71	0	150.65	17.25	2.19	277.48	142.9	0	596.05	0	0	10.38	3264.82	3356.05	243.74	315.7	0	734.5	22.63	0	0	0	0	0	0	0	0	0	0											75 per day max 30 days		25/day 1-20 150/day 21-100		100	0	0	50 Emerg./25 Urg. Care	100		10 except 75 MRI CT Ultrasound PET Stress and 20 radiation therapy				15	25	15 I/25 G visits 1-20 50 visits 21+	20																								66.75	66.75	75	0	100	0.2	0.2	45	100	0	39.25	0	0	24.16	15	24.74	24.16	24.46	0	24.98	0.2	0	0	0	0	0	0	0	0	0	0												66.75	66.75	75	0	100	0.2	0.2	45	100	0	39.25	0	0	24.16	15	24.74	24.16	24.46	0	24.98	0.2	0	0	0	0	0	0	0	0	0	0												10.89	0.47	3.47	-	1.26	3.45	0.44	1.04	1.19	-	1.95	-	-	0.02	4.08	6.92	0.49	0.64	-	1.53	4.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.37	10.89	0.47	3.47	-	1.26	3.45	0.44	1.04	1.19	-	1.95	-	-	0.02	4.08	6.92	0.49	0.64	-	1.53	4.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.37
H4525_005_0	2006											2960											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	2072.02	36.12	832.16	0	98.22	17.32	2.19	321.43	177.93	0	777.42	0	0	0	3053.27	4123.7	219.82	321.26	0	881.83	19.32	0	0	0	0	0	0	0	0	0	0											75 per day max 30 days		25/day 1-20 150/day 21-100		100	0	0	50 Emerg./25 Urg. Care	100		10 except 75 MRI CT Ultrasound PET Stress and 20 radiation therapy				15	25	15 I/25 G visits 1-20 50 visits 21+	20																								66.75	66.75	75	0	100	0.2	0.2	45	100	0	39.25	0	0	0	15	24.85	24.16	24.75	0	25	0.2	0	0	0	0	0	0	0	0	0	0												66.75	66.75	75	0	100	0.2	0.2	45	100	0	39.25	0	0	0	15	24.85	24.16	24.75	0	25	0.2	0	0	0	0	0	0	0	0	0	0												11.53	0.2	5.2	-	0.82	3.46	0.44	1.21	1.48	-	2.54	-	-	-	3.82	8.54	0.44	0.66	-	1.84	3.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.04	11.53	0.2	5.2	-	0.82	3.46	0.44	1.21	1.48	-	2.54	-	-	-	3.82	8.54	0.44	0.66	-	1.84	3.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.04
H4525_801_0	2006											2960											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1957.51	42.37	737.24	0	103.23	17.74	20.46	320.56	413.76	9200.09	771.51	32.18	0	1048.6	3235.37	5284.2	186.49	471.92	29.09	14066.41	17.73	58.6	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				128.6	61.78	67.39	0	82.97	0.23	0.23	110.54	257.69	7.32	78.9	367.96	0	54.27	13.82	16.34	21.59	19.79	0.23	20.09	0.23	14.41	0	0	0	0	0	0	0	0	0												128.6	61.78	67.39	0	82.97	0.23	0.23	110.54	257.69	7.32	78.9	367.96	0	54.27	13.82	16.34	21.59	19.79	0.23	20.09	0.23	14.41	0	0	0	0	0	0	0	0	0												20.98	0.22	4.14	-	0.71	4.13	4.77	2.95	8.89	5.61	5.07	0.99	-	4.74	3.73	7.2	0.34	0.78	6.78	23.55	4.13	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.76	20.98	0.22	4.14	-	0.71	4.13	4.77	2.95	8.89	5.61	5.07	0.99	-	4.74	3.73	7.2	0.34	0.78	6.78	23.55	4.13	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.76
H4526_001_0	2006											4000											D	D	D		T	Coin	Coin	V	V		Coin	V	Coin	V	V	V	V	V			Coin				V		V																																																									-	1676.59	134.77	809.78		152.24	13.08	13.88	343.93	353.96		19.71	45.68	0.47	1100.38	4273.85	5394.13	418.95	868.12			21.85				124		222															475 per admit	812/admit203 days 61-90	101.50 days 21-100											15 Rehab/30 MH/200 Dx Card.		15 Pod/30 Other		15 Chiro/30 Other																								86.55	89.26	26.7		100	0.2	0.2	50	200		0.2	200	0.2	33.49	15	29.34	30	21.43			0.2				30		30																76.12	78.5	23.48		87.94	0.18	0.18	43.97	175.88		0.18	175.88	0.18	29.45	15	29.34	30	21.43			0.2				30		30																10.63	0.88	1.58	-	1.12	2.3	2.44	1.26	5.19	-	3.47	0.67	0.08	2.7	5.34	13.19	1.05	1.55	-	-	4.37	-	-	-	0.31	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.69	10.63	0.88	1.58	-	1.12	2.3	2.44	1.26	5.19	-	3.47	0.67	0.08	2.7	5.34	13.19	1.05	1.55	-	-	4.37	-	-	-	0.31	-	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.69
H4527_001_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	Coin	P	S	P	P	V	V	P	V	P	P	P	P																																																					-	1440.11	52.8	763.93	0	200.72	8.69	7.16	370.6	249.05	0	207.86	0	0	132.72	5352.1	4094.5	336.36	146.94	20.83	0	0	0	0	0	68.3	159.6	182.15	0	0	0	0											20.925	12775	16.04		50	0	0	45	79		0.2				5	20	20	20	20						20	20	20															20.93	127.75	16.04	0	50	0.2	0.07	43.75	80.13	0	258.2	0	0	20	5	20	19.36	20	0.18	0	0	0	0	0	20	20	20	0	0	0	0												20.93	127.75	16.04	0	50	0.2	0.07	43.75	80.13	0	258.2	0	0	20	5	20	19.36	20	0.18	0	0	0	0	0	20	20	20	0	0	0	0												2.51	0.56	1.02	-	0.84	1.74	0.48	1.35	1.66	-	4.47	-	-	0.22	2.23	6.82	0.54	0.24	3.68	-	-	-	-	-	0.11	0.27	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.06	2.51	0.56	1.02	-	0.84	1.74	0.48	1.35	1.66	-	4.47	-	-	0.22	2.23	6.82	0.54	0.24	3.68	-	-	-	-	-	0.11	0.27	0.3	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.06
H4527_002_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	Coin	P	S	P	P	P	V	P	P	P	P	P	P																																																					-	1341.16	44.75	753.7	0	194.29	9.12	7.15	339.16	238.52	0	199.79	0	0	125.17	5227.73	3999.75	298.47	142.9	21.88	0	0	0	0	0	67.28	159.88	186.48	0	0	0	0																																																				41.85	127.75	16.04	0	100	0.2	0.07	43.75	80.13	0	260.53	0	0	20	10	20	19.53	20	0.18	0	0	0	0	0	20	20	20	0	0	0	0												41.85	127.75	16.04	0	100	0.2	0.07	43.75	80.13	0	260.53	0	0	20	10	20	19.53	20	0.18	0	0	0	0	0	20	20	20	0	0	0	0												4.68	0.48	1.01	-	1.62	1.82	0.51	1.24	1.59	-	4.34	-	-	0.21	4.36	6.67	0.49	0.24	3.89	-	-	-	-	-	0.11	0.27	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.81	4.68	0.48	1.01	-	1.62	1.82	0.51	1.24	1.59	-	4.34	-	-	0.21	4.36	6.67	0.49	0.24	3.89	-	-	-	-	-	0.11	0.27	0.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.81
H4527_003_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	Coin	P	S	P	P	P	V	P	P	P	P	P	P																																																					-	0	48.8	821.94	0	158.91	10.85	2.75	369.86	156.74	0	217.88	0	0	0.38	0	0	310.18	0	26.03	0	0	0	0	0	0	0	0	0	0	0	0											62.78	12775	16.04		100	0	0	45	29		0.2				10	20	20	20	20						20	20	20															0	127.75	16.04	0	50	0.1	0.1	43.75	50	0	142.06	0	0	10	0	0	10	0	0.09	0	0	0	0	0	0	0	0	0	0	0	0												0	127.75	16.04	0	50	0.1	0.1	43.75	50	0	142.06	0	0	10	0	0	10	0	0.09	0	0	0	0	0	0	0	0	0	0	0	0												-	0.52	1.1	-	0.66	1.08	0.27	1.35	0.65	-	2.58	-	-	0	-	-	0.26	-	2.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.79	-	0.52	1.1	-	0.66	1.08	0.27	1.35	0.65	-	2.58	-	-	0	-	-	0.26	-	2.31	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.79
H4527_004_0	2006																							D	D		T	Coin	Coin	V	V		V			V			P		Coin																																																																	-		57.78	836.09		164.76	10.41	2.6	405.61	164.24		227.5			0.5			352.4		24.95																								12775	16.04		50	0	0	45	29		0.2			10			10		10																								127.75	16.04		50	0.1	0.1	43.75	50		141.29			10			10		0.09																									127.75	16.04		50	0.1	0.1	43.75	50		141.29			10			10		0.09																								-	0.62	1.12	-	0.69	1.04	0.26	1.48	0.68	-	2.68	-	-	0	-	-	0.29	-	2.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.06	-	0.62	1.12	-	0.69	1.04	0.26	1.48	0.68	-	2.68	-	-	0	-	-	0.29	-	2.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.06
H4528_001_0	2006																						D	D	Coin	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P	P	P							0	0		0		0	0	0	0						0	0																					0	1767.22	49.97	41.4	0	252.21	11.02	12.64	282.59	37.07	0	19.51	2.54	0.23	19.21	3787.65	4700.09	228.96	761.28	0	87.14	20.32	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1-6: 120; 7-90:0	1-6: 120; 7-90:0	mcare ffs ded/coin	0	100	mcare ffs ded/coin	mcare ffs ded/coin	50	125/mcare ffs ded/coin	0	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	35/mcare ffs ded/coin	0	20	35	35	0	mcare ffs ded/coin	mcare ffs ded/coin				25																	91.05	84.51	0.2	0	100	0.23	0.23	50	0.22	0	0.23	0.23	0.23	0.17	10	34.76	34.69	35	0	0.23	0.23	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		91.05	84.51	0.2	0	100	0.23	0.23	50	0.22	0	0.23	0.23	0.23	0.17	10	34.76	34.69	35	0	0.23	0.23	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	13.41	0.35	8.17	-	2.1	2.57	2.95	1.18	8.15	-	4.55	0.59	0.05	3.27	3.16	13.61	0.66	2.22	-	20.3	4.73	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.29	13.41	0.35	8.17	-	2.1	2.57	2.95	1.18	8.15	-	4.55	0.59	0.05	3.27	3.16	13.61	0.66	2.22	-	20.3	4.73	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	92.29
H4528_002_0	2006																						D	D	Coin	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	P	Coin	V	V	V	Coin	Coin	P	P	V	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P							0	0				0	0	0	0		0				0	0																					0	2846.2	377.54	83.85	0	314.95	31.74	27.43	630.15	283.66	0	16.09	2.27	2.8	30.6	0	31.57	797.65	543.22	0	74.31	17.08	0	0	0	124	0	262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1-4:75:5-90:0	1-4:75:5-90:0	mcare ffs ded/coin	0	50	mcare ffs ded/coin	mcare ffs ded/coin	50	120/200	0	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	20/med ded/coins	0	20/med ded/coins	20	20	0	mcare ffs ded/coin	mcare ffs ded/coin				20		20															44.94	40.97	0.2	0	50	0.23	0.23	50	172.37	0	0.23	0.23	0.23	0.15	0	0.23	20	20	0	0.23	0.23	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0		44.94	40.97	0.2	0	50	0.23	0.23	50	172.37	0	0.23	0.23	0.23	0.15	0	0.23	20	20	0	0.23	0.23	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	10.66	1.29	16.55	-	1.31	7.4	6.39	2.63	4.07	-	3.75	0.53	0.65	4.58	-	7.15	1.33	0.91	-	17.31	3.98	-	-	-	0.21	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.13	10.66	1.29	16.55	-	1.31	7.4	6.39	2.63	4.07	-	3.75	0.53	0.65	4.58	-	7.15	1.33	0.91	-	17.31	3.98	-	-	-	0.21	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.13
H4528_003_0	2006																						D	D	Coin	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P	P	P							0	0		0		0	0	0	0						0	0																					0	1904.57	53.86	47.68	0	274.77	13.36	15.33	307.87	44.94	0	23.66	3.08	0.28	23.29	4215.15	5226.28	254.81	847.2	0	107.92	25.17	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1-6: 95; 7-90:0	1-6: 95; 7-90:0	mcare ffs ded/coin	0	100	mcare ffs ded/coin	mcare ffs ded/coin	50	125/mcare ffs ded/coin	0	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	35/mcare ffs ded/coin	10	25	25	25	0	mcare ffs ded/coin	mcare ffs ded/coin				25																	72.09	66.9	0.18	0	100	0.23	0.23	50	0.22	0	0.23	0.23	0.23	0.16	10	24.85	24.82	25	0	0.23	0.23	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		72.09	66.9	0.18	0	100	0.23	0.23	50	0.22	0	0.23	0.23	0.23	0.16	10	24.85	24.82	25	0	0.23	0.23	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	11.44	0.3	8.74	-	2.29	3.11	3.57	1.28	9.69	-	5.51	0.72	0.06	3.71	3.51	10.82	0.53	1.77	-	25.14	5.86	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.33	11.44	0.3	8.74	-	2.29	3.11	3.57	1.28	9.69	-	5.51	0.72	0.06	3.71	3.51	10.82	0.53	1.77	-	25.14	5.86	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.33
H4528_004_0	2006																						D	D	Coin	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	P	Coin	V	V	V	Coin	Coin	P	P	V	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P							0	0				0	0	0	0		0				0	0																					0	3167.44	420.15	103.84	0	350.5	39.31	33.98	701.27	315.68	0	19.93	2.81	3.47	37.9	0	39.06	887.68	604.53	0	92.03	21.16	0	0	0	124	0	262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1-6:50:5-90:0	1-6:50:5-90:0	mcare ffs ded/coin	0	50	mcare ffs ded/coin	mcare ffs ded/coin	50	100/250	0	mcare ffs ded/coin	mcare ffs ded/coin	mcare ffs ded/coin	20/med ded/coins	0	20/med ded/coins	20	20	0	mcare ffs ded/coin	mcare ffs ded/coin				20		20															37.94	35.16	0.18	0	50	0.23	0.23	50	198.19	0	0.23	0.23	0.23	0.15	0	0.2	20	20	0	0.23	0.23	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0		37.94	35.16	0.18	0	50	0.23	0.23	50	198.19	0	0.23	0.23	0.23	0.15	0	0.2	20	20	0	0.23	0.23	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110	10.01	1.23	19.03	-	1.46	9.16	7.92	2.92	5.21	-	4.64	0.66	0.81	5.61	-	7.96	1.48	1.01	-	21.44	4.93	-	-	-	0.21	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	106.13	10.01	1.23	19.03	-	1.46	9.16	7.92	2.92	5.21	-	4.64	0.66	0.81	5.61	-	7.96	1.48	1.01	-	21.44	4.93	-	-	-	0.21	-	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	106.13
H4529_001_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1858.13	93.99	704.52	0	172.44	13.25	8.88	259.24	31.21	0	15.04	2.51	0.28	17.87	3881.17	4763.99	317.83	527.95	15.98	0.72	24.26	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50 days 1-5	50 days 1-5	25 days 10-100	0	100	15	15	50	10 NTE 100 ASC; 10 NTE 200 OPH	0	10 Ther: 20	15	15	15	10	25	30 SA: 20	10 Chiro: 10	0 OF/OP: 10	0 Chemo: 20	20				25	150 Allowance																30.98	61.96	12.87	0	100	0.15	0.15	50	0.09	0	0.13	0.15	0.2	0.09	9.91	25	27.5	10	0.1	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		30.98	61.96	12.87	0	100	0.15	0.15	50	0.09	0	0.13	0.15	0.2	0.09	9.91	25	27.5	10	0.1	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		4.8	0.49	0.76	-	1.44	1.99	1.33	1.08	2.9	-	1.89	0.38	0.06	1.64	3.2	9.92	0.73	0.44	1.6	0.14	4.85	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.89	4.8	0.49	0.76	-	1.44	1.99	1.33	1.08	2.9	-	1.89	0.38	0.06	1.64	3.2	9.92	0.73	0.44	1.6	0.14	4.85	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.89
H4529_002_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1858.13	93.99	704.52	2056.08	172.44	13.25	8.88	259.24	31.21	0	15.04	2.51	0.28	17.87	3881.17	4763.99	317.83	527.95	15.98	0.72	24.26	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105 days 1-5	105 days 1-5	30 days 10-100	10	125	20	20	50	15 NTE 200 ASC; 15 NTE 400 OPH	0	15 Ther: 20	15	15	15	15	30	45 SA: 25	10 Chiro: 15	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																65.06	123.92	15.45	10	125	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.09	14.91	30	40	14.65	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		65.06	123.92	15.45	10	125	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.09	14.91	30	40	14.65	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		10.07	0.97	0.91	1.71	1.8	2.65	1.78	1.08	4.65	-	2.45	0.38	0.06	1.65	4.82	11.91	1.06	0.64	2.4	0.14	4.85	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.23	10.07	0.97	0.91	1.71	1.8	2.65	1.78	1.08	4.65	-	2.45	0.38	0.06	1.65	4.82	11.91	1.06	0.64	2.4	0.14	4.85	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.23
H4529_003_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1899.87	96.1	720.33	0	176.32	13.85	9.28	265.05	32.62	0	15.72	2.62	0.3	18.68	3893.71	4870.99	324.97	539.81	16.71	0.75	25.36	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50 days 1-5	50 days 1-5	25 days 10-100	0	100	15	15	50	15 NTE 150 ASC; 15 NTE 300 OPH	0	10 Ther: 20	15	15	15	5	15	35 SA: 20	10 Chiro: 15	0 OF/OP: 10	0 Chemo: 20	20				25	125 Allowance																30.98	92.94	12.87	0	100	0.15	0.15	50	0.14	0	0.13	0.15	0.2	0.09	5	15	31.25	12.62	0.1	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		30.98	92.94	12.87	0	100	0.15	0.15	50	0.14	0	0.13	0.15	0.2	0.09	5	15	31.25	12.62	0.1	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		4.9	0.74	0.77	-	1.47	2.08	1.39	1.1	4.54	-	1.97	0.39	0.06	1.71	1.62	6.09	0.85	0.57	1.67	0.15	5.07	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.42	4.9	0.74	0.77	-	1.47	2.08	1.39	1.1	4.54	-	1.97	0.39	0.06	1.71	1.62	6.09	0.85	0.57	1.67	0.15	5.07	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.42
H4529_004_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1899.87	96.1	720.33	2102.26	176.32	13.85	9.28	265.05	32.62	0	15.72	2.62	0.3	18.68	3966.71	4870.99	324.97	539.81	16.71	0.75	25.36	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105 days 1-5	105 days 1-5	35 days 10-100	10	125	20	20	50	15 NTE200 ASC; 15 NTE 400 OPH	0	15 Ther: 20	15	15	15	15	25	45 SA: 25	15 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																65.06	92.94	18.02	10	125	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.1	14.82	25	40	17.62	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		65.06	92.94	18.02	10	125	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.1	14.82	25	40	17.62	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		10.3	0.74	1.08	1.75	1.84	2.77	1.86	1.1	4.85	-	2.56	0.39	0.06	1.79	4.9	10.15	1.08	0.79	2.51	0.15	5.07	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56	10.3	0.74	1.08	1.75	1.84	2.77	1.86	1.1	4.85	-	2.56	0.39	0.06	1.79	4.9	10.15	1.08	0.79	2.51	0.15	5.07	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56
H4529_005_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1713.4	74.33	688.44	1819.02	152.23	11.66	8.06	229.82	29.84	0	14.16	2.36	0.1	16.55	3636.53	4527.39	260.97	503.26	15.23	0.68	22.97	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150 days 1-5	150 days 1-5	35 days 10-100	10	150	20	20	50	15 NTE 200 ASC; 15 NTE 400 OPH	0	15 Ther: 20	15	15	15	20	35	50 SA: 30	10 Chiro: 15	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																92.94	123.92	18.02	10	150	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.09	19.8	35	45	14.69	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		92.94	123.92	18.02	10	150	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.09	19.8	35	45	14.69	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		13.27	0.77	1.03	1.52	1.9	2.33	1.61	0.96	4.45	-	2.31	0.35	0.02	1.52	6	13.2	0.98	0.62	2.28	0.14	4.59	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.11	13.27	0.77	1.03	1.52	1.9	2.33	1.61	0.96	4.45	-	2.31	0.35	0.02	1.52	6	13.2	0.98	0.62	2.28	0.14	4.59	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.11
H4529_006_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1751.89	76	703.89	1859.88	155.65	12.18	8.42	234.97	31.2	0	14.81	2.47	0.11	17.31	3716.58	4629.08	266.83	514.56	15.92	0.72	24.02	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150 days 1-5	150 days 1-5	35 days 10-100	10	150	20	20	50	15 NTE 200 ASC; 15 NTE 400 OPH	0	15 Ther: 20	15	15	15	20	30	50 SA: 30	15 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																92.94	123.92	18.02	10	150	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.1	19.8	30	45	17.69	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		92.94	123.92	18.02	10	150	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.1	19.8	30	45	17.69	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		13.57	0.78	1.06	1.55	1.95	2.44	1.68	0.98	4.64	-	2.41	0.37	0.02	1.65	6.13	11.57	1	0.76	2.39	0.14	4.8	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.16	13.57	0.78	1.06	1.55	1.95	2.44	1.68	0.98	4.64	-	2.41	0.37	0.02	1.65	6.13	11.57	1	0.76	2.39	0.14	4.8	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.16
H4531_001_0	2006											2700											A		D	V	T	Coin	0	V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin				V		V				V											5000																																										-	319.63		1178.1	2759.4	412.63	25.85	0	777.61	437.19	296.59	594.88	35.48		1199.43	5301.08	5033.15	292.59	365.84	12.86	5.33	4.12				642.36		107.46				672.52											100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance	0	50 emrg/20 Urgent	50 per visit	50 per visit	50 per visit	20 per visit		50 per visit	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance				25 per visit		25 per visist				15/25											427.6		20	10	100	0.1	0	48.11	50	50	50	20		50	15	25	25	25	0.1	0.1	0.1				25		25				17.5											7700	382.99		17.91	8.96	89.57	0.09	0	43.09	44.78	44.78	44.78	17.91		44.78	13.44	22.39	22.39	22.39	0.09	0.09	0.09				22.39		22.39				15.67												10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	1.2	-	0.2	-	-	-	0.88	-	-	-	-	-	-	-	-	-	-	52.53	10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	1.2	-	0.2	-	-	-	0.88	-	-	-	-	-	-	-	-	-	-	52.53
H4531_801_0	2006											2700											A		D	V	T	Coin		V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin																					5000																																										-	319.63		1178.1	2759.4	412.63	25.85		777.61	437.19	296.59	594.88	35.48		1199.43	5301.08	5033.15	292.59	365.84	12.86	5.33	4.12																					100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance		50 emrg/20 Urgent	50 per visit	50 per visit	50 per visit	20 per visit		50 per visit	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance																					427.6		20	10	100	0.1		48.11	50	50	50	20		50	15	25	25	25	0.1	0.1	0.1																					7700	382.99		17.91	8.96	89.57	0.09		43.09	44.78	44.78	44.78	17.91		44.78	13.44	22.39	22.39	22.39	0.09	0.09	0.09																						10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25	10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25
H4531_802_0	2006											2700											A		D	V	T	Coin		V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin																					5000																																										-	319.63		1178.1	2759.4	412.63	25.85		777.61	437.19	296.59	594.88	35.48		1199.43	5301.08	5033.15	292.59	365.84	12.86	5.33	4.12																					100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance		50 emrg/20 Urgent	50 per visit	50 per visit	50 per visit	20 per visit		50 per visit	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance																					427.6		20	10	100	0.1		48.11	50	50	50	20		50	15	25	25	25	0.1	0.1	0.1																					7700	382.99		17.91	8.96	89.57	0.09		43.09	44.78	44.78	44.78	17.91		44.78	13.44	22.39	22.39	22.39	0.09	0.09	0.09																						10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25	10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25
H4531_803_0	2006											2700											A		D	V	T	Coin		V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin																					5000																																										-	319.63		1178.1	2759.4	412.63	25.85		777.61	437.19	296.59	594.88	35.48		1199.43	5301.08	5033.15	292.59	365.84	12.86	5.33	4.12																					100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance		50 emrg/20 Urgent	50 per visit	50 per visit	50 per visit	20 per visit		50 per visit	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance																					427.6		20	10	100	0.1		48.11	50	50	50	20		50	15	25	25	25	0.1	0.1	0.1																					7700	382.99		17.91	8.96	89.57	0.09		43.09	44.78	44.78	44.78	17.91		44.78	13.44	22.39	22.39	22.39	0.09	0.09	0.09																						10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25	10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25
H4531_804_0	2006											2700											A		D	V	T	Coin		V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin																					5000																																										-	319.63		1178.1	2759.4	412.63	25.85		777.61	437.19	296.59	594.88	35.48		1199.43	5301.08	5033.15	292.59	365.84	12.86	5.33	4.12																					100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance		50 emrg/20 Urgent	50 per visit	50 per visit	50 per visit	20 per visit		50 per visit	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance																					427.6		20	10	100	0.1		48.11	50	50	50	20		50	15	25	25	25	0.1	0.1	0.1																					7700	382.99		17.91	8.96	89.57	0.09		43.09	44.78	44.78	44.78	17.91		44.78	13.44	22.39	22.39	22.39	0.09	0.09	0.09																						10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25	10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25
H4531_805_0	2006											2700											A		D	V	T	Coin		V	V	V	V	V		V	V	V	V	V	Coin	Coin	Coin																					5000																																										-	319.63		1178.1	2759.4	412.63	25.85		777.61	437.19	296.59	594.88	35.48		1199.43	5301.08	5033.15	292.59	365.84	12.86	5.33	4.12																					100 for 1st 7 days		20 per day	10 per day	100 per trip	10 coinsurance		50 emrg/20 Urgent	50 per visit	50 per visit	50 per visit	20 per visit		50 per visit	15 per visit	25 per visit	25 per visit	25 per visit	10 coinsurance	10 coinsurance	10 coinsurance																					427.6		20	10	100	0.1		48.11	50	50	50	20		50	15	25	25	25	0.1	0.1	0.1																					7700	382.99		17.91	8.96	89.57	0.09		43.09	44.78	44.78	44.78	17.91		44.78	13.44	22.39	22.39	22.39	0.09	0.09	0.09																						10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25	10.2	-	1.76	2.06	3.08	2.32	-	2.79	1.63	1.11	2.22	0.05	-	4.48	5.94	9.39	0.55	0.68	1.15	0.48	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.25
H4590_010_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1446.39	37.05	765.13	2211.68	267.85	17.51	115.47	355.54	354.53	0	14.81	0	69.85	609.75	5717.64	3912.28	179.2	276.87	3433.12	7025.89	38.85	0	0	0	91.87	256.24	0	0	0	0	273.28											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	15	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	25.85	49.12	50	0	0.2	0	0	46.88	5	15	30	30	3.99	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	25.85	49.12	50	0	0.2	0	0	46.88	5	15	30	30	3.99	0	0.2	0	0	0	25	20	0	0	0	0	0												1.05	0.34	3.12	-	1.67	3.5	0.25	1.46	1.48	-	2.96	-	-	2.38	2.38	4.89	0.45	0.69	1.14	-	7.77	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.16	1.05	0.34	3.12	-	1.67	3.5	0.25	1.46	1.48	-	2.96	-	-	2.38	2.38	4.89	0.45	0.69	1.14	-	7.77	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.16
H4590_012_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1802.75	46.18	798.18	2255.5	273.16	17.84	112.99	348.99	367.6	0	15.09	0	68.35	606.8	5830.94	3644.32	182.75	282.36	3340.29	6818.97	39.59	0	0	0	93.69	261.32	0	0	0	0	278.69											100 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	5	25	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											17.42	109.69	49	0	75	0.2	26.93	49.12	100	0	0.2	0	0	89.28	5	25	30	30	4.18	0	0.2	0	0	0	25	20	0	0	0	0	0											0	17.42	109.69	49	0	75	0.2	26.93	49.12	100	0	0.2	0	0	89.28	5	25	30	30	4.18	0	0.2	0	0	0	25	20	0	0	0	0	0												2.62	0.42	3.26	-	1.71	3.57	0.25	1.43	3.06	-	3.02	-	-	4.51	2.43	7.59	0.46	0.71	1.16	-	7.92	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.75	2.62	0.42	3.26	-	1.71	3.57	0.25	1.43	3.06	-	3.02	-	-	4.51	2.43	7.59	0.46	0.71	1.16	-	7.92	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.75
H4590_020_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	P	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1750.13	44.83	925.81	2631.64	318.71	26.06	131.93	407.71	428.98	0	686.29	0	79.8	707.45	7316.21	5721.26	252.09	453.76	4712.7	9622.92	57.82	0	0	1538.5	136.78	304.9	250.18	43.26	0	0	325.17											0 per admit	812 Copay;0 [Day(s) 1-60]; 203 [Day(s) 61-90]; 406 [Day(s) 91-190]	No copay [Day(s) 1-20]; 50 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	50 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	5 Office Visit2 teeth cleanings/year and preventative care	Exam 5 copay (12 months)	materials copay 5 (12 months)	5/12 months	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	98	24	0	50	0.2	33.68	49.12	0	0	44.61	0	0	0	0	0	10	0	3.64	0	0.2	0	0	1.77	5	5	5	0	0	0	0											0	0	98	24	0	50	0.2	33.68	49.12	0	0	44.61	0	0	0	0	0	10	0	3.64	0	0.2	0	0	1.77	5	5	5	0	0	0	0												-	0.37	1.85	-	1.33	5.21	0.37	1.67	-	-	2.55	-	-	-	-	-	0.21	-	1.43	-	11.56	-	-	0.23	0.06	0.13	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.07	-	0.37	1.85	-	1.33	5.21	0.37	1.67	-	-	2.55	-	-	-	-	-	0.21	-	1.43	-	11.56	-	-	0.23	0.06	0.13	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.07
H4590_022_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	P	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	2181.33	55.87	965.8	2526.92	306.03	23.25	131.93	406.22	444.8	0	673.93	0	79.8	696.66	7025.08	5493.59	242.05	435.7	4522.9	9239.99	48.75	0	0	1538.5	131.33	292.77	240.23	41.54	0	0	312.23											0 per admit	812 Copay;0 [Day(s) 1-60]; 203 [Day(s) 61-90]; 406 [Day(s) 91-190]	No copay [Day(s) 1-20]; 50 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	50 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	10	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 20; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	0/24 one-way trips/year	5 Office Visit2 teeth cleanings/year and preventative care	Exam 5 copay (12 months)	materials copay 5 (12 months)	5/12 months	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	98	24	0	50	0.2	30.05	49.12	0	0	41.07	0	0	0	0	0	10	0	3.44	0	0.2	0	0	1.77	5	5	5	0	0	0	0											0	0	98	24	0	50	0.2	30.05	49.12	0	0	41.07	0	0	0	0	0	10	0	3.44	0	0.2	0	0	1.77	5	5	5	0	0	0	0												-	0.46	1.93	-	1.28	4.65	0.33	1.66	-	-	2.31	-	-	-	-	-	0.2	-	1.29	-	9.75	-	-	0.23	0.05	0.12	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.36	-	0.46	1.93	-	1.28	4.65	0.33	1.66	-	-	2.31	-	-	-	-	-	0.2	-	1.29	-	9.75	-	-	0.23	0.05	0.12	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.36
H4590_025_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1703.96	43.65	798.18	2257.06	273.35	18.86	114.47	353.58	364.85	0	15.95	0	69.25	620.61	5834.96	3992.56	182.87	282.55	3502.58	7170.05	40.29	0	0	0	93.76	261.5	0	0	0	0	278.89											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	15	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	28.09	49.12	50	0	0.2	0	0	46.96	5	15	30	30	4.21	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	28.09	49.12	50	0	0.2	0	0	46.96	5	15	30	30	4.21	0	0.2	0	0	0	25	20	0	0	0	0	0												1.24	0.4	3.26	-	1.71	3.77	0.27	1.45	1.52	-	3.19	-	-	2.43	2.43	4.99	0.46	0.71	1.23	-	8.06	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.74	1.24	0.4	3.26	-	1.71	3.77	0.27	1.45	1.52	-	3.19	-	-	2.43	2.43	4.99	0.46	0.71	1.23	-	8.06	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.74
H4590_027_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1802.75	46.18	798.18	2255.5	273.16	18.65	112.99	348.99	367.6	0	15.77	0	68.35	606.8	5830.94	4209.03	182.75	282.36	3628.21	7421.59	40.29	0	0	0	93.69	261.32	0	0	0	0	278.69											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	28.14	49.12	50	0	0.2	0	0	46.94	5	10	30	30	4.02	0	0.2	0	0	0	25	20	0	0	0	0	0											0	8.71	109.69	49	0	75	0.2	28.14	49.12	50	0	0.2	0	0	46.94	5	10	30	30	4.02	0	0.2	0	0	0	25	20	0	0	0	0	0												1.31	0.42	3.26	-	1.71	3.73	0.26	1.43	1.53	-	3.15	-	-	2.37	2.43	3.51	0.46	0.71	1.22	-	8.06	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.18	1.31	0.42	3.26	-	1.71	3.73	0.26	1.43	1.53	-	3.15	-	-	2.37	2.43	3.51	0.46	0.71	1.22	-	8.06	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.18
H4590_028_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1518.71	38.9	803.39	2322.26	281.24	18.25	121.24	373.32	372.26	0	15.44	0	73.34	640.24	6003.52	4333.61	188.16	290.72	3735.14	7641.25	38.51	0	0	0	96.47	269.06	176.45	38.17	0	0	286.94											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	25.67	49.12	50	0	0.2	0	0	46.88	5	10	30	30	3.82	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	25.67	49.12	50	0	0.2	0	0	46.88	5	10	30	30	3.82	0	0.2	0	0	0	25	20	25	0	0	0	0												1.1	0.36	3.28	-	1.76	3.65	0.26	1.53	1.55	-	3.09	-	-	2.5	2.5	3.61	0.47	0.73	1.19	-	7.7	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.29	1.1	0.36	3.28	-	1.76	3.65	0.26	1.53	1.55	-	3.09	-	-	2.5	2.5	3.61	0.47	0.73	1.19	-	7.7	-	-	-	0.2	0.45	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.29
H4590_029_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1446.39	37.05	765.13	2211.68	267.85	18.82	115.47	355.54	354.53	0	15.92	0	69.85	609.75	6148.66	4808.24	179.2	276.87	3959.11	8087.26	40.29	0	0	0	91.87	256.24	0	0	0	0	273.28											0 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :0 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	109.69	49	0	75	0.2	27.79	49.12	0	0	0.2	0	0	4.67	0	0	30	30	3.72	0	0.2	0	0	0	25	20	0	0	0	0	0											0	0	109.69	49	0	75	0.2	27.79	49.12	0	0	0.2	0	0	4.67	0	0	30	30	3.72	0	0.2	0	0	0	25	20	0	0	0	0	0												-	0.34	3.12	-	1.67	3.76	0.27	1.46	-	-	3.18	-	-	0.24	-	-	0.45	0.69	1.23	-	8.06	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.09	-	0.34	3.12	-	1.67	3.76	0.27	1.46	-	-	3.18	-	-	0.24	-	-	0.45	0.69	1.23	-	8.06	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.09
H4590_030_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1983.02	50.79	878	2481.05	300.48	20.28	124.29	383.89	404.36	0	17.15	0	75.18	667.48	6414.03	4629.93	201.02	310.59	3989.42	8163.75	39.61	0	0	0	103.06	287.45	188.51	40.78	0	0	306.56											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	10	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	25 1/yr	400 3/yrs	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	27.82	49.12	50	0	0.2	0	0	46.94	5	10	30	30	3.98	0	0.2	0	0	0	25	20	25	0	0	0	0											0	8.71	109.69	49	0	75	0.2	27.82	49.12	50	0	0.2	0	0	46.94	5	10	30	30	3.98	0	0.2	0	0	0	25	20	25	0	0	0	0												1.44	0.46	3.59	-	1.88	4.06	0.29	1.57	1.68	-	3.43	-	-	2.61	2.67	3.86	0.5	0.78	1.32	-	7.92	-	-	-	0.21	0.48	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.15	1.44	0.46	3.59	-	1.88	4.06	0.29	1.57	1.68	-	3.43	-	-	2.61	2.67	3.86	0.5	0.78	1.32	-	7.92	-	-	-	0.21	0.48	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.15
H4590_801_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.33	0.03	0.2	0.58		0.54		0.04	0.44	1.19	2.29	0.14	0.04	0.48	0.25	1.41	0.26																				8.5	1638.24	41.96	789.25	2151.52	12.25	14.23	1.27	11.91	34.82	0	23.15	0	1.73	18.85	51.07	98.24	2.42	1.59	20.53	10.53	60.52	11.22	0	0	0	0	0	0	0	0	265.85											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.65	0.38	3.68	-	2.45	2.85	0.25	2.38	6.96	-	4.63	-	0.35	3.77	10.21	19.65	1.21	0.32	4.11	2.11	12.1	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.31	14.65	0.38	3.68	-	2.74	3.18	0.28	2.58	7.54	-	5.17	-	0.39	4.21	11.41	21.94	1.35	0.36	4.58	2.35	13.51	2.51	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	102.8
H4590_802_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.33	0.03	0.2	0.58		0.54		0.04	0.44	1.19	2.29	0.14	0.04	0.48	0.25	1.41	0.26																				8.5	1638.24	41.96	789.25	2151.52	12.25	14.23	1.27	11.91	34.82	0	23.15	0	1.73	18.85	51.07	98.24	2.42	1.59	20.53	10.53	60.52	11.22	0	0	0	0	0	0	0	0	265.85											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.65	0.38	3.68	-	2.45	2.85	0.25	2.38	6.96	-	4.63	-	0.35	3.77	10.21	19.65	1.21	0.32	4.11	2.11	12.1	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.31	14.65	0.38	3.68	-	2.74	3.18	0.28	2.58	7.54	-	5.17	-	0.39	4.21	11.41	21.94	1.35	0.36	4.58	2.35	13.51	2.51	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	102.8
H4590_803_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.33	0.03	0.2	0.58		0.54		0.04	0.44	1.19	2.29	0.14	0.04	0.48	0.25	1.41	0.26																				8.5	1638.24	41.96	789.25	2151.52	12.25	14.23	1.27	11.91	34.82	0	23.15	0	1.73	18.85	51.07	98.24	2.42	1.59	20.53	10.53	60.52	11.22	0	0	0	0	0	0	0	0	265.85											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.65	0.38	3.68	-	2.45	2.85	0.25	2.38	6.96	-	4.63	-	0.35	3.77	10.21	19.65	1.21	0.32	4.11	2.11	12.1	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.31	14.65	0.38	3.68	-	2.74	3.18	0.28	2.58	7.54	-	5.17	-	0.39	4.21	11.41	21.94	1.35	0.36	4.58	2.35	13.51	2.51	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	102.8
H4590_804_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.29	0.33	0.03	0.2	0.58		0.54		0.04	0.44	1.19	2.29	0.14	0.04	0.48	0.25	1.41	0.26																				8.5	1638.24	41.96	789.25	2151.52	12.25	14.23	1.27	11.91	34.82	0	23.15	0	1.73	18.85	51.07	98.24	2.42	1.59	20.53	10.53	60.52	11.22	0	0	0	0	0	0	0	0	265.85											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.65	0.38	3.68	-	2.45	2.85	0.25	2.38	6.96	-	4.63	-	0.35	3.77	10.21	19.65	1.21	0.32	4.11	2.11	12.1	2.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	94.31	14.65	0.38	3.68	-	2.74	3.18	0.28	2.58	7.54	-	5.17	-	0.39	4.21	11.41	21.94	1.35	0.36	4.58	2.35	13.51	2.51	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	102.8
H4604_003_0	2006											3000											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	Coin	P	P																																																					-	987.54	44.91	659.13		69.99	9.61	21	296.9	38.01		13.71	3.19	0	19.61	3438.21	3811.17	132.5	4.32	15.44	171.53	13.53				117.8		210.9		31.5													275	275	150		150	30	30	50	25		0/25	25	30	25/40/30	5.00/0	25	40/30	25	0/25	0/25	30				25		25		See PBP													275	275	150		150	0.3	0.3	50	0.25		0.22	0.25	0.3	0.25	5	23.03	37.5	0.25	0.13	0.7	0.3				25		25		0.25														174.53	168.95	92.15		92.15	0.18	0.18	30.72	0.15		0.13	0.15	0.18	0.15	5	23.03	37.5	0.16	0.08	0.7	0.18				25		25		0.25														14.36	0.63	5.06	-	0.54	1.77	3.87	0.76	5.84	-	1.82	0.49	0	2.99	1.43	7.31	0.41	0.69	1.27	0.01	2.49	-	-	-	0.25	-	0.44	-	7.81	-	-	-	-	-	-	-	-	-	-	-	-	60.26	14.36	0.63	5.06	-	0.54	1.77	3.87	0.76	5.84	-	1.82	0.49	0	2.99	1.43	7.31	0.41	0.69	1.27	0.01	2.49	-	-	-	0.25	-	0.44	-	7.81	-	-	-	-	-	-	-	-	-	-	-	-	60.26
H4604_005_0	2006											2400											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	Coin	P	P																																																					-	987.56	44.91	659.14	0	69.99	9.61	21	296.9	38.02	0	13.71	3.19	0	19.61	3438.27	3811.23	132.5	4.32	15.44	171.54	13.54	0	0	0	117.8	0	210.9	0	31.5	0	0											265	265	100	0	150	20	20	50	15	0	0/15	15	20	15/40/30	5.00/0	20	40/30	15	0/15	0/20	20	0			20		20		See PBP	0												265	265	100	0	150	0.2	0.2	50	0.15	0	0.13	0.15	0.2	0.15	5	19.01	37.5	0.15	0.08	0.7	0.2	0	0	0	20	0	20	0	16.4	0	0												171.89	166.72	62.91	0	94.37	0.13	0.13	31.46	0.09	0	0.08	0.09	0.13	0.09	5	19.01	37.5	0.1	0.05	0.7	0.13	0	0	0	20	0	20	0	16.4	0	0												14.15	0.62	3.46	-	0.55	1.21	2.64	0.78	3.59	-	1.12	0.3	0	1.84	1.43	6.04	0.41	0.42	0.78	0.01	1.7	-	-	-	0.2	-	0.35	-	5.17	-	-	-	-	-	-	-	-	-	-	-	-	46.78	14.15	0.62	3.46	-	0.55	1.21	2.64	0.78	3.59	-	1.12	0.3	0	1.84	1.43	6.04	0.41	0.42	0.78	0.01	1.7	-	-	-	0.2	-	0.35	-	5.17	-	-	-	-	-	-	-	-	-	-	-	-	46.78
H4604_006_0	2006											600											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P	T	P	P	P	P	P	Coin	P	P																																																					-	1234.65	58.64	652.31		97.61	13.4	29.29	505.7	64.8		25.14	5.44	0.01	33.46	7520.44	5066.88	195.32	5.69	22.63	227.57	17.96				117.8		310.88		44.17													25	25	15		100	20	20	40	15		0/10	15	20	15/10//8/4	Feb-00	4	04-Aug	10	0/10	0/4	20				4.00/5.00		4		See PBP													25	25	15		100	0.2	0.2	40	0.01		0.03	0.02	0.2	0.07	1.28	3.8	7	0.11	0.08	0.4	0.2				4		4		0.24														16.52	16.05	9.63		64.21	0.13	0.13	25.69	0.01		0.02	0.01	0.13	0.04	1.28	3.8	7	0.07	0.05	0.4	0.13				4		4		0.24														1.7	0.08	0.52	-	0.52	1.72	3.76	1.08	0.48	-	0.41	0.07	0	1.4	0.8	1.61	0.11	0.4	1.16	0.01	2.31	-	-	-	0.04	-	0.1	-	10.78	-	-	-	-	-	-	-	-	-	-	-	-	29.07	1.7	0.08	0.52	-	0.52	1.72	3.76	1.08	0.48	-	0.41	0.07	0	1.4	0.8	1.61	0.11	0.4	1.16	0.01	2.31	-	-	-	0.04	-	0.1	-	10.78	-	-	-	-	-	-	-	-	-	-	-	-	29.07
H4604_801_0	2006											3400											D	D	D	V	P	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	P	P	P	Coin	Coin	P	Coin	P			P		P			P																																																						-	1080.06	46.9	676.46		73.14	10.15	23.05	320.1	42.92		18.1	3.53		21.15	3853.81	4329.61	125.54	4.92	17.37	194.13	16.13				133.3		238.65															265	175	150		150	30	30	50	30	20	20/30	30	30	30/40/30	35/0	35	40/30	30	0/30	0/35	30				35		35															265	175	150		150	0.3	0.3	50	0.3		0.24	0.3		0.3	35	33.3	10.5	0.3	0.29	0.65	0.3				35		35																168.57	107.83	92.42		92.42	0.18	0.18	30.81	0.18		0.15	0.18		0.18	35	33.3	10.5	0.18	0.18	0.65	0.19				35		35																15.17	0.42	5.21	-	0.56	1.88	4.26	0.82	7.93	-	2.73	0.65	-	3.87	11.24	12.01	0.11	0.91	3.09	0.01	3.08	-	-	-	0.39	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.06	15.17	0.42	5.21	-	0.56	1.88	4.26	0.82	7.93	-	2.73	0.65	-	3.87	11.24	12.01	0.11	0.91	3.09	0.01	3.08	-	-	-	0.39	-	0.7	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.06
H4605_001_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	522.45	8.46	0	0	236.7	11.57	7.53	500.4	0	0	0	0	0	0	4288.15	3794.75	207.9	861.3	0	1391.4	6.31	627.3	0	0	369	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	33.33	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												4.35	0.07	-	-	0.99	1.29	-	1.39	-	-	-	-	-	-	1.79	1.58	0.09	0.32	-	0.58	0.7	0.26	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.56	4.35	0.07	-	-	0.99	1.29	-	1.39	-	-	-	-	-	-	1.79	1.58	0.09	0.32	-	0.58	0.7	0.26	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.56
H4605_002_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	522.45	8.46	0	0	236.7	11.57	7.53	500.4	0	0	0	0	0	0	4288.15	3794.75	207.9	861.3	0	1391.4	6.31	627.3	0	0	369	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	33.33	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												4.35	0.07	-	-	0.99	1.29	-	1.39	-	-	-	-	-	-	1.79	1.58	0.09	0.32	-	0.58	0.7	0.26	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.56	4.35	0.07	-	-	0.99	1.29	-	1.39	-	-	-	-	-	-	1.79	1.58	0.09	0.32	-	0.58	0.7	0.26	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.56
H4606_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				6000	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V				6000	0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	977.95	20.72	511.9	477.2	133.77	15.27	1.15	376.96	298.66				16.28	1840.39	5904.24	10296.74					4.45			6.11	0		0					51.47	1.09	0	0	0	0	0				100 per day (1-5)	100 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100				0	0-100	5-100	25-100					20			25								100 per day (1-5)	100 per day (1-5)	0	0	0	0	0				68.02	68.02	23.59	10	100	0.2	0.2	40.7	100				0	33.75	6.86	26.47					20			0.35	0		0					68.02	68.02	0	0	0	0	0					58.02	68.02	20.12	8.53	85.3	0.17	0.17	34.72	85.3				0	28.79	5.85	22.58					20			0.35	0		0					58.02	68.02	0	0	0	0	0				0	4.73	0.12	0.86	0.34	0.95	2.6	0.2	1.09	2.12	-	-	-	-	4.41	2.88	19.37	-	-	-	-	0.89	-	-	2.16	-	-	-	-	-	-	-	0.25	0.01	-	-	-	-	-	-	-	-	42.98	4.73	0.12	0.86	0.34	0.95	2.6	0.2	1.09	2.12	-	-	-	-	4.41	2.88	19.37	-	-	-	-	0.89	-	-	2.16	-	-	-	-	-	-	-	0.25	0.01	-	-	-	-	-	-	-	-	42.98
H4606_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1036.71	21.96	1085.31	505.88	141.81	17.15	1.29	399.61	316.61				17.26	1950.98	6259.02	10915.48					4.45			6.11	0		0					54.56	1.16	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100				0	0-100	5-100	25-100					0.2			25 - 75								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	10	100	0.2	0.2	40.7	100				0	34.08	6.86	26.47					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	10	100	0.2	0.2	40.7	100				0	34.08	6.86	26.47					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0				0	10.28	0.22	1.07	0.42	1.18	3.43	0.26	1.36	2.64	-	-	-	-	5.54	3.58	24.08	-	-	-	-	0.89	-	-	2.16	-	-	-	-	-	-	-	0.54	0.01	-	-	-	-	-	-	-	-	57.65	10.28	0.22	1.07	0.42	1.18	3.43	0.26	1.36	2.64	-	-	-	-	5.54	3.58	24.08	-	-	-	-	0.89	-	-	2.16	-	-	-	-	-	-	-	0.54	0.01	-	-	-	-	-	-	-	-	57.65
H4606_003_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	999.58	21.17	1046.44	487.76	136.73	16.67	1.25	385.3	305.27				16.64	1881.11	6034.87	10524.56					4.45			6.11	0		0					52.61	1.11	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100				0	0-100	5-100	25-100					0.2			25 - 75								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	10	100	0.2	0.2	40.7	100				0	33.87	6.86	26.47					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	10	100	0.2	0.2	40.7	100				0	33.87	6.86	26.47					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0				0	9.92	0.21	1.03	0.41	1.14	3.33	0.25	1.31	2.54	-	-	-	-	5.31	3.45	23.22	-	-	-	-	0.89	-	-	2.16	-	-	-	-	-	-	-	0.52	0.01	-	-	-	-	-	-	-	-	55.7	9.92	0.21	1.03	0.41	1.14	3.33	0.25	1.31	2.54	-	-	-	-	5.31	3.45	23.22	-	-	-	-	0.89	-	-	2.16	-	-	-	-	-	-	-	0.52	0.01	-	-	-	-	-	-	-	-	55.7
H4606_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	243	5.52	1071	499.21	139.94	17.44	1.31	394.34	312.43				17.04	1925.24	6176.46	10771.5					4.45			0	0		0					12.79	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.45	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.45	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.15	0.28	0.79	0.42	1.17	4.36	0.33	1.49	5.21	-	-	-	-	5.53	12.97	31.42	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	77.63	12.15	0.28	0.79	0.42	1.17	4.36	0.33	1.49	5.21	-	-	-	-	5.53	12.97	31.42	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	77.63
H4606_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	243	5.52	1071	499.21	139.94	17.44	1.31	394.34	312.44				17.04	1925.25	6176.5	10771.56					4.45			0	0		0					12.79	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.45	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.45	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.15	0.28	0.79	0.42	1.17	4.36	0.33	1.49	5.21	-	-	-	-	5.53	12.97	31.42	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	77.63	12.15	0.28	0.79	0.42	1.17	4.36	0.33	1.49	5.21	-	-	-	-	5.53	12.97	31.42	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	77.63
H4606_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	243	5.52	1071	499.21	139.94	17.44	1.31	394.34	312.43				17.04	1925.24	6176.46	10771.5					4.45			0	0		0					12.79	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.45	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.45	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.15	0.28	0.79	0.42	1.17	4.36	0.33	1.49	5.21	-	-	-	-	5.53	12.97	31.42	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	77.63	12.15	0.28	0.79	0.42	1.17	4.36	0.33	1.49	5.21	-	-	-	-	5.53	12.97	31.42	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	77.63
H4606_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	243	5.52	1071	499.21	139.94	17.44	1.31	394.34	312.44				17.04	1925.25	6176.5	10771.56					4.45			0	0		0					12.79	0.29	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.45	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.45	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.15	0.28	0.79	0.42	1.17	4.36	0.33	1.49	5.21	-	-	-	-	5.53	12.97	31.42	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	77.63	12.15	0.28	0.79	0.42	1.17	4.36	0.33	1.49	5.21	-	-	-	-	5.53	12.97	31.42	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.64	0.01	-	-	-	-	-	-	-	-	77.63
H4908_001_0	2006											3500											D	D	D	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P											3500																																										-	0	0	0	106.6	81.35	0	1059.55	306.98	0	0	213.22	0	2.1	179.43	4417.04	5336.13	337.26	310.56	0	69.91	19.38	0	0	0	117.8	0	0	0	0	0	0														10	50		0/10	Oct-50			0/50		10	0/10	10	10	10	10		0/10	10				10																	0	0	0	10	50	0	0.83	45.67	0	0	43.23	0	10	9.89	10	10	10	10	0	0.2	0.1	0	0	0	10	0	0	0	0	0	0												0	0	0	9.63	48.14	0	0.8	43.97	0	0	41.62	0	9.63	9.52	9.63	9.63	9.63	9.63	0	0.19	0.1	0	0	0	9.63	0	0	0	0	0	0												-	-	-	0.09	0.33	-	0.07	1.12	-	-	0.74	-	0	0.14	3.54	4.28	0.27	0.25	-	0	1.87	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.8	-	-	-	0.09	0.33	-	0.07	1.12	-	-	0.74	-	0	0.14	3.54	4.28	0.27	0.25	-	0	1.87	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.8
H4908_002_0	2006											3500											D	D	D	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P											3500																																										-	0	0	0	112.07	85.52	0	1113.92	322.68	0	0	224.16	0	2.21	188.64	4608.81	5575.8	352.62	326.5	0	73.5	21.42	0	0	0	117.8	0	0	0	0	0	0														10	50		0/10	Oct-50			0/50		10	0/10	10	10	10	10		0/10	10				10																	0	0	0	10	50	0	0.79	45.66	0	0	43.02	0	10	9.89	10	10	10	10	0	0.19	0.1	0	0	0	10	0	0	0	0	0	0												0	0	0	9.59	47.96	0	0.76	43.8	0	0	41.26	0	9.59	9.49	9.59	9.59	9.59	9.59	0	0.18	0.1	0	0	0	9.59	0	0	0	0	0	0												-	-	-	0.09	0.34	-	0.07	1.18	-	-	0.77	-	0	0.15	3.68	4.46	0.28	0.26	-	0	2.05	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.43	-	-	-	0.09	0.34	-	0.07	1.18	-	-	0.77	-	0	0.15	3.68	4.46	0.28	0.26	-	0	2.05	-	-	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.43
H4909_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			0	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			0																																										-	309.5	5.5	177.51		209.11	8.01	3.08	266.97	336.67	653.53	894.09	40.76	27.72	0.5	4826.08	1426.39	5.52	324.7			229.98				20.16		148.1					698.7	18.48	50.85	315.76	91.6	0.03	696.27	2.99			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	30 copay	15 copay	30 copay	30 copay	30 copay			15/30/40/80 copay levels				50 max		50 max					30 copay	50 copay	30 copay	30 copay	15 copay	20 coinsurance	30 copay	30 copay			500	500	75		75	0.2	0.2	50	250	51.31	59.45	250	34.28	20	20	20	20	20			26.71				50		50					30	50	30	30	15	0.2	30	30			4000	602.24	666.12	72.23		72.23	0.2	0.2	48.15	240.76	49.42	57.25	240.76	33.02	20	20	20	20	20			26.71				50		50					20	50	20	20	20	0.2	20	20				15.53	0.31	1.07	-	1.26	1.6	0.62	1.07	6.75	2.69	4.27	0.82	0.08	0	8.04	2.38	0.01	0.54	-	-	0.51	-	-	-	0.08	-	0.62	-	-	-	-	1.16	0.08	0.08	0.53	0.15	0.01	1.16	0	-	-	51.42	15.53	0.31	1.07	-	1.26	1.6	0.62	1.07	6.75	2.69	4.27	0.82	0.08	0	8.04	2.38	0.01	0.54	-	-	0.51	-	-	-	0.08	-	0.62	-	-	-	-	1.16	0.08	0.08	0.53	0.15	0.01	1.16	0	-	-	51.42
H4909_004_0	2006																						A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V																																													-	1830.23	43.69	179.42		211.36	8.08	3.11	269.84	340.3	660.56	903.71	41.2	28.02	0.51	5035.35	1475.26	5.71	335.82			232.45				20.38		149.7					722.64	18.68	52.59	326.58	95.57	0.03	720.13	3.1			175/day with 1750 yearly max	175/day with 1750 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	175 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	175 copay	15/35 copay for in-home/facility	25 copay	10 copay	25 copay	25 copay	25 copay			15/30/40/80 copay levels				50 max		50 max					25 copay	50 copay	25 copay	25 copay	10 copay	20 coinsurance	25 copay	25 copay			750	750	75		75	0.2	0.2	50	250	51.31	59.45	250	34.28	20	20	20	20	20			26.71				50		50					20	50	20	20	20	0.2	20	20				108.75	128.27	40.92		60.72	0.2	0.2	45.37	158.78	46.56	53.94	158.78	31.1	22.68	13.61	22.68	22.68	22.68			27.48				47.61		47.61					22.68	45.37	22.68	22.68	9.07	0.19	22.68	22.68				16.59	0.47	0.61	-	1.07	1.62	0.62	1.02	4.5	2.56	4.06	0.55	0.07	0	5.71	2.79	0.01	0.63	-	-	0.53	-	-	-	0.08	-	0.59	-	-	-	-	1.37	0.07	0.1	0.62	0.07	0.01	1.36	0.01	-	-	47.69	16.59	0.47	0.61	-	1.07	1.62	0.62	1.02	4.5	2.56	4.06	0.55	0.07	0	5.71	2.79	0.01	0.63	-	-	0.53	-	-	-	0.08	-	0.59	-	-	-	-	1.37	0.07	0.1	0.62	0.07	0.01	1.36	0.01	-	-	47.69
H4909_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			0	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			0																																										-	234.42	4.16	134.45		158.38	6.07	2.33	202.21	255	495	677.2	30.87	20.99	0.38	3655.35	1080.37	4.18	245.93			174.19											529.21	14	38.52	239.16	69.38	0.02	527.37	2.27			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels											30 copay	50 copay	30 copay	30 copay	30 copay	20 coinsurance	30 copay	30 copay			750	750	75		75	0.2	0.2	50	250	51.31	59.45	250	34.28	20	20	20	20	20			26.71											20	50	20	20	20	0.2	20	20			4000	602.24	666.12	72.23		72.23	0.2	0.2	48.15	240.76	49.42	57.25	240.76	33.02	20	14.45	20	20	20			26.71											20	50	20	20	20	0.2	20	20				11.76	0.23	0.81	-	0.95	1.21	0.47	0.81	5.12	2.04	3.23	0.62	0.06	0	4.4	1.8	0.01	0.41	-	-	0.39	-	-	-	-	-	-	-	-	-	-	0.88	0.06	0.06	0.4	0.12	0	0.88	0	-	-	36.72	11.76	0.23	0.81	-	0.95	1.21	0.47	0.81	5.12	2.04	3.23	0.62	0.06	0	4.4	1.8	0.01	0.41	-	-	0.39	-	-	-	-	-	-	-	-	-	-	0.88	0.06	0.06	0.4	0.12	0	0.88	0	-	-	36.72
H4910_001_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1700.72	17.18	1327.43	1337.27	229.06	2.11	0.02	241.73	49.02	854.34	273.92	0	66.01	41.72	2976.62	10120.32	0.41	688.52	614.4	0	292.41	725.34			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-10 75/d 11-100 days																																							122.35	122.35	47.6	20	100	0.2	0.2	48	100	30	50	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	47.6	20	100	0.2	0.2	48	100	30	50	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	17.34	0.18	5.27	2.23	1.91	0.42	0	0.97	0.41	2.14	1.14	-	0.17	0.1	3.72	25.3	0	1.72	1.54	-	1.1	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.46	17.34	0.18	5.27	2.23	1.91	0.42	0	0.97	0.41	2.14	1.14	-	0.17	0.1	3.72	25.3	0	1.72	1.54	-	1.1	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.46
H4910_002_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1759.39	17.77	1360.43	1370.51	234.75	2.17	0.02	247.74	50.24	885.48	284.42	0	68.41	43.24	3090.72	10597.41	0.43	720.98	643.36	0	299.68	743.37			0	0	0	0	0	0	0											250/admission	250/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							40.78	40.78	70.65	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0												40.78	40.78	70.65	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0											0	5.98	0.06	8.01	2.28	1.96	0.43	0	0.99	0.42	1.48	1.42	-	0.11	0.07	2.58	17.66	0	1.2	1.07	-	1.12	1.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.1	5.98	0.06	8.01	2.28	1.96	0.43	0	0.99	0.42	1.48	1.42	-	0.11	0.07	2.58	17.66	0	1.2	1.07	-	1.12	1.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.1
H4910_003_0	2006											4000											D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																					27.39	0.28							0.57																																	28.23	1656.12	16.73	1308.05	1317.75	225.71	2.08	0.02	238.21	48.18	851.38	273.63	0	65.78	41.57	2971.72	10189.4	0.41	693.22	618.59	0	288.14	714.75			0	0	0	0	0	0	0											15 Coin	15 Coin	0/d 1-9 75/d 10-19 125 20-100 days																																							277.5	277.5	70.85	20	100	0.2	0.2	48	112.5	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0												217.62	217.62	55.56	15.68	78.42	0.16	0.16	37.64	88.22	15.68	47.05	0	15.68	15.68	7.84	15.68	15.68	15.68	15.68	0	45	15.68			0	0	0	0	0	0	0											500	30.03	0.3	6.06	1.72	1.48	0.33	0	0.75	0.35	1.11	1.07	-	0.09	0.05	1.94	13.32	0	0.91	0.81	-	1.08	0.93	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	62.34	57.42	0.58	6.06	1.72	1.48	0.33	0	0.75	0.92	1.11	1.07	-	0.09	0.05	1.94	13.32	0	0.91	0.81	-	1.08	0.93	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	90.57
H4910_004_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1700.72	17.18	1327.43	1337.27	229.06	2.11	0.02	241.73	49.02	854.34	273.92	0	66.01	41.72	2976.62	10120.32	0.41	688.52	614.4	0	292.41	725.34			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	17.34	0.18	7.84	2.23	1.91	0.42	0	0.97	0.41	2.14	1.48	-	0.17	0.1	3.72	25.3	0	1.72	1.54	-	1.1	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.37	17.34	0.18	7.84	2.23	1.91	0.42	0	0.97	0.41	2.14	1.48	-	0.17	0.1	3.72	25.3	0	1.72	1.54	-	1.1	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.37
H4910_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1519.97	15.35	1169.27	1141.63	205.38	1.9	0.02	214.41	43.49	801.25	245.36	0	59.17	37.4	2366	8975.53	0.36	610.64	544.9	0	262.18	650.36																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																				0	18.2	0.18	9.74	3.33	2.57	0.57	0.01	0.89	0.54	0.54	2.01	-	0.17	0.11	6.9	26.18	0	1.78	1.59	-	1.47	1.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.69	18.2	0.18	9.74	3.33	2.57	0.57	0.01	0.89	0.54	0.54	2.01	-	0.17	0.11	6.9	26.18	0	1.78	1.59	-	1.47	1.9	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	78.69
H4910_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1735.39	17.53	1334.99	1303.43	234.49	2.17	0.02	244.79	49.66	914.81	280.13	0	67.56	42.7	2701.33	10247.61	0.41	697.18	622.12	0	299.34	742.53																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																				0	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84
H4910_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1735.39	17.53	1334.99	1303.43	234.49	2.17	0.02	244.79	49.66	914.81	280.13	0	67.56	42.7	2701.33	10247.61	0.41	697.18	622.12	0	299.34	742.53																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																				0	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84	20.78	0.21	11.12	3.8	2.93	0.65	0.01	1.02	0.62	0.62	2.29	-	0.2	0.12	7.88	29.89	0	2.03	1.81	-	1.68	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.84
H4911_001_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				5000																																										-	1626.37	16.43	1269.39	1278.8	219.04	2.02	0.02	231.17	46.87	816.99	266.02	0	63.12	39.89	2846.49	9677.87	0.39	658.42	587.54	0	279.62	693.63			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	16.58	0.17	7.49	2.13	1.83	0.4	0	0.92	0.39	2.04	1.44	-	0.16	0.1	3.56	24.19	0	1.65	1.47	-	1.05	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.32	16.58	0.17	7.49	2.13	1.83	0.4	0	0.92	0.39	2.04	1.44	-	0.16	0.1	3.56	24.19	0	1.65	1.47	-	1.05	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.32
H4911_002_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				3500																																										-	1548.8	15.64	1197.59	1206.47	206.65	1.91	0.02	218.09	44.22	779.49	246.9	0	60.22	38.06	2720.78	9328.95	0.38	634.68	566.35	0	263.81	654.39			0	0	0	0	0	0	0											250/admission	250/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0												40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0											0	5.26	0.05	7.07	2.01	1.72	0.38	0	0.87	0.37	1.3	1.23	-	0.1	0.06	2.27	15.55	0	1.06	0.94	-	0.99	1.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.34	5.26	0.05	7.07	2.01	1.72	0.38	0	0.87	0.37	1.3	1.23	-	0.1	0.06	2.27	15.55	0	1.06	0.94	-	0.99	1.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.34
H4911_003_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				5000																																										-	1626.37	16.43	1269.39	1278.8	219.04	2.02	0.02	231.17	46.87	816.99	266.02	0	63.12	39.89	2846.49	9677.87	0.39	658.42	587.54	0	279.62	693.63			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	16.58	0.17	7.49	2.13	1.83	0.4	0	0.92	0.39	2.04	1.44	-	0.16	0.1	3.56	24.19	0	1.65	1.47	-	1.05	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.32	16.58	0.17	7.49	2.13	1.83	0.4	0	0.92	0.39	2.04	1.44	-	0.16	0.1	3.56	24.19	0	1.65	1.47	-	1.05	1.73	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.32
H4911_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																																																														-	1337.57	13.51	1028.96	1004.63	180.73	1.67	0.02	188.68	38.27	705.1	215.91	0	52.07	32.91	2082.08	7898.47	0.32	537.36	479.51	0	230.72	572.31																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance																															143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3	0	35	35	35	35	35	35	35	0	67.5	35																				0	16.02	0.16	8.57	2.93	2.26	0.5	0.01	0.79	0.48	0.48	1.77	-	0.15	0.1	6.07	23.04	0	1.57	1.4	-	1.3	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.25	16.02	0.16	8.57	2.93	2.26	0.5	0.01	0.79	0.48	0.48	1.77	-	0.15	0.1	6.07	23.04	0	1.57	1.4	-	1.3	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.25
H4911_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1337.57	13.51	1028.96	1004.63	180.73	1.67	0.02	188.68	38.27	705.1	215.91		52.07	32.91	2082.08	7898.47	0.32	537.36	479.51		230.72	572.31																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																				0	16.02	0.16	8.57	2.93	2.26	0.5	0.01	0.79	0.48	0.48	1.77	-	0.15	0.1	6.07	23.04	0	1.57	1.4	-	1.3	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.25	16.02	0.16	8.57	2.93	2.26	0.5	0.01	0.79	0.48	0.48	1.77	-	0.15	0.1	6.07	23.04	0	1.57	1.4	-	1.3	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.25
H4911_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1337.57	13.51	1028.96	1004.63	180.73	1.67	0.02	188.68	38.27	705.1	215.91		52.07	32.91	2082.08	7898.47	0.32	537.36	479.51		230.72	572.31																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35																				0	16.02	0.16	8.57	2.93	2.26	0.5	0.01	0.79	0.48	0.48	1.77	-	0.15	0.1	6.07	23.04	0	1.57	1.4	-	1.3	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.25	16.02	0.16	8.57	2.93	2.26	0.5	0.01	0.79	0.48	0.48	1.77	-	0.15	0.1	6.07	23.04	0	1.57	1.4	-	1.3	1.67	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.25
H5005_001_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1277.54	32.72	1307.48	2227.82	269.81	16.49	111.81	341.78	451.45	0	13.94	0	72.84	593.53	5338.4	3725.04	191.21	295.44	3227.19	6594.82	68.53	0	0	0	92.54	258.11	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	25.14	49.12	200	0	0.2	0	0	173.65	15	30	30	30	4	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	25.14	49.12	200	0	0.2	0	0	173.65	15	30	30	30	4	0	0.2	0	0	0	25	20	0	0	0	0	0												7.42	0.3	5.34	-	1.69	3.3	0.23	1.4	7.52	-	2.79	-	-	8.59	6.67	9.31	0.48	0.74	1.08	-	13.71	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.18	7.42	0.3	5.34	-	1.69	3.3	0.23	1.4	7.52	-	2.79	-	-	8.59	6.67	9.31	0.48	0.74	1.08	-	13.71	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.18
H5005_010_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1188.71	30.45	1085.27	2154.52	260.93	17.26	112.48	340.93	358.47	0	14.6	0	73.28	601.17	5446.41	3815.43	184.92	285.72	3358.38	6856.99	70.03	0	0	0	89.5	249.62	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	26.16	49.12	100	0	0.2	0	0	89.22	10	20	30	30	4.02	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	26.16	49.12	100	0	0.2	0	0	89.22	10	20	30	30	4.02	0	0.2	0	0	0	25	20	0	0	0	0	0												6.9	0.28	4.43	-	1.63	3.45	0.25	1.4	2.99	-	2.92	-	-	4.47	4.54	6.36	0.46	0.71	1.13	-	14.01	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.52	6.9	0.28	4.43	-	1.63	3.45	0.25	1.4	2.99	-	2.92	-	-	4.47	4.54	6.36	0.46	0.71	1.13	-	14.01	-	-	-	0.19	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.52
H5005_011_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1130.64	28.96	1408.77	2269.24	274.82	16	112.1	344.18	501.83	0	13.54	0	73.03	599.1	5437.64	3794.29	194.77	300.93	3287.86	6717.41	67.54	0	0	0	94.26	262.91	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :15 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 200; Outpatient Hospital: 200	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 200; Non-Surgical Cases - ASC: 200	15	30	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	24.34	49.12	200	0	0.2	0	0	173.83	15	30	30	30	3.81	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	24.34	49.12	200	0	0.2	0	0	173.83	15	30	30	30	3.81	0	0.2	0	0	0	25	20	0	0	0	0	0												6.57	0.26	5.75	-	1.72	3.2	0.23	1.41	8.36	-	2.71	-	-	8.68	6.8	9.49	0.49	0.75	1.04	-	13.51	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.59	6.57	0.26	5.75	-	1.72	3.2	0.23	1.41	8.36	-	2.71	-	-	8.68	6.8	9.49	0.49	0.75	1.04	-	13.51	-	-	-	0.2	0.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.59
H5005_012_0	2006											1500											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1500																																										-	1277.54	32.72	1307.48	2234.74	270.65	17.9	112.16	342.84	451.45	0	15.14	0	73.07	595.37	6119.98	4187.58	191.81	296.35	3687.04	7520.28	70.03	0	0	0	92.83	258.92	0	0	0	0	276.13											50 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :5 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	15	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											8.71	109.69	49	0	75	0.2	27.2	49.12	50	0	0.2	0	0	46.9	5	15	30	30	3.8	0	0.2	0	0	0	25	20	0	0	0	0	0											1500	8.71	109.69	49	0	75	0.2	27.2	49.12	50	0	0.18	0	0	46.9	5	15	30	30	3.8	0	0.18	0	0	0	25	20	0	0	0	0	0												0.93	0.3	5.34	-	1.69	3.58	0.25	1.4	1.88	-	2.72	-	-	2.33	2.55	5.23	0.48	0.74	1.17	-	12.61	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.83	0.93	0.3	5.34	-	1.69	3.58	0.25	1.4	1.88	-	2.72	-	-	2.33	2.55	5.23	0.48	0.74	1.17	-	12.61	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.83
H5005_013_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1223.27	31.33	1311.81	2147.96	260.14	16.31	112.14	339.89	455.65	0	13.79	0	73.06	599.34	5429.84	3803.82	184.36	284.85	3349.53	6836.13	70.03	0	0	0	89.22	248.86	0	0	0	0	0											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	24.79	49.12	100	0	0.2	0	0	89.22	10	20	30	30	3.81	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	24.79	49.12	100	0	0.2	0	0	89.22	10	20	30	30	3.81	0	0.2	0	0	0	25	20	0	0	0	0	0												7.1	0.29	5.36	-	1.63	3.26	0.23	1.39	3.8	-	2.76	-	-	4.46	4.52	6.34	0.46	0.71	1.06	-	14.01	-	-	-	0.19	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.98	7.1	0.29	5.36	-	1.63	3.26	0.23	1.39	3.8	-	2.76	-	-	4.46	4.52	6.34	0.46	0.71	1.06	-	14.01	-	-	-	0.19	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.98
H5005_015_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1277.54	32.72	1307.48	2227.82	269.81	17.9	111.81	341.78	451.45	0	15.14	0	72.84	593.53	5631.72	3945.24	191.21	295.44	3472.7	7090.29	70.03	0	0	0	92.54	258.11	0	0	0	0	275.27											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 175; Outpatient Hospital: 175	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 175; Non-Surgical Cases - ASC: 175	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	27.29	49.12	175	0	0.2	0	0	152.52	10	20	30	30	4.03	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	27.29	49.12	175	0	0.2	0	0	152.52	10	20	30	30	4.03	0	0.2	0	0	0	25	20	0	0	0	0	0												7.42	0.3	5.34	-	1.69	3.58	0.25	1.4	6.58	-	3.03	-	-	7.54	4.69	6.58	0.48	0.74	1.17	-	14.01	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.41	7.42	0.3	5.34	-	1.69	3.58	0.25	1.4	6.58	-	3.03	-	-	7.54	4.69	6.58	0.48	0.74	1.17	-	14.01	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.41
H5005_018_0	2006											0											D	D	D	V	T	Coin	P	V	P	P	Coin	P	P	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											0																																										-	1277.54	32.72	1307.48	2234.41	270.61	16.32	112.14	342.79	451.45	0	13.8	0	73.06	595.28	5648.38	3956.91	191.78	296.31	3484.97	7111.27	70.03	0	0	0	92.82	258.88	0	0	0	0	276.09											400 per admit	912 per admit	No copay [Day(s) 1-20]; 100 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	75 per trip	20 Coinsurance	Prosthetics: 20 Coinsurance; Supplies: 0 Coinsurance	ER: 50; Urgent Care :10 PCP Copay;30 In Area/In Network;50 Other	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		0	Cardiac Rehabilitation: 30; Pulmonary Rehabilitation: 30; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	20	30	Occupational Therapy: 30; PT/ Speech Therapy: 30	Routine Xray: 0; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	25 1/yr	20	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	109.69	49	0	75	0.2	24.81	49.12	100	0	0.2	0	0	89.15	10	20	30	30	3.67	0	0.2	0	0	0	25	20	0	0	0	0	0											0	69.69	109.69	49	0	75	0.2	24.81	49.12	100	0	0.2	0	0	89.15	10	20	30	30	3.67	0	0.2	0	0	0	25	20	0	0	0	0	0												7.42	0.3	5.34	-	1.69	3.26	0.23	1.4	3.76	-	2.76	-	-	4.42	4.71	6.59	0.48	0.74	1.06	-	14.01	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.81	7.42	0.3	5.34	-	1.69	3.26	0.23	1.4	3.76	-	2.76	-	-	4.42	4.71	6.59	0.48	0.74	1.06	-	14.01	-	-	-	0.19	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.81
H5005_801_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.3	0.33	0.03	0.2	0.55		0.51		0.04	0.42	1.2	2.31	0.14	0.04	0.48	0.25	2.42	0.02																				9.23	1265.31	32.41	1310.87	2173.44	12.67	14.33	1.28	11.98	33.1	0	21.87	0	1.63	17.8	51.44	98.96	2.44	1.6	20.68	10.61	103.7	0.9	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	11.31	0.3	6.12	-	2.53	2.87	0.26	2.4	6.62	-	4.37	-	0.33	3.56	10.29	19.79	1.22	0.32	4.14	2.12	20.74	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.46	11.31	0.3	6.12	-	2.83	3.2	0.29	2.59	7.17	-	4.88	-	0.36	3.98	11.49	22.1	1.36	0.36	4.62	2.37	23.16	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.69
H5005_802_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.3	0.33	0.03	0.2	0.55		0.51		0.04	0.42	1.2	2.31	0.14	0.04	0.48	0.25	2.42	0.02																				9.23	1265.31	32.41	1310.87	2173.44	12.67	14.33	1.28	11.98	33.1	0	21.87	0	1.63	17.8	51.44	98.96	2.44	1.6	20.68	10.61	103.7	0.9	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	11.31	0.3	6.12	-	2.53	2.87	0.26	2.4	6.62	-	4.37	-	0.33	3.56	10.29	19.79	1.22	0.32	4.14	2.12	20.74	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.46	11.31	0.3	6.12	-	2.83	3.2	0.29	2.59	7.17	-	4.88	-	0.36	3.98	11.49	22.1	1.36	0.36	4.62	2.37	23.16	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.69
H5005_803_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.3	0.33	0.03	0.2	0.55		0.51		0.04	0.42	1.2	2.31	0.14	0.04	0.48	0.25	2.42	0.02																				9.23	1265.31	32.41	1310.87	2173.44	12.67	14.33	1.28	11.98	33.1	0	21.87	0	1.63	17.8	51.44	98.96	2.44	1.6	20.68	10.61	103.7	0.9	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	11.31	0.3	6.12	-	2.53	2.87	0.26	2.4	6.62	-	4.37	-	0.33	3.56	10.29	19.79	1.22	0.32	4.14	2.12	20.74	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.46	11.31	0.3	6.12	-	2.83	3.2	0.29	2.59	7.17	-	4.88	-	0.36	3.98	11.49	22.1	1.36	0.36	4.62	2.37	23.16	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.69
H5005_804_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.3	0.33	0.03	0.2	0.55		0.51		0.04	0.42	1.2	2.31	0.14	0.04	0.48	0.25	2.42	0.02																				9.23	1265.31	32.41	1310.87	2173.44	12.67	14.33	1.28	11.98	33.1	0	21.87	0	1.63	17.8	51.44	98.96	2.44	1.6	20.68	10.61	103.7	0.9	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	11.31	0.3	6.12	-	2.53	2.87	0.26	2.4	6.62	-	4.37	-	0.33	3.56	10.29	19.79	1.22	0.32	4.14	2.12	20.74	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.46	11.31	0.3	6.12	-	2.83	3.2	0.29	2.59	7.17	-	4.88	-	0.36	3.98	11.49	22.1	1.36	0.36	4.62	2.37	23.16	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.69
H5006_001_1	2006																						D		D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	V	Coin	Coin																																																														-	873.46	21.81	333.72	11.59	129.4	7.73	3.88	259.43	65.03	30.42	3.54	0.72	0.04	0.38	3418.56	2182.62	1.65	3.19	0	0	31.45	2.63																				150 day for 1st 5 days	150 day for 1st 5 days	35 day for days 11+	15 Coinsurance	150 Copay	25 Coinsurance	25 Coinsurance	50 per visit	15 Coinsurance	15 Coinsurance	15 Coinsurance	15 Coinsurance	15 Coinsurance	15 Coinsurance	10 Per Visit	35 Per Visit	50 Coinsurance	15 Coinsurance	15 Coinsurance	35 Per Visit	25 Coinsurance	25 Coinsurance																																																														150	150	35	0.15	150	0.25	0.25	50	0.15	0.15	0.15	0.5	0.15	0.15	10	35	0.5	0.15	0	0	0.25	0.25																					10.92	0.27	0.97	1.74	1.62	1.93	0.97	1.08	9.76	4.56	0.53	0.36	0.01	0.06	2.85	6.37	0.83	0.48	-	-	7.86	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.81	10.92	0.27	0.97	1.74	1.62	1.93	0.97	1.08	9.76	4.56	0.53	0.36	0.01	0.06	2.85	6.37	0.83	0.48	-	-	7.86	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.81
H5006_001_2	2006																						D		D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	V	Coin	Coin																																																														-	3065.38	67.32	1610.48	6.12	460.22	10.05	8.99	638.29	72.34	30.74	1.23	0.46	0.23	0.22	10079.7	5970.86	2.44	3.15	0	0	27.18	5.46																				150 day for 1st 5 days	150 day for 1st 5 days	35 day for days 11+	15 Coinsurance	150 Copay	25 Coinsurance	25 Coinsurance	50 per visit	15 Coinsurance	15 Coinsurance	15 Coinsurance	50 Coinsurance	15 Coinsurance	15 Coinsurance	10 Per Visit	35 Per Visit	50 Coinsurance	15 Coinsurance	15 Coinsurance	35 Per Visit	25 Coinsurance	15 Coinsurance																																																														150	150	35	0.15	150	0.25	0.25	50	0.15	0.15	0.15	0.5	0.15	0.15	10	35	0.5	0.15	0.15	0.35	0.25	0.15																					38.32	0.84	4.7	0.92	5.75	2.51	2.25	2.66	10.85	4.61	0.18	0.23	0.03	0.03	8.4	17.42	1.22	0.47	-	-	6.8	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.01	38.32	0.84	4.7	0.92	5.75	2.51	2.25	2.66	10.85	4.61	0.18	0.23	0.03	0.03	8.4	17.42	1.22	0.47	-	-	6.8	0.82	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	109.01
H5006_801_0	2006																						D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	V	Coin	Coin																																																														-	1048.83	24.29	921.16	11.43	152.12	8.05	4.26	287.41	65.36	30.49	3.4	0.7	0.05	0.32	3891.2	2535.86	1.69	3.19	0	0	31.24	7.24																				250 day for 1st 5 days	250 day for 1st 5 days	75 day	20 Coinsurance	150 Copay	20 Coinsurance	20 Coinsurance	50 per visit	20 Coinsurance	20 Coinsurance	20 Coinsurance	50 Coinsurance	20 Coinsurance	20 Coinsurance	20 Per Visit	40 Per Visit	50 Coinsurance	20 Coinsurance	20 Coinsurance	40 Per Visit	25 Coinsurance	25 Coinsurance																																																														250	250	75	0.2	150	0.2	0.2	50	0.2	0.2	0.2	0.5	0.2	0.2	20	40	0.5	0.2	0.2	40	0.25	0.25																					21.85	0.51	5.76	2.29	1.9	1.61	0.85	1.2	13.07	6.1	0.68	0.35	0.01	0.06	6.49	8.45	0.84	0.64	-	-	7.81	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.27	21.85	0.51	5.76	2.29	1.9	1.61	0.85	1.2	13.07	6.1	0.68	0.35	0.01	0.06	6.49	8.45	0.84	0.64	-	-	7.81	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.27
H5006_802_0	2006																						D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	V	Coin	Coin																																																														-	1048.83	24.29	921.16	11.43	152.12	8.05	4.26	287.41	65.36	30.49	3.4	0.7	0.05	0.32	3891.2	2535.86	1.69	3.19	0	0	31.24	7.24																				250 day for 1st 5 days	250 day for 1st 5 days	75 day	20 Coinsurance	150 Copay	20 Coinsurance	20 Coinsurance	50 per visit	20 Coinsurance	20 Coinsurance	20 Coinsurance	50 Coinsurance	20 Coinsurance	20 Coinsurance	20 Per Visit	40 Per Visit	50 Coinsurance	20 Coinsurance	20 Coinsurance	40 Per Visit	25 Coinsurance	25 Coinsurance																																																														250	250	75	0.2	150	0.2	0.2	50	0.2	0.2	0.2	0.5	0.2	0.2	20	40	0.5	0.2	0.2	40	0.25	0.25																					21.85	0.51	5.76	2.29	1.9	1.61	0.85	1.2	13.07	6.1	0.68	0.35	0.01	0.06	6.49	8.45	0.84	0.64	-	-	7.81	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.27	21.85	0.51	5.76	2.29	1.9	1.61	0.85	1.2	13.07	6.1	0.68	0.35	0.01	0.06	6.49	8.45	0.84	0.64	-	-	7.81	1.81	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	82.27
H5008_001_0	2006	OP Facility - Emergency										2250											D	D	D	P	P	Coin	Coin	V	Coin	V	V	Coin	Coin	Coin	P	Coin	P	Coin		Coin	Coin	Coin	P		P	P	Coin					V																																																				-	2516.27	178.9			1866.73	18.63	7.02	187.35	11.3	3214.36	166.91	1.86	0.16	7.34		120.3		0.02		10.96	3.9	7.23										103.82										195/day 1 - 14	175/day 1-16			150/trip	20	20	50	20	0/10 SNF/Non-SNF	0/10 SNF/Non-SNF	20	20	20		20		20		20	20	20					20					40										195	175			50	0.2	0.2	50	0.2	0.5	0.5	0.2	0.2	0.2		0.2		0.2		0.2	0.2	0.2					0.2					40											66.72	59.88			17.11	0.07	0.07	17.11	0.07	0.17	0.17	0.07	0.07	0.07		0.07		0.07		0.07	0.07	0.07					0.07					13.69											13.99	0.89	-	-	2.66	1.27	0.48	0.27	0.77	0.05	0	0.13	0.01	0.5	-	8.23	-	0	-	0.75	0.27	0.5	-	-	-	-	-	-	-	-	-	0.12	-	-	-	-	-	-	-	-	-	30.89	13.99	0.89	-	-	2.66	1.27	0.48	0.27	0.77	0.05	0	0.13	0.01	0.5	-	8.23	-	0	-	0.75	0.27	0.5	-	-	-	-	-	-	-	-	-	0.12	-	-	-	-	-	-	-	-	-	30.89
H5008_002_0	2006											325											D	D			P	P	P	V	V	V	V	V	V	V		P	P	P																																																																		-	2345.91	538.73			306.01	2534.35	2318.43	816.62	327.48	1659.08	816.36	55.91	12.36	2124.41		3207.98	1106.33	534.31																								75/day	75/day			100	20	20	35	25	10	10	50	20	50		25	35 indiv/25 group	10																								75	75			100	27.66	26.62	35	25	10	10	50	530.52	46.38		25	32.5	10																									20.46	20.46			27.28	7.55	7.26	9.55	6.82	2.73	2.73	13.64	144.75	12.65		6.82	8.87	5.32																									4	0.92	-	-	0.7	1.59	1.4	0.65	0.19	0.38	0.19	0.06	0.15	2.24	-	1.82	0.82	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.34	4	0.92	-	-	0.7	1.59	1.4	0.65	0.19	0.38	0.19	0.06	0.15	2.24	-	1.82	0.82	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.34
H5009_001_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	548.82	9.36	0	0	231.3	11.03	7.16	550.8	0	0	0	0	0	0	4693.04	4174.66	238.5	987.3	0	1628.1	6.97	685.8	0	0	402.3	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	33.46	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												4.57	0.08	-	-	0.96	1.23	-	1.54	-	-	-	-	-	-	1.96	1.74	0.1	0.37	-	0.68	0.77	0.29	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.45	4.57	0.08	-	-	0.96	1.23	-	1.54	-	-	-	-	-	-	1.96	1.74	0.1	0.37	-	0.68	0.77	0.29	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.45
H5009_002_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	548.82	9.36	0	0	231.3	11.03	7.16	550.8	0	0	0	0	0	0	4693.04	4174.66	238.5	987.3	0	1628.1	6.97	685.8	0	0	402.3	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	33.46	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												4.57	0.08	-	-	0.96	1.23	-	1.54	-	-	-	-	-	-	1.96	1.74	0.1	0.37	-	0.68	0.77	0.29	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.45	4.57	0.08	-	-	0.96	1.23	-	1.54	-	-	-	-	-	-	1.96	1.74	0.1	0.37	-	0.68	0.77	0.29	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.45
H5010_001_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	600.84	10.17	0	0	268.2	12.25	7.94	468	0	0	0	0	0	0	4732.55	4217.05	252	1041.3	0	1725.3	6	691.2	0	0	404.1	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	30.36	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												5.01	0.08	-	-	1.12	1.36	-	1.18	-	-	-	-	-	-	1.97	1.76	0.11	0.39	-	0.72	0.67	0.29	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.82	5.01	0.08	-	-	1.12	1.36	-	1.18	-	-	-	-	-	-	1.97	1.76	0.11	0.39	-	0.72	0.67	0.29	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.82
H5010_002_0	2006											1500											D	D			T	Coin	Coin	V	V					V	V	V	V			V	Coin	V			V						V											3000																																										-	600.84	10.17	0	0	268.2	12.25	7.94	468	0	0	0	0	0	0	4732.55	4217.05	252	1041.3	0	1725.3	6	691.2	0	0	404.1	0	0	0	0	0	0											100/day (days 1-3)	100/day (days 1-3)						50 ER 5 Urgent																																																																											1500	100	100	0	0	50	0.11	0	30.36	0	0	0	0	0	0	5	5	5	4.5	0	5	0.11	5	0	0	5	0	0	0	0	0	0												5.01	0.08	-	-	1.12	1.36	-	1.18	-	-	-	-	-	-	1.97	1.76	0.11	0.39	-	0.72	0.67	0.29	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.82	5.01	0.08	-	-	1.12	1.36	-	1.18	-	-	-	-	-	-	1.97	1.76	0.11	0.39	-	0.72	0.67	0.29	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.82
H5050_001_0	2006											1000											D	D			T	Coin	Coin	V	V						V	V	V	V	V	V		V	T		V		V		Coin																																																							-	430.36	6.55	0	0	268.49	6.16	3.08	163.21	134.86	0	0	0	0	0	4600.76	2676.81	167.3	250.95	0	669.2	0	623.48	7.87	0	365.16	0	171.04	0	0.23	0	0											100 for 1st 3 days	100 for 1st 3 days																																								100	100	0	0	75	0.2	0.2	50	100	0	0	0	0	0	15	15	15	15		15	0	15	75	0	15	0	15	0	0.2	0	0												95	95	0	0	71.25	0.19	0.19	47.5	95	0	0	0	0	0	14.25	14.25	14.25	14.25	0	14.25	0	14.25	71.25	0	14.25	0	14.25	0	0.19	0	0												3.41	0.05	-	-	1.59	1.17	0.59	0.65	1.07	-	-	-	-	-	5.46	3.18	0.2	0.3	-	0.79	-	0.74	0.05	-	0.43	-	0.2	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	19.92	3.41	0.05	-	-	1.59	1.17	0.59	0.65	1.07	-	-	-	-	-	5.46	3.18	0.2	0.3	-	0.79	-	0.74	0.05	-	0.43	-	0.2	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	19.92
H5050_002_0	2006											1000											D	D			T	Coin	Coin	V	V						V	V	V	V	V	V		V	T		V		V		Coin																																																							-	544.34	8.29	0	0	243.97	5.9	2.95	166.02	178.31	0	0	0	0	0	3712.93	2160.25	135.02	202.52	0	540.06	0	498	4.61	0	1074.6	0	371.79	0	0.33	0	0											100 for 1st 3 days	100 for 1st 3 days																																								100	100	0	0	75	0.2	0.2	50	100	0	0	0	0	0	15	15	15	15		15	0	15	75	0	15	0	15	0	0.2	0	0												95	95	0	0	71.25	0.19	0.19	47.5	95	0	0	0	0	0	14.25	14.25	14.25	14.25	0	14.25	0	14.25	71.25	0	14.25	0	14.25	0	0.19	0	0												4.31	0.07	-	-	1.45	1.12	0.56	0.66	1.41	-	-	-	-	-	4.41	2.57	0.16	0.24	-	0.64	-	0.59	0.03	-	1.28	-	0.44	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	19.99	4.31	0.07	-	-	1.45	1.12	0.56	0.66	1.41	-	-	-	-	-	4.41	2.57	0.16	0.24	-	0.64	-	0.59	0.03	-	1.28	-	0.44	-	0.06	-	-	-	-	-	-	-	-	-	-	-	-	19.99
H5050_004_0	2006											1000											D	D			T	Coin	Coin	V	V						V	V	V	V	V	V		V	T		V		V		Coin																																																							-	669.86	10.2	0	0	536.32	10.54	5.27	256.26	162.35	0	0	0	0	0	6207.51	3611.64	225.73	338.59	0	902.91	0	661.69	11.97	0	261.93	0	621.41	0	0.39	0	0											100 for 1st 3 days	100 for 1st 3 days																																								100	100	0	0	75	0.2	0.2	50	100	0	0	0	0	0	15	15	15	15		15	0	15	75	0	15	0	15	0	0.2	0	0												95	95	0	0	71.25	0.19	0.19	47.5	95	0	0	0	0	0	14.25	14.25	14.25	14.25	0	14.25	0	14.25	71.25	0	14.25	0	14.25	0	0.19	0	0												5.3	0.08	-	-	3.18	2	1	1.01	1.29	-	-	-	-	-	7.37	4.29	0.27	0.4	-	1.07	-	0.79	0.07	-	0.31	-	0.74	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	29.25	5.3	0.08	-	-	3.18	2	1	1.01	1.29	-	-	-	-	-	7.37	4.29	0.27	0.4	-	1.07	-	0.79	0.07	-	0.31	-	0.74	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	29.25
H5050_005_0	2006											1000											D	D			T	Coin	Coin	V	V						V	V	V	V	V	V		V	T		V		V		Coin																																																							-	444.76	6.77	0	0	278.16	1.95	0.98	169.26	139.19	0	0	0	0	0	4758.34	2768.49	173.03	259.55	0	692.12	0	644.93	8.11	0	377.06	0	176.3	0	0	0	0											100 for 1st 3 days	100 for 1st 3 days																																								100	100	0	0	75	0.2	0.2	50	100	0	0	0	0	0	15	15	15	15		15	0	15	75	0	15	0	15	0	0.2	0	0												95	95	0	0	71.25	0.19	0.19	47.5	95	0	0	0	0	0	14.25	14.25	14.25	14.25	0	14.25	0	14.25	71.25	0	14.25	0	14.25	0	0.19	0	0												3.52	0.05	-	-	1.65	0.37	0.19	0.67	1.1	-	-	-	-	-	5.65	3.29	0.21	0.31	-	0.82	-	0.77	0.05	-	0.45	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.3	3.52	0.05	-	-	1.65	0.37	0.19	0.67	1.1	-	-	-	-	-	5.65	3.29	0.21	0.31	-	0.82	-	0.77	0.05	-	0.45	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.3
H5050_006_0	2006											1000											D	D			T	Coin	Coin	V	V						V	V	V	V	V	V		V	T		V		V		Coin																																																							-	669.21	10.19	0	0	535.92	5.22	2.61	256.54	162.04	0	0	0	0	0	6203.02	3609.03	225.56	338.35	0	902.26	0	662.22	12.07	0	261.43	0	620.23	0	0	0	0											100 for 1st 3 days	100 for 1st 3 days																																								100	100	0	0	75	0.2	0.2	50	100	0	0	0	0	0	15	15	15	15		15	0	15	75	0	15	0	15	0	0.2	0	0												95	95	0	0	71.25	0.19	0.19	47.5	95	0	0	0	0	0	14.25	14.25	14.25	14.25	0	14.25	0	14.25	71.25	0	14.25	0	14.25	0	0.19	0	0												5.3	0.08	-	-	3.18	0.99	0.5	1.02	1.28	-	-	-	-	-	7.37	4.29	0.27	0.4	-	1.07	-	0.79	0.07	-	0.31	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.65	5.3	0.08	-	-	3.18	0.99	0.5	1.02	1.28	-	-	-	-	-	7.37	4.29	0.27	0.4	-	1.07	-	0.79	0.07	-	0.31	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.65
H5050_009_0	2006											1000											D	D			T	Coin	Coin	V	V						V	V	V	V	V	V		V	T		V		V		Coin																																																							-	489.44	7.45	0	0	305.35	7.01	3.5	185.61	153.37	0	0	0	0	0	5232.29	3044.24	190.27	285.4	0	761.06	0	709.07	8.95	0	415.29	0	194.51	0	0.26	0	0											100 for 1st 3 days	100 for 1st 3 days																																								100	100	0	0	75	0.2	0.2	50	100	0	0	0	0	0	15	15	15	15		15	0	15	75	0	15	0	15	0	0.2	0	0												95	95	0	0	71.25	0.19	0.19	47.5	95	0	0	0	0	0	14.25	14.25	14.25	14.25	0	14.25	0	14.25	71.25	0	14.25	0	14.25	0	0.19	0	0												3.87	0.06	-	-	1.81	1.33	0.67	0.73	1.21	-	-	-	-	-	6.21	3.62	0.23	0.34	-	0.9	-	0.84	0.05	-	0.49	-	0.23	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	22.66	3.87	0.06	-	-	1.81	1.33	0.67	0.73	1.21	-	-	-	-	-	6.21	3.62	0.23	0.34	-	0.9	-	0.84	0.05	-	0.49	-	0.23	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	22.66
H5050_010_0	2006											1000											D	D			T	Coin	Coin	V	V						V	V	V	V	V	V		V	T		V		V		Coin																																																							-	618.24	9.41	0	0	277.08	6.7	3.35	188.56	202.52	0	0	0	0	0	4216.97	2453.51	153.34	230.02	0	613.38	0	565.6	5.24	0	1220.49	0	422.27	0	0.38	0	0											100 for 1st 3 days	100 for 1st 3 days																																								100	100	0	0	75	0.2	0.2	50	100	0	0	0	0	0	15	15	15	15		15	0	15	75	0	15	0	15	0	0.2	0	0												95	95	0	0	71.25	0.19	0.19	47.5	95	0	0	0	0	0	14.25	14.25	14.25	14.25	0	14.25	0	14.25	71.25	0	14.25	0	14.25	0	0.19	0	0												4.89	0.07	-	-	1.65	1.27	0.64	0.75	1.6	-	-	-	-	-	5.01	2.91	0.18	0.27	-	0.73	-	0.67	0.03	-	1.45	-	0.5	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	22.7	4.89	0.07	-	-	1.65	1.27	0.64	0.75	1.6	-	-	-	-	-	5.01	2.91	0.18	0.27	-	0.73	-	0.67	0.03	-	1.45	-	0.5	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	22.7
H5050_801_0	2006											1000											D	D			T	Coin	Coin	V	V						V	V	V	V	V	V		V	T		V		V		Coin																																																							-	520.01	7.92	0	0	248.03	6.47	3.23	158.63	164.57	0	0	0	0	0	4689.38	2728.37	170.52	255.78	0	682.09	0	656.47	8.15	0	491.7	0	147.44	0	0.37	0	0											100 for 1st 3 days	100 for 1st 3 days																																								100	100	0	0	75	0.2	0.2	50	100	0	0	0	0	0	15	15	15	15		15	0	15	75	0	15	0	15	0	0.2	0	0												95	95	0	0	71.25	0.19	0.19	47.5	95	0	0	0	0	0	14.25	14.25	14.25	14.25	0	14.25	0	14.25	71.25	0	14.25	0	14.25	0	0.19	0	0												4.12	0.06	-	-	1.47	1.23	0.61	0.63	1.3	-	-	-	-	-	5.57	3.24	0.2	0.3	-	0.81	-	0.78	0.05	-	0.58	-	0.18	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	21.21	4.12	0.06	-	-	1.47	1.23	0.61	0.63	1.3	-	-	-	-	-	5.57	3.24	0.2	0.3	-	0.81	-	0.78	0.05	-	0.58	-	0.18	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	21.21
H5050_802_0	2006											1000											D	D			T	Coin	Coin	V	V						V	V	V	V	V	V		V	T		V		V		Coin																																																							-	591.74	9.01	0	0	282.25	7.36	3.68	180.51	187.28	0	0	0	0	0	5336.27	3104.74	194.05	291.07	0	776.18	0	747.03	9.27	0	559.53	0	167.77	0	0.42	0	0											100 for 1st 3 days	100 for 1st 3 days																																								100	100	0	0	75	0.2	0.2	50	100	0	0	0	0	0	15	15	15	15		15	0	15	75	0	15	0	15	0	0.2	0	0												95	95	0	0	71.25	0.19	0.19	47.5	95	0	0	0	0	0	14.25	14.25	14.25	14.25	0	14.25	0	14.25	71.25	0	14.25	0	14.25	0	0.19	0	0												4.68	0.07	-	-	1.68	1.4	0.7	0.71	1.48	-	-	-	-	-	6.34	3.69	0.23	0.35	-	0.92	-	0.89	0.06	-	0.66	-	0.2	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	24.13	4.68	0.07	-	-	1.68	1.4	0.7	0.71	1.48	-	-	-	-	-	6.34	3.69	0.23	0.35	-	0.92	-	0.89	0.06	-	0.66	-	0.2	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	24.13
H5106_007_0	2006											1500											A	A	D	Coin	T	Coin	Coin	P	Coin	Coin	Coin		Coin	Coin			V	V	Coin	Coin	Coin	Coin			V		V															3000	4.06	0.04	0.57	0.3	0	0.28	0.02	0	0.42	0.16	0.45		0	0.16			0	0	0.11	1.12	0.12	0.01			0		0															7.83	380.88	5.34	1273	19.27	231.93	17.98	1.28	440.56	27.16	10.56	28.68		0.32	27.73			171.76	227.91	18.31	155.26	7.82	0.87			378.9		138															10 / admit	10 / admit	10 / day	10 coinsurance	100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	10 coinsurance for Amb. Surg. Svcs and 10 copay for Cardiac Rehabilitation Services and 30 copay for Outpatient Substance Abuse Svcs	10 coinsurance plus 10 for Hospital Based physician costs	10 coinsurance plus 10 for Hospital Based physician costs		10 coinsurance and 0 coinsurance for misc services	15 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	15 copay	10 coinsurance for IP and OP and 0 coinsurance for Office Visits	15 copay for office visits and 20 coinsurance for other services	20 coinsurance	10 coinsurance			15 copay		15 copay															818.48	616.43	34.38	0.1	100	0.2	0.2	41.46	0.1	0.1	0.1		0.08	0.07			30	15	0.04	0.13	0.2	0.1			15		15																399.75	301.07	16.79	0.05	100	0.15	0.15	41.44	0.05	0.05	0.05		0.04	0.05			30	15	0.02	0.11	0.15	0.05			15		15															150	12.69	0.13	1.78	0.94	1.93	2.68	0.19	1.52	1.33	0.52	1.4	-	0.01	1.49	-	-	0.43	0.28	0.34	17.05	1.16	0.04	-	-	0.47	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.57	16.74	0.18	2.35	1.24	1.93	2.96	0.21	1.52	1.75	0.68	1.85	-	0.02	1.65	-	-	0.43	0.28	0.45	18.17	1.29	0.06	-	-	0.47	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.4
H5106_008_0	2006											1500											A	A	D	Coin	T	Coin	Coin	P	Coin	Coin	Coin		Coin	Coin			V	V	Coin	Coin	Coin	Coin			V		V															3000	4.06	0.04	0.57	0.3	0	0.28	0.02	0	0.42	0.16	0.45		0	0.16			0	0	0.11	1.12	0.12	0.01			0		0															7.83	380.88	5.34	1273	19.27	231.93	17.98	1.28	440.56	27.16	10.56	28.68		0.32	27.73			171.76	227.91	18.31	155.26	7.82	0.87			378.9		138															10 / admit	10 / admit	10 / day	10 coinsurance	100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	10 coinsurance for Amb. Surg. Svcs and 10 copay for Cardiac Rehabilitation Services and 30 copay for Outpatient Substance Abuse Svcs	10 coinsurance plus 10 for Hospital Based physician costs	10 coinsurance plus 10 for Hospital Based physician costs		10 coinsurance and 0 coinsurance for misc services	15 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	15 copay	10 coinsurance for IP and OP and 0 coinsurance for Office Visits	15 copay for office visits and 20 coinsurance for other services	20 coinsurance	10 coinsurance			15 copay		15 copay															818.48	616.43	34.38	0.1	100	0.2	0.2	41.46	0.1	0.1	0.1		0.08	0.07			30	15	0.04	0.13	0.2	0.1			15		15																399.75	301.07	16.79	0.05	100	0.15	0.15	41.44	0.05	0.05	0.05		0.04	0.05			30	15	0.02	0.11	0.15	0.05			15		15															150	12.69	0.13	1.78	0.94	1.93	2.68	0.19	1.52	1.33	0.52	1.4	-	0.01	1.49	-	-	0.43	0.28	0.34	17.05	1.16	0.04	-	-	0.47	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.57	16.74	0.18	2.35	1.24	1.93	2.96	0.21	1.52	1.75	0.68	1.85	-	0.02	1.65	-	-	0.43	0.28	0.45	18.17	1.29	0.06	-	-	0.47	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.4
H5106_009_0	2006											1000											A	A			T	Coin	Coin	P	P				Coin	Coin			V	V		Coin	Coin	Coin			V		V															2000	0	0			0	0	0	0	0				0	0			0	0		0	0	0			0		0															-	380.88	5.34			231.93	17.98	1.28	440.56	427.62				0.32	27.73			171.76	227.91		155.26	7.82	0.87			378.9		138															100 / admit	100 / admit			100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	50 Copay				10 coinsurance and 0 coinsurance for misc services	10 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	10 copay		10 copay for office visits and 20 coinsurance for other services	20 coinsurance	10 coinsurance			10 copay		10 copay															100	100			100	0.2	0.2	41.46	50				0.08	0.06			30	10		0.11	0.2	0.1			10		10																-9.11	17.82			100	0.19	0.19	41.46	39.84				0.07	0.06			30	10		0.1	0.19	0.09			10		10															0	-0.29	0.01	-	-	1.93	3.36	0.24	1.52	1.42	-	-	-	0.02	1.54	-	-	0.43	0.19	-	15.77	1.46	0.08	-	-	0.32	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.11	-0.29	0.01	-	-	1.93	3.36	0.24	1.52	1.42	-	-	-	0.02	1.54	-	-	0.43	0.19	-	15.77	1.46	0.08	-	-	0.32	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.11
H5106_010_0	2006											1500											A	A	D	Coin	T	Coin	Coin	P	Coin	Coin	Coin		Coin	Coin			V	V	Coin	Coin	Coin	Coin			V		V															3000	4.02	0.04	0.6	0.35	0	0.27	0.02	0	0.43	0.17	0.45		0	0.16			0	0	0.09	1.12	0.12	0.01			0		0															7.87	409.77	5.89	1450.84	23.75	223.19	18.18	1.29	549.68	29.3	11.39	30.91		0.34	29.86			179.77	238.49	16.04	162.37	8.42	0.94			372.5		135.7															10 / admit	10 / admit	10 / day	10 coinsurance	100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	10 coinsurance for Amb. Surg. Svcs and 10 copay for Cardiac Rehabilitation Services and 30 copay for Outpatient Substance Abuse Svcs	10 coinsurance plus 10 for Hospital Based physician costs	10 coinsurance plus 10 for Hospital Based physician costs		10 coinsurance and 0 coinsurance for misc services	15 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	15 copay	10 coinsurance for IP and OP and 0 coinsurance for Office Visits	15 copay for office visits and 20 coinsurance for other services	20 coinsurance	10 coinsurance			15 copay		15 copay															801.29	587.87	33.76	0.1	100	0.2	0.2	41.46	0.1	0.1	0.1		0.08	0.08			30	15	0.04	0.13	0.2	0.1			15		15																515.35	378.09	9.67	0.03	100	0.13	0.13	41.43	0.03	0.03	0.03		0.02	0.05			30	15	0.01	0.1	0.13	0.03			15		15															150	17.6	0.19	1.17	0.68	1.86	2.34	0.17	1.9	0.84	0.33	0.88	-	0.01	1.55	-	-	0.45	0.3	0.18	15.7	1.08	0.03	-	-	0.47	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.88	21.62	0.23	1.77	1.03	1.86	2.61	0.19	1.9	1.27	0.49	1.34	-	0.01	1.71	-	-	0.45	0.3	0.27	16.83	1.21	0.04	-	-	0.47	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.74
H5106_011_0	2006											1500											A	A	D	Coin	T	Coin	Coin	P	Coin	Coin	Coin		Coin	Coin			V	V	Coin	Coin	Coin	Coin			V		V															3000	4.02	0.04	0.6	0.35	0	0.27	0.02	0	0.43	0.17	0.45		0	0.16			0	0	0.09	1.12	0.12	0.01			0		0															7.87	409.77	5.89	1450.84	23.75	223.19	18.18	1.29	549.68	29.3	11.39	30.91		0.34	29.86			179.77	238.49	16.04	162.37	8.42	0.94			372.5		135.7															10 / admit	10 / admit	10 / day	10 coinsurance	100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	10 coinsurance for Amb. Surg. Svcs and 10 copay for Cardiac Rehabilitation Services and 30 copay for Outpatient Substance Abuse Svcs	10 coinsurance plus 10 for Hospital Based physician costs	10 coinsurance plus 10 for Hospital Based physician costs		10 coinsurance and 0 coinsurance for misc services	15 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	15 copay	10 coinsurance for IP and OP and 0 coinsurance for Office Visits	15 copay for office visits and 20 coinsurance for other services	20 coinsurance	10 coinsurance			15 copay		15 copay															801.29	587.87	33.76	0.1	100	0.2	0.2	41.46	0.1	0.1	0.1		0.08	0.08			30	15	0.04	0.13	0.2	0.1			15		15																515.35	378.09	9.67	0.03	100	0.13	0.13	41.43	0.03	0.03	0.03		0.02	0.05			30	15	0.01	0.1	0.13	0.03			15		15															150	17.6	0.19	1.17	0.68	1.86	2.34	0.17	1.9	0.84	0.33	0.88	-	0.01	1.55	-	-	0.45	0.3	0.18	15.7	1.08	0.03	-	-	0.47	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.88	21.62	0.23	1.77	1.03	1.86	2.61	0.19	1.9	1.27	0.49	1.34	-	0.01	1.71	-	-	0.45	0.3	0.27	16.83	1.21	0.04	-	-	0.47	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.74
H5106_012_0	2006											1000											A	A			T	Coin	Coin	P	P				Coin	Coin			V	V		Coin	Coin	Coin			V		V															2000	0	0			0	0	0	0	0				0	0			0	0		0	0	0			0		0															-	409.77	5.89			223.19	18.18	1.29	549.68	534.06				0.34	29.86			179.77	238.49		162.37	8.42	0.94			372.5		135.7															100 / admit	100 / admit			100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	50 Copay				10 coinsurance and 0 coinsurance for misc services	10 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	10 copay		10 copay for office visits and 20 coinsurance for other services	20 coinsurance	10 coinsurance			10 copay		10 copay															100	100			100	0.2	0.2	41.46	50				0.08	0.06			30	10		0.11	0.2	0.1			10		10																13.05	36.21			100	0.18	0.18	41.45	35.71				0.06	0.06			30	10		0.1	0.18	0.08			10		10															0	0.45	0.02	-	-	1.86	3.24	0.23	1.9	1.59	-	-	-	0.02	1.68	-	-	0.45	0.2	-	15.55	1.5	0.07	-	-	0.31	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.18	0.45	0.02	-	-	1.86	3.24	0.23	1.9	1.59	-	-	-	0.02	1.68	-	-	0.45	0.2	-	15.55	1.5	0.07	-	-	0.31	-	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.18
H5106_801_0	2006											1500											A	A	D	Coin	T	Coin	Coin	P	Coin	Coin	Coin		Coin	Coin			V	V	Coin	Coin	Coin	Coin			V		V															7500	4.05	0.04	0.58	0.31	0	0.28	0.02	0	0.43	0.17	0.45		0	0.16			0	0	0.1	1.12	0.12	0.01			0		0															7.85	387.32	5.52	1312.84	20.24	230.09	18.03	1.28	464.91	27.82	10.81	29.36		0.32	28.38			173.6	230.31	17.81	156.94	8	0.89			377.6		137.6															10 / admit	10 / admit	10 / day	10 coinsurance	100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	10 coinsurance for Amb. Surg. Svcs and 25 copay for Cardiac Rehabilitation Services and 25 copay for Outpatient Substance Abuse Svcs	10 coinsurance plus 10 for Hospital Based physician costs	10 coinsurance plus 10 for Hospital Based physician costs		10 coinsurance and 0 coinsurance for misc services	25 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	25 copay	10 coinsurance for IP and OP and 0 coinsurance for Office Visits	25 copay for office visits and 10 coinsurance for other services	20 coinsurance	10 coinsurance			25 copay		25 copay															814.6	601.61	34.24	0.1	100	0.2	0.2	41.46	0.1	0.1	0.1		0.08	0.1			30	18.74	0.04	0.18	0.2	0.1			25		25																415.62	306.95	17.47	0.05	100	0.1	0.1	41.44	0.05	0.05	0.05		0.04	0.08			30	18.74	0.02	0.16	0.1	0.05			25		25															150	13.41	0.14	1.91	1.03	1.92	1.84	0.13	1.61	1.42	0.55	1.5	-	0.01	2.28	-	-	0.43	0.36	0.35	25.21	0.82	0.05	-	-	0.79	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.04	17.46	0.18	2.49	1.34	1.92	2.12	0.15	1.61	1.85	0.72	1.95	-	0.02	2.44	-	-	0.43	0.36	0.45	26.33	0.94	0.06	-	-	0.79	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.89
H5106_802_0	2006											1500											A	A	D	Coin	T	Coin	Coin	P	Coin	Coin	Coin		Coin	Coin			V	V	Coin	Coin	Coin	Coin			V		V															7500	4.05	0.04	0.58	0.31	0	0.28	0.02	0	0.43	0.17	0.45		0	0.16			0	0	0.1	1.12	0.12	0.01			0		0															7.85	387.32	5.52	1312.84	20.24	230.09	18.03	1.28	464.91	27.82	10.81	29.36		0.32	28.38			173.6	230.31	17.81	156.94	8	0.89			377.6		137.6															10 / admit	10 / admit	10 / day	10 coinsurance	100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	10 coinsurance for Amb. Surg. Svcs and 25 copay for Cardiac Rehabilitation Services and 25 copay for Outpatient Substance Abuse Svcs	10 coinsurance plus 10 for Hospital Based physician costs	10 coinsurance plus 10 for Hospital Based physician costs		10 coinsurance and 0 coinsurance for misc services	25 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	25 copay	10 coinsurance for IP and OP and 0 coinsurance for Office Visits	25 copay for office visits and 10 coinsurance for other services	20 coinsurance	10 coinsurance			25 copay		25 copay															814.6	601.61	34.24	0.1	100	0.2	0.2	41.46	0.1	0.1	0.1		0.08	0.1			30	18.74	0.04	0.18	0.2	0.1			25		25																415.62	306.95	17.47	0.05	100	0.1	0.1	41.44	0.05	0.05	0.05		0.04	0.08			30	18.74	0.02	0.16	0.1	0.05			25		25															150	13.41	0.14	1.91	1.03	1.92	1.84	0.13	1.61	1.42	0.55	1.5	-	0.01	2.28	-	-	0.43	0.36	0.35	25.21	0.82	0.05	-	-	0.79	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.04	17.46	0.18	2.49	1.34	1.92	2.12	0.15	1.61	1.85	0.72	1.95	-	0.02	2.44	-	-	0.43	0.36	0.45	26.33	0.94	0.06	-	-	0.79	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.89
H5106_803_0	2006											1500											A	A	D	Coin	T	Coin	Coin	P	Coin	Coin	Coin		Coin	Coin			V	V	Coin	Coin	Coin	Coin			V		V															7500	4.05	0.04	0.58	0.31	0	0.28	0.02	0	0.43	0.17	0.45		0	0.16			0	0	0.1	1.12	0.12	0.01			0		0															7.85	387.32	5.52	1312.84	20.24	230.09	18.03	1.28	464.91	27.82	10.81	29.36		0.32	28.38			173.6	230.31	17.81	156.94	8	0.89			377.6		137.6															10 / admit	10 / admit	10 / day	10 coinsurance	100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	10 coinsurance for Amb. Surg. Svcs and 25 copay for Cardiac Rehabilitation Services and 25 copay for Outpatient Substance Abuse Svcs	10 coinsurance plus 10 for Hospital Based physician costs	10 coinsurance plus 10 for Hospital Based physician costs		10 coinsurance and 0 coinsurance for misc services	25 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	25 copay	10 coinsurance for IP and OP and 0 coinsurance for Office Visits	25 copay for office visits and 10 coinsurance for other services	20 coinsurance	10 coinsurance			25 copay		25 copay															814.6	601.61	34.24	0.1	100	0.2	0.2	41.46	0.1	0.1	0.1		0.08	0.1			30	18.74	0.04	0.18	0.2	0.1			25		25																415.62	306.95	17.47	0.05	100	0.1	0.1	41.44	0.05	0.05	0.05		0.04	0.08			30	18.74	0.02	0.16	0.1	0.05			25		25															150	13.41	0.14	1.91	1.03	1.92	1.84	0.13	1.61	1.42	0.55	1.5	-	0.01	2.28	-	-	0.43	0.36	0.35	25.21	0.82	0.05	-	-	0.79	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.04	17.46	0.18	2.49	1.34	1.92	2.12	0.15	1.61	1.85	0.72	1.95	-	0.02	2.44	-	-	0.43	0.36	0.45	26.33	0.94	0.06	-	-	0.79	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.89
H5106_804_0	2006											1500											A	A	D	Coin	T	Coin	Coin	P	Coin	Coin	Coin		Coin	Coin			V	V	Coin	Coin	Coin	Coin			V		V															7500	4.05	0.04	0.58	0.31	0	0.28	0.02	0	0.43	0.17	0.45		0	0.16			0	0	0.1	1.12	0.12	0.01			0		0															7.85	387.32	5.52	1312.84	20.24	230.09	18.03	1.28	464.91	27.82	10.81	29.36		0.32	28.38			173.6	230.31	17.81	156.94	8	0.89			377.6		137.6															10 / admit	10 / admit	10 / day	10 coinsurance	100 copay	20 coinsurance	20 coinsurance	50 copay for ER and 25 copay for Urgent Care	10 coinsurance for Amb. Surg. Svcs and 25 copay for Cardiac Rehabilitation Services and 25 copay for Outpatient Substance Abuse Svcs	10 coinsurance plus 10 for Hospital Based physician costs	10 coinsurance plus 10 for Hospital Based physician costs		10 coinsurance and 0 coinsurance for misc services	25 copay for cardiovascular and PT/OT/ST and 10 coinsurance and 0 coinsurance for misc services for other services			30 copay	25 copay	10 coinsurance for IP and OP and 0 coinsurance for Office Visits	25 copay for office visits and 10 coinsurance for other services	20 coinsurance	10 coinsurance			25 copay		25 copay															814.6	601.61	34.24	0.1	100	0.2	0.2	41.46	0.1	0.1	0.1		0.08	0.1			30	18.74	0.04	0.18	0.2	0.1			25		25																415.62	306.95	17.47	0.05	100	0.1	0.1	41.44	0.05	0.05	0.05		0.04	0.08			30	18.74	0.02	0.16	0.1	0.05			25		25															150	13.41	0.14	1.91	1.03	1.92	1.84	0.13	1.61	1.42	0.55	1.5	-	0.01	2.28	-	-	0.43	0.36	0.35	25.21	0.82	0.05	-	-	0.79	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.04	17.46	0.18	2.49	1.34	1.92	2.12	0.15	1.61	1.85	0.72	1.95	-	0.02	2.44	-	-	0.43	0.36	0.45	26.33	0.94	0.06	-	-	0.79	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.89
H5151_002_0	2006											N/A											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	P	V	P	O	O	O											N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2166	37.1	2048	1741.7	306.8	915.1	0	325.2	358.5	14657.7	2145.4	67.8	44.1	5772.9	4080.4	3616	164.3	4.3	0	28.3	2662.1	0	0	0	0	0	16.5	0	0	0	0											50 / days 1-10	50 / days 1-10	0	0	0	20	20	50	0	0	0	0	0	20	15	15	20	20	0	0	20	0	0	0	15	15	0	0	0	0	0											43.72	43.72	0	0	0	40.37	0.2	50	0	0	0	0	0	11.2	15	15	20	20	0	0	11.01	0	0	0	15	15	0	0	0	0	0											N/A	43.72	43.72	0	0	0	40.37	0.2	50	0	0	0	0	0	11.2	15	15	20	20	0	0	11.01	0	0	0	15	15	0	0	0	0	0											0	7.89	0.14	-	-	-	3.08	-	1.36	-	-	-	-	-	5.39	5.1	4.52	0.27	0.01	-	-	2.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.19	7.89	0.14	-	-	-	3.08	-	1.36	-	-	-	-	-	5.39	5.1	4.52	0.27	0.01	-	-	2.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.19
H5151_003_0	2006											N/A											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	P	V	P	O	O	O											N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1940.2	33.3	1834.4	1560.1	274.8	819.7	0	291.3	321.2	13129.5	1921.8	60.7	39.5	5171	3654.9	3239	147.2	3.9	0	25.3	2384.5	0	0	0	0	0	14.8	0	0	0	0											50 / days 1-10	50 / days 1-10	0	0	0	20	20	50	0	0	0	0	0	20	15	15	20	20	0	0	20	0	0	0	15	15	0	0	0	0	0											43.72	43.72	0	0	0	40.67	0.2	50	0	0	0	0	0	11.2	15	15	20	20	0	0	11.09	0	0	0	15	15	0	0	0	0	0											N/A	43.72	43.72	0	0	0	40.67	0.2	50	0	0	0	0	0	11.2	15	15	20	20	0	0	11.09	0	0	0	15	15	0	0	0	0	0											0	7.07	0.12	-	-	-	2.78	-	1.21	-	-	-	-	-	4.83	4.57	4.05	0.25	0.01	-	-	2.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.08	7.07	0.12	-	-	-	2.78	-	1.21	-	-	-	-	-	4.83	4.57	4.05	0.25	0.01	-	-	2.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.08
H5151_004_0	2006											N/A											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	P	V	P	O	O	O											N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2077.5	35.6	1964.3	1670.5	294.3	877.7	0	311.9	343.9	14058.5	2057.7	65	42.3	5536.9	3913.6	3468.2	157.6	4.1	0	27.1	2553.2	0	0	0	0	0	15.9	0	0	0	0											50 / days 1-10	50 / days 1-10	0	0	0	20	20	50	0	0	0	0	0	20	15	15	20	20	0	0	20	0	0	0	15	15	0	0	0	0	0											43.72	43.72	0	0	0	38.27	0.2	50	0	0	0	0	0	11.2	15	15	20	20	0	0	10.44	0	0	0	15	15	0	0	0	0	0											N/A	43.72	43.72	0	0	0	38.27	0.2	50	0	0	0	0	0	11.2	15	15	20	20	0	0	10.44	0	0	0	15	15	0	0	0	0	0												7.57	0.13	-	-	-	2.8	-	1.3	-	-	-	-	-	5.17	4.89	4.34	0.26	0.01	-	-	2.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.68	7.57	0.13	-	-	-	2.8	-	1.3	-	-	-	-	-	5.17	4.89	4.34	0.26	0.01	-	-	2.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.68
H5151_005_0	2006											N/A											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	P	V	P	O	O	O											N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1860.9	31.9	1759.5	1496.3	263.6	786.2	0	279.4	308	12592.8	1843.2	58.2	37.9	4959.7	3505.5	3106.6	141.2	3.7	0	24.3	2287	0	0	0	0	0	14.2	0	0	0	0											50 / days 1-10	50 / days 1-10	0	0	0	20	20	50	0	0	0	0	0	20	15	15	20	20	0	0	20	0	0	0	15	15	0	0	0	0	0											43.72	43.72	0	0	0	38.54	0.2	50	0	0	0	0	0	11.2	15	15	20	20	0	0	10.51	0	0	0	15	15	0	0	0	0	0											N/A	43.72	43.72	0	0	0	38.54	0.2	50	0	0	0	0	0	11.2	15	15	20	20	0	0	10.51	0	0	0	15	15	0	0	0	0	0												6.78	0.12	-	-	-	2.52	-	1.16	-	-	-	-	-	4.63	4.38	3.88	0.24	0.01	-	-	2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.72	6.78	0.12	-	-	-	2.52	-	1.16	-	-	-	-	-	4.63	4.38	3.88	0.24	0.01	-	-	2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.72
H5151_802_0	2006											N/A											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	V	V	P	V	P	O	O	O											N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	2455.3	36.6	2017.7	1700.3	297.8	930	0	320.6	350.3	14443.3	2108.1	65.1	41	5681	4016.3	3621.1	155	11.2	0	27.3	2740.6	0	0	0	0	0	15.1	0	0	0	0											50 / days 1-10	50 / days 1-10	0	0	0	20	20	50	0	0	0	0	0	20	15	15	20	20	0	0	20	0	0	0	15	15	0	0	0	0	0											43.72	43.72	0	0	0	55	0.2	50	0	0	0	0	0	4.82	15	15	20	20	0	0	19.55	0	0	0	15	15	0	0	0	0	0											N/A	43.72	43.72	0	0	0	55	0.2	50	0	0	0	0	0	4.82	15	15	20	20	0	0	19.55	0	0	0	15	15	0	0	0	0	0											0	8.94	0.13	-	-	-	4.26	-	1.34	-	-	-	-	-	2.28	5.02	4.53	0.26	0.02	-	-	4.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.25	8.94	0.13	-	-	-	4.26	-	1.34	-	-	-	-	-	2.28	5.02	4.53	0.26	0.02	-	-	4.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.25
H5204_002_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	524.61	120.87	235.25	0	33.66	29.03	37	28.74	38.33	51.64	16.83	1.83	2.44	148.35	12.42	33.29	55.99	2.4	22.53	216.05	44.46	0																				Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co																				0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					41.71	9.61	39.24	-	7.84	6.76	8.62	6.7	8.93	12.03	3.92	0.43	0.57	34.57	2.89	7.76	13.05	0.56	5.25	50.34	10.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	271.13	41.71	9.61	39.24	-	7.84	6.76	8.62	6.7	8.93	12.03	3.92	0.43	0.57	34.57	2.89	7.76	13.05	0.56	5.25	50.34	10.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	271.13
H5206_002_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	475.28	46.42	239.19	0	40.36	24.39	37.92	32.7	30.09	35.03	9.5	1.43	2.67	100.74	8	28.97	32.96	1.81	24.01	211.88	34.99	0																				Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co																				0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					37.78	3.69	39.9	-	9.4	5.68	8.84	7.62	7.01	8.16	2.21	0.33	0.62	23.47	1.86	6.75	7.68	0.42	5.59	49.37	8.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	234.56	37.78	3.69	39.9	-	9.4	5.68	8.84	7.62	7.01	8.16	2.21	0.33	0.62	23.47	1.86	6.75	7.68	0.42	5.59	49.37	8.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	234.56
H5207_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	523.73	41.07	244.57	0	52.91	15	25	28.93	21.76	53.98	14.52	2.29	4.38	154.68	9.52	36.66	38.3	2.31	31.27	272.37	30.63	0																				Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					37.62	2.95	40.59	-	12.33	3.49	5.82	6.74	5.07	12.58	3.38	0.53	1.02	36.04	2.22	8.54	8.92	0.54	7.29	63.46	7.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	266.27	37.62	2.95	40.59	-	12.33	3.49	5.82	6.74	5.07	12.58	3.38	0.53	1.02	36.04	2.22	8.54	8.92	0.54	7.29	63.46	7.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	266.27
H5209_002_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	425.69	31.96	304.29	0	38.68	14.86	24.73	23.08	17.11	43.45	11.4	1.86	3.67	123.14	7.53	29.42	30.1	1.8	25.32	219.81	26.68	0																				Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co																				0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					33.84	2.54	50.76	-	9.01	3.46	5.76	5.38	3.99	10.12	2.66	0.43	0.85	28.69	1.76	6.85	7.01	0.42	5.9	51.22	6.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	236.87	33.84	2.54	50.76	-	9.01	3.46	5.76	5.38	3.99	10.12	2.66	0.43	0.85	28.69	1.76	6.85	7.01	0.42	5.9	51.22	6.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	236.87
H5211_001_0	2006											500																		V							V	V	V								V		V															500																																										-								201.33							3302.15	5033.96	59.17								1.49		0.33																																																															50							20	20	20								20		20															500								50							19.4	19.4	19.4								19.4		19.4																-	-	-	-	-	-	-	0.84	-	-	-	-	-	-	5.34	8.14	0.1	-	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.41	-	-	-	-	-	-	-	0.84	-	-	-	-	-	-	5.34	8.14	0.1	-	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.41
H5211_002_0	2006											2500											D	D	D		T	Coin	Coin	V	V						V	V	V								V		V															2500																																										-	1430.45	15.49	1308.17		126.32	3.49	7.55	201.33	744.16						3302.15	5033.96	59.17								1.49		0.33															150 for 1st 5 days	150 for 1st 5 days	50 for 1st 20 days																																							117.26	117.26	33.18		50	0.2	0.2	50	50						30	30	30								30		30															2500	111.87	111.87	31.65		47.7	0.19	0.19	50	47.7						28.62	28.62	28.62								28.62		28.62																13.34	0.14	3.45	-	0.5	0.67	1.44	0.84	2.96	-	-	-	-	-	7.88	12.01	0.14	-	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.36	13.34	0.14	3.45	-	0.5	0.67	1.44	0.84	2.96	-	-	-	-	-	7.88	12.01	0.14	-	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.36
H5211_003_0	2006											2500											D	D	D		T	Coin	Coin	V	V						V	V	V								V		V															2500																																										-	1430.45	15.49	1308.17		126.32	3.49	7.55	201.33	744.16						3302.15	5033.96	59.17								1.49		0.33															150 for 1st 5 days	150 for 1st 5 days	50 for 1st 20 days																																							117.26	117.26	33.18		50	0.2	0.2	50	50						30	30	30								30		30															2500	111.87	111.87	31.65		47.7	0.19	0.19	50	47.7						28.62	28.62	28.62								28.62		28.62																13.34	0.14	3.45	-	0.5	0.67	1.44	0.84	2.96	-	-	-	-	-	7.88	12.01	0.14	-	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.36	13.34	0.14	3.45	-	0.5	0.67	1.44	0.84	2.96	-	-	-	-	-	7.88	12.01	0.14	-	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.36
H5211_004_0	2006											500																		V							V	V	V								V		V															500																																										-								201.33							3302.15	5033.96	59.17								1.49		0.33																																																															50							20	20	20								20		20															500								50							19.4	19.4	19.4								19.4		19.4																-	-	-	-	-	-	-	0.84	-	-	-	-	-	-	5.34	8.14	0.1	-	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.41	-	-	-	-	-	-	-	0.84	-	-	-	-	-	-	5.34	8.14	0.1	-	-	-	-	-	-	-	0	-	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.41
H5214_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	943.82	19.99	988.06	460.55	129.1	16.79	1.26	363.8	288.24				15.72	1776.16	5698.18	9937.4					4.45			6.69	0		0					49.67	1.05	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-175	Oct-50	35-50					0.2			25 - 75								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	51.64	10.78	35.29					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	51.64	10.78	35.29					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0				0	9.36	0.2	0.97	0.38	1.08	3.36	0.25	1.23	2.8	-	-	-	-	7.64	5.12	29.23	-	-	-	-	0.89	-	-	2.36	-	-	-	-	-	-	-	0.49	0.01	-	-	-	-	-	-	-	-	65.38	9.36	0.2	0.97	0.38	1.08	3.36	0.25	1.23	2.8	-	-	-	-	7.64	5.12	29.23	-	-	-	-	0.89	-	-	2.36	-	-	-	-	-	-	-	0.49	0.01	-	-	-	-	-	-	-	-	65.38
H5214_003_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	943.87	19.99	988.12	460.58	129.11	16.79	1.26	363.82	288.26				15.72	1776.26	5698.52	9937.98					4.45			6.69	0		0					49.68	1.05	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	10	100	20	20	35-50	100-150				0	0-175	0-50	35-50					0.2			25 - 75								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	51.64	0.98	35.29					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	10	100	0.2	0.2	40.7	116.5				0	51.64	0.98	35.29					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0				0	9.36	0.2	0.97	0.38	1.08	3.36	0.25	1.23	2.8	-	-	-	-	7.64	0.47	29.23	-	-	-	-	0.89	-	-	2.36	-	-	-	-	-	-	-	0.49	0.01	-	-	-	-	-	-	-	-	60.73	9.36	0.2	0.97	0.38	1.08	3.36	0.25	1.23	2.8	-	-	-	-	7.64	0.47	29.23	-	-	-	-	0.89	-	-	2.36	-	-	-	-	-	-	-	0.49	0.01	-	-	-	-	-	-	-	-	60.73
H5214_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	233.85	5.31	1022.13	476.43	133.56	18.1	1.36	376.34	298.18				16.26	1837.4	5894.65	10280.03					4.45			0	0		0					12.31	0.28	0	0	0	0	0				600 per admit	600 per admit	100 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35-50					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.19	25.2	35.29					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.19	25.2	35.29					20			0	0		0					600	600	0	0	0	0	0				0	11.69	0.27	0.75	0.4	1.11	4.53	0.34	1.42	4.97	-	-	-	-	5.23	12.38	30.24	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.84	11.69	0.27	0.75	0.4	1.11	4.53	0.34	1.42	4.97	-	-	-	-	5.23	12.38	30.24	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.84
H5214_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	233.85	5.31	1022.13	476.43	133.56	18.1	1.36	376.34	298.18				16.26	1837.39	5894.63	10279.99					4.45			0	0		0					12.31	0.28	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.19	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.19	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	11.69	0.27	0.75	0.4	1.11	4.53	0.34	1.42	4.97	-	-	-	-	5.23	12.38	29.98	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.59	11.69	0.27	0.75	0.4	1.11	4.53	0.34	1.42	4.97	-	-	-	-	5.23	12.38	29.98	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.59
H5214_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	233.85	5.31	1022.13	476.43	133.56	18.1	1.36	376.34	298.18				16.26	1837.4	5894.65	10280.03					4.45			0	0		0					12.31	0.28	0	0	0	0	0				600 per admit	600 per admit	100 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35-50					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.19	25.2	35.29					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.19	25.2	35.29					20			0	0		0					600	600	0	0	0	0	0				0	11.69	0.27	0.75	0.4	1.11	4.53	0.34	1.42	4.97	-	-	-	-	5.23	12.38	30.24	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.84	11.69	0.27	0.75	0.4	1.11	4.53	0.34	1.42	4.97	-	-	-	-	5.23	12.38	30.24	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.84
H5214_805_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	233.85	5.31	1022.13	476.43	133.56	18.1	1.36	376.34	298.18				16.26	1837.39	5894.63	10279.99					4.45			0	0		0					12.31	0.28	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.19	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.19	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	11.69	0.27	0.75	0.4	1.11	4.53	0.34	1.42	4.97	-	-	-	-	5.23	12.38	29.98	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.59	11.69	0.27	0.75	0.4	1.11	4.53	0.34	1.42	4.97	-	-	-	-	5.23	12.38	29.98	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	74.59
H5215_001_0	2006											0											D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	V	V	V	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	-	-	-	-	254.48	6.85	4.44	377.9	-	2014.52	859.95	-	23.4	-	3375.9	2578.5	186.3	230.4	-	1287	6.54	493.2	-	-	-	-	-	-	-	-	-											-	-	-	-	25	10	10	50	-	0	May-50	-	10	-	5	5	10	10	-	10	10	10	-	-	-	-	-	-	-	-	-											-	-	-	-	25	10	10	49.9	-	5	35	-	10	-	5	10	10	10	-	10	10	10	-	-	-	-	-	-	-	-	-											0	-	-	-	-	25	10	10	49.9	-	5	35	-	10	-	5	10	10	10	-	10	5	10	-	-	-	-	-	-	-	-	-												-	-	-	-	0.53	0.68	0.44	1.57	-	0.84	2.51	-	0.02	-	1.41	2.15	0.16	0.19	-	1.07	0.33	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.3	-	-	-	-	0.53	0.68	0.44	1.57	-	0.84	2.51	-	0.02	-	1.41	2.15	0.16	0.19	-	1.07	0.33	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.3
H5215_002_0	2006											0											D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	V	V	V	O	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	-	-	-	-	254.48	6.85	4.44	377.9	-	2014.52	859.95	-	23.4	-	3375.9	2578.5	186.3	230.4	-	1287	6.54	493.2	-	-	-	-	-	-	-	-	-											-	-	-	-	25	10	10	50	-	0	May-50	-	10	-	5	5	10	10	-	10	10	10	-	-	-	-	-	-	-	-	-											-	-	-	-	25	10	10	49.9	-	5	35	-	10	-	5	10	10	10	-	10	10	10	-	-	-	-	-	-	-	-	-											0	-	-	-	-	25	10	10	49.9	-	5	35	-	10	-	5	10	10	10	-	10	5	10	-	-	-	-	-	-	-	-	-												-	-	-	-	0.53	0.68	0.44	1.57	-	0.84	2.51	-	0.02	-	1.41	2.15	0.16	0.19	-	1.07	0.33	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.3	-	-	-	-	0.53	0.68	0.44	1.57	-	0.84	2.51	-	0.02	-	1.41	2.15	0.16	0.19	-	1.07	0.33	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	12.3
H5215_801_0	2006											0											D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	V	T	V	V	P	V	V	Coin	V	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	575.56	11.16	564.3	581.4	253.35	6.83	4.4	376.9	344.34	2006.51	856.58	-	22.5	-	3053.7	2333.7	170.1	210.6	-	1170	6.53	451.26	-	-	-	-	-	-	-	-	-											175	175	40	30	25	15	15	50	100	15	10 or 50	-	30	-	15	30	30	30	-	30	15	30	-	-	-	-	-	-	-	-	-											175	175	40	30	25	15	15	50	100	15	75	-	30	-	15	30	30	30	-	30	15	30	-	-	-	-	-	-	-	-	-											0	175	175	40	30	25	15	15	49.95	100	15	75	-	30	-	15	30	30	30	-	29.26	8	30	-	-	-	-	-	-	-	-	-											0	8.39	0.16	1.88	1.45	0.53	1.02	0.65	1.57	2.87	2.51	5.35	-	0.06	-	3.82	5.83	0.43	0.53	-	2.85	0.49	1.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.52	8.39	0.16	1.88	1.45	0.53	1.02	0.65	1.57	2.87	2.51	5.35	-	0.06	-	3.82	5.83	0.43	0.53	-	2.85	0.49	1.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.52
H5215_804_0	2006											0											D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V	V	Coin	V	T	V	V	P	V	V	Coin	V	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	583.88	11.16	571.5	600.3	253.35	6.83	4.4	376.9	344.34	2006.51	856.58	-	22.5	-	3191.4	2438.1	173.7	215.1	-	1197	6.53	461.16	-	-	-	-	-	-	-	-	-											75	75	25	20	25	10	10	50	100	10	10 or 50	-	20	-	10	20	20	20	-	20	10	20	-	-	-	-	-	-	-	-	-											75	75	25	20	25	10	10	50	100	10	50	-	20	-	10	20	20	20	-	20	10	20	-	-	-	-	-	-	-	-	-											0	75	75	25	20	25	10	10	49.93	100	10	50	-	20	-	10	20	20	20	-	20	5	20	-	-	-	-	-	-	-	-	-											0	3.65	0.07	1.19	1	0.53	0.68	0.43	1.57	2.87	1.67	3.57	-	0.04	-	2.66	4.06	0.29	0.36	-	2	0.33	0.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.73	3.65	0.07	1.19	1	0.53	0.68	0.43	1.57	2.87	1.67	3.57	-	0.04	-	2.66	4.06	0.29	0.36	-	2	0.33	0.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.73
H5216_001_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	974.3	20.64	1019.97	475.42	133.27	17.04	1.28	375.55	297.55				16.22	1833.52	5882.22	10258.34					4.45			7.94	0		0					51.28	1.09	0	0	0	0	0				175 per day (1-5)	175 per day (1-5)	0 per day (1-13) 75 per day (14-100)	0	100	20	20	35-50	100				0	0-50	Oct-50	35-50					0.2			25 - 75								175 per day (1-5)	175 per day (1-5)	0	0	0	0	0				119.04	119.04	11.79	0	100	0.2	0.2	40.7	100				0	37.08	10.78	35.29					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0					119.04	119.04	11.79	0	100	0.2	0.2	40.7	100				0	37.08	10.78	35.29					0.2			0.35	0		0					119.04	119.04	0	0	0	0	0				0	9.66	0.2	1	-	1.11	3.41	0.26	1.27	2.48	-	-	-	-	5.66	5.29	30.17	-	-	-	-	0.89	-	-	2.8	-	-	-	-	-	-	-	0.51	0.01	-	-	-	-	-	-	-	-	64.73	9.66	0.2	1	-	1.11	3.41	0.26	1.27	2.48	-	-	-	-	5.66	5.29	30.17	-	-	-	-	0.89	-	-	2.8	-	-	-	-	-	-	-	0.51	0.01	-	-	-	-	-	-	-	-	64.73
H5216_002_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	932.11	19.75	487.9	454.84	127.5	15.39	1.16	359.29	284.66				15.52	1754.12	5627.48	9814.1					4.45			7.94	0		0					49.06	1.04	0	0	0	0	0				75 per day (1-5)	75 per day (1-5)	0 per day (1-13) 25 per day (14-100)	0	100	20	20	35-50	50				0	0-50	Oct-50	35-50					20			25								75 per day (1-5)	75 per day (1-5)	0	0	0	0	0				51.02	51.02	7.86	0	100	0.2	0.2	40.7	50				0	36.81	10.78	35.29					20			0.35	0		0					51.02	51.02	0	0	0	0	0					51.02	51.02	7.86	0	100	0.2	0.2	40.7	50				0	36.81	10.78	35.29					20			0.35	0		0					51.02	51.02	0	0	0	0	0				0	3.96	0.08	0.32	-	1.06	3.08	0.23	1.22	1.19	-	-	-	-	5.38	5.06	28.87	-	-	-	-	0.89	-	-	2.8	-	-	-	-	-	-	-	0.21	0	-	-	-	-	-	-	-	-	54.35	3.96	0.08	0.32	-	1.06	3.08	0.23	1.22	1.19	-	-	-	-	5.38	5.06	28.87	-	-	-	-	0.89	-	-	2.8	-	-	-	-	-	-	-	0.21	0	-	-	-	-	-	-	-	-	54.35
H5216_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	235.21	5.34	1036.24	483.01	135.4	17.65	1.33	381.54	302.3				16.48	1862.77	5976.04	10421.96					4.45			0	0		0					12.38	0.28	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.27	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.27	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	11.76	0.27	0.76	0.4	1.13	4.41	0.33	1.44	5.04	-	-	-	-	5.32	12.55	30.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	75.33	11.76	0.27	0.76	0.4	1.13	4.41	0.33	1.44	5.04	-	-	-	-	5.32	12.55	30.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	75.33
H5216_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	235.2	5.34	1036.23	483	135.4	17.65	1.33	381.54	302.29				16.48	1862.74	5975.95	10421.82					4.45			0	0		0					12.38	0.28	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.27	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.27	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	11.76	0.27	0.76	0.4	1.13	4.41	0.33	1.44	5.04	-	-	-	-	5.32	12.55	30.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	75.33	11.76	0.27	0.76	0.4	1.13	4.41	0.33	1.44	5.04	-	-	-	-	5.32	12.55	30.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	75.33
H5216_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	235.21	5.34	1036.24	483.01	135.4	17.65	1.33	381.54	302.3				16.48	1862.77	5976.04	10421.96					4.45			0	0		0					12.38	0.28	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.27	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.27	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	11.76	0.27	0.76	0.4	1.13	4.41	0.33	1.44	5.04	-	-	-	-	5.32	12.55	30.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	75.33	11.76	0.27	0.76	0.4	1.13	4.41	0.33	1.44	5.04	-	-	-	-	5.32	12.55	30.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	75.33
H5216_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	235.2	5.34	1036.23	483	135.4	17.65	1.33	381.54	302.29				16.48	1862.74	5975.95	10421.82					4.45			0	0		0					12.38	0.28	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.27	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.27	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	11.76	0.27	0.76	0.4	1.13	4.41	0.33	1.44	5.04	-	-	-	-	5.32	12.55	30.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	75.33	11.76	0.27	0.76	0.4	1.13	4.41	0.33	1.44	5.04	-	-	-	-	5.32	12.55	30.4	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.62	0.01	-	-	-	-	-	-	-	-	75.33
H5253_004_0	2006																						D	D	D	Coin	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	1679.82	8.01	846.83		170.9	6.26	3.27	222.89	71.48	7668.9	46.44		5.11	0.86	3260.94	2711.59	4.91	1.57			12.11	732.95			46.18	42.18	212.97		2266.87													295	17500	150	0	150	0	0	25/50	0	10	20-Oct	20 (included in G)	0.3	20.0 / 40 / 30	20 / 0	35	40 / 30	0	0	0	0.3	0 / 35			35	15	35		See PBP	0												295	175	150		150	0.2	0.2	25/50	0.2	10	20-Oct		0.3	20.0 / 40 / 30	20	35	40 / 30	0.2			0.3	0 / 35			35	15	35		See PBP													4800	189.93	112.67	96.57		96.57	0.13	0.16	31.59	0.13	2.58	0.09		0.19	0.13	20	35	37.5	0.13			0.19	35			35	15	35		29.17														26.59	0.08	6.82	-	1.38	0.81	0.53	0.59	9.2	1.65	4.01	-	0.99	0.11	5.43	7.91	0.02	0.2	-	-	2.34	2.14	-	-	0.13	0.05	0.62	-	5.51	-	-	-	-	-	-	-	-	-	-	-	-	77.08	26.59	0.08	6.82	-	1.38	0.81	0.53	0.59	9.2	1.65	4.01	-	0.99	0.11	5.43	7.91	0.02	0.2	-	-	2.34	2.14	-	-	0.13	0.05	0.62	-	5.51	-	-	-	-	-	-	-	-	-	-	-	-	77.08
H5253_006_0	2006											4200											D	D	D	Coin	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	1775.33	9.02	872.71		173.9	6.55	3.48	233.55	80.17	8411.4	53.91		5.03	0.94	3521.32	2981.87	5.11	1.83			17.78	801.42			49.96	45.69	213.92															250	175	125	0	150	0	0	25/50	0	10	20-Oct	20 (included in G)	0.2	20.0 / 40 / 30	15 / 0	25	40 / 30	0	0	0	0.2	0 / 25			25	15	25			0												250	175	125		150	0.2	0.2	25/50	0.2	10	20-Oct		0.2	20.0 / 40 / 30	15	25	40 / 30	0.2			0.2	0 / 25			25	15	25																160.48	112.34	80.24		96.29	0.13	0.16	31.51	0.13	2.57	0.09		0.13	0.13	15	25	37.5	0.13			0.13	25			25	15	25																23.74	0.08	5.84	-	1.4	0.84	0.55	0.61	10.29	1.8	4.64	-	0.65	0.12	4.4	6.21	0.02	0.23	-	-	2.28	1.67	-	-	0.1	0.06	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.98	23.74	0.08	5.84	-	1.4	0.84	0.55	0.61	10.29	1.8	4.64	-	0.65	0.12	4.4	6.21	0.02	0.23	-	-	2.28	1.67	-	-	0.1	0.06	0.45	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.98
H5253_007_0	2006	OP Facility - Emergency	OP Facility - Other	OP Facility - Other	Professional							775		Observation	Other	Specialist excl. MH							D	D	D	P	P	Coin	Coin	V	Coin	V	V	Coin	Coin	Coin	V	Coin	V	Coin		Coin	Coin	Coin	P		P	P	Coin					V	V	V	Coin																																																	-	2087.66	148.43			1906.17	19.42	7.32	191.31	11.78	3282.27	170.44	1.94	0.17	7.66		125.79	70.24	0.02		11.43	3.9	7.54										106.02		0.07	0.22							75/day	75/day			75/Trip	20	20	50	20	0/25 SNF/Non-SNF	0/25 SNF/Non-SNF	20	20	20		20	40/30 Ind/Grp	0/20 SNF/Non-SNF		20	20	20					20					25/50 In/OON	40	40	20							75	75			25	0.2	0.2	50	0.2	1.25	1.25	0.2	0.2	0.2		0.2	35	0.01		0.2	0.2	0.2					0.2					35	40	40	0.2								46.88	46.88			15.63	0.13	0.13	31.25	0.13	0.78	0.78	0.13	0.13	0.13		0.13	21.88	0.01		0.13	0.13	0.13					0.13					21.88	25	25	0.2								8.15	0.58	-	-	2.48	2.43	0.92	0.5	1.47	0.21	0.01	0.24	0.02	0.96	-	15.72	0.13	0	-	1.43	0.49	0.94	-	-	-	-	-	-	-	-	-	0.19	-	0	0.04	-	-	-	-	-	-	36.92	8.15	0.58	-	-	2.48	2.43	0.92	0.5	1.47	0.21	0.01	0.24	0.02	0.96	-	15.72	0.13	0	-	1.43	0.49	0.94	-	-	-	-	-	-	-	-	-	0.19	-	0	0.04	-	-	-	-	-	-	36.92
H5253_011_0	2006											2700											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V			V	V	V		Coin	P																																																						-	1407.95	82.09	447.09	0	137.62	15.75	13.62	278.61	32.38	0	12.24	1.31	0.01	16	3978.39	4185.23	131.74	2.22	18.35	0	24.89	0			117.8	252.34	210.9		32.89	0												250	175	95	0	150	30	30	50	20	0	0/20	20	30	20/40/30	Oct-00	20	40/30	20	0/20	0/20	30	0			20	15	20		See PBP	0												250	175	95	0	150	0.3	0.3	50	0.2	0	0.18	0.2	0.3	0.2	10	19.54	37.5	0.2	0.11	0	0.3	0			20	15	20		0.2	0													146.68	102.68	55.74	0	88.01	0.18	0.18	29.34	0.12	0	0.11	0.12	0.18	0.12	10	19.54	37.5	0.12	0.06	0	0.18	0			20	15	20		0.2	0													17.21	0.7	2.08	-	1.01	2.77	2.4	0.68	3.8	-	1.29	0.15	0	1.87	3.32	6.81	0.41	0.26	1.15	-	4.38	-	-	-	0.2	0.32	0.35	-	6.46	-	-	-	-	-	-	-	-	-	-	-	-	57.62	17.21	0.7	2.08	-	1.01	2.77	2.4	0.68	3.8	-	1.29	0.15	0	1.87	3.32	6.81	0.41	0.26	1.15	-	4.38	-	-	-	0.2	0.32	0.35	-	6.46	-	-	-	-	-	-	-	-	-	-	-	-	57.62
H5253_015_0	2006											2700											D	D	D	Coin	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V	V		V		V			P																																																						-	1283.77	67.45	439.48	0	93.18	13.99	13.74	297.04	33.75	0	13.38	1.92	0.12	13.38	4067.55	5105.17	140.1	2.1	20.48	0	20.4	0			124	250.97	222			0												250	175	95	0	150	30	30	50	30	0	0/30	30	30	30/40/30	Oct-00	20	40/30	30	0/30	0/20	30	0			20	15	20			0												250	175	95	0	150	0.3	0.3	50	0.3	0	0.26	0.3	0.3	0.29	10	18.83	37.5	0.3	0.16	0	0.3	0			20	15	20			0													147.89	103.52	56.2	0	88.73	0.18	0.18	29.58	0.18	0	0.15	0.18	0.18	0.17	10	18.83	37.5	0.18	0.1	0	0.18	0			20	15	20			0													15.82	0.58	2.06	-	0.69	2.48	2.44	0.73	5.99	-	2.03	0.34	0.02	2.31	3.39	8.01	0.44	0.37	1.95	-	3.62	-	-	-	0.21	0.31	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.17	15.82	0.58	2.06	-	0.69	2.48	2.44	0.73	5.99	-	2.03	0.34	0.02	2.31	3.39	8.01	0.44	0.37	1.95	-	3.62	-	-	-	0.21	0.31	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.17
H5253_021_0	2006																						D	D	D	Coin	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	1679.82	8.01	846.83		170.9	6.26	3.27	222.89	71.48	7668.9	46.44		5.11	0.86	3260.94	2711.59	4.91	1.57			12.11	732.95			46.18	42.18	212.97		2266.87													265	175	150	0	150	0	0	25/50	0	10	20-Oct	20 (included in G)	20	20.0 / 40 / 30	20 / 0	25	40 / 30	0	0	0	20	0 / 25			25	15	25		See PBP	0												265	175	150		150	0.2	0.2	25/50	0.2	10	20-Oct		0.2	20.0 / 40 / 30	20 / 0	25	40 / 30	0.2			0.2	0 / 25			25	15	25		See PBP													4600	172.88	114.17	97.86		97.86	0.13	0.16	32	0.13	2.61	0.09		0.13	0.13	20	25	37.5	0.13			0.13	25			25	15	25		25.22														24.2	0.08	6.91	-	1.39	0.82	0.53	0.59	9.33	1.67	4.06	-	0.67	0.11	5.43	5.65	0.02	0.2	-	-	1.58	1.53	-	-	0.1	0.05	0.44	-	4.76	-	-	-	-	-	-	-	-	-	-	-	-	70.12	24.2	0.08	6.91	-	1.39	0.82	0.53	0.59	9.33	1.67	4.06	-	0.67	0.11	5.43	5.65	0.02	0.2	-	-	1.58	1.53	-	-	0.1	0.05	0.44	-	4.76	-	-	-	-	-	-	-	-	-	-	-	-	70.12
H5253_022_0	2006											2000											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V			V	V	V		Coin	P																																																						-	1407.95	82.09	447.09	0	137.62	15.75	13.62	278.61	32.38	0	12.24	1.31	0.01	16	3978.39	4185.23	131.74	2.22	18.35	0	24.89	0			117.8	252.34	210.9		32.89	0												250	175	75	0	150	20	20	50	15	0	0/15	15	20	15/40/30	May-00	15	40/30	15	0/15	0/15	20	0			15	15	15		See PBP	0												250	175	75	0	150	0.2	0.2	50	0.15	0	0.13	0.15	0.2	0.15	5	14.09	37.5	0.15	0.08	0	0.2	0			15	15	15		0.16	0													137.76	96.43	41.33	0	82.65	0.11	0.11	27.55	0.08	0	0.07	0.08	0.11	0.08	5	14.09	37.5	0.08	0.04	0	0.11	0			15	15	15		0.16	0													16.16	0.66	1.54	-	0.95	1.74	1.5	0.64	2.68	-	0.91	0.11	0	1.32	1.66	4.92	0.41	0.18	0.81	-	2.74	-	-	-	0.15	0.32	0.26	-	5.21	-	-	-	-	-	-	-	-	-	-	-	-	44.85	16.16	0.66	1.54	-	0.95	1.74	1.5	0.64	2.68	-	0.91	0.11	0	1.32	1.66	4.92	0.41	0.18	0.81	-	2.74	-	-	-	0.15	0.32	0.26	-	5.21	-	-	-	-	-	-	-	-	-	-	-	-	44.85
H5253_023_0	2006											2000											D	D	D	Coin	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V	V		V		V			P																																																						-	1283.77	67.45	439.48	0	93.18	13.99	13.74	297.04	33.75	0	13.38	1.92	0.12	13.38	4067.55	5105.17	140.1	2.1	20.48	0	20.4	0			124	249.6	222			0												250	175	75	0	150	20	20	50	15	0	0/15	15	20	15/40/30	May-00	15	40/30	15	0/15	0/15	20	0			15	15	15			0												250	175	75	0	150	0.2	0.2	50	0.15	0	0.13	0.15	0.2	0.15	5	14.12	37.5	0.15	0.08	0	0.2	0			15	15	15			0													145.82	102.08	43.75	0	87.49	0.12	0.12	29.16	0.09	0	0.07	0.09	0.12	0.09	5	14.12	37.5	0.09	0.05	0	0.12	0			15	15	15			0													15.6	0.57	1.6	-	0.68	1.63	1.6	0.72	2.95	-	1	0.17	0.01	1.14	1.69	6.01	0.44	0.18	0.96	-	2.38	-	-	-	0.16	0.31	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.1	15.6	0.57	1.6	-	0.68	1.63	1.6	0.72	2.95	-	1	0.17	0.01	1.14	1.69	6.01	0.44	0.18	0.96	-	2.38	-	-	-	0.16	0.31	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.1
H5253_024_0	2006											600											D	D	D	Coin	T	Coin	Coin	V	V	P	V	V	Coin	V	V	V	V	V	V	V	Coin	V	V		V		V			V																																																						-	2246.15	231.64	1412.69	0	214.16	39.9	28.6	779.45	316.71	0	414.09	45.86	0.75	1307.82	5082.93	4479.97	353.53	188.86	4131.09	0	26.23	0	0		124	0	222	0		0												25	2500	15	0	100	0	0	40	15	0	0/10	15	0.2	4/8 / 10 / 15	Feb-00	4	08-Apr	10	0/10	0/4	0.2	0	0		04-May	0	4	0		0												25	25	15	0	100	0.2	0.2	40	14.8	0	9.49	15	0.2	1.57	2	3.67	7	10	5.36	0	0.2	0	0		4	0	4	0		0													14.34	14.34	8.6	0	57.35	0.11	0.11	22.94	8.48	0	5.44	8.6	0.11	0.9	2	3.67	7	5.73	3.07	0	0.11	0	0		4	0	4	0		0													2.68	0.28	1.01	-	1.02	4.58	3.28	1.49	0.22	-	0.19	0.03	0.09	0.1	0.85	1.37	0.21	0.09	1.06	-	3.01	-	-	-	0.04	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.67	2.68	0.28	1.01	-	1.02	4.58	3.28	1.49	0.22	-	0.19	0.03	0.09	0.1	0.85	1.37	0.21	0.09	1.06	-	3.01	-	-	-	0.04	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.67
H5253_025_0	2006											600											D	D	D	Coin	T	Coin	Coin	V	V	P	V	V	Coin	V	V	V	V	V	V	V	Coin	V	V		V		V			V																																																						-	2130.89	219.75	1340.22	0	203.17	35.91	25.74	739.51	300.46	0	392.84	43.5	0.68	1240.7	4825.84	4253.98	335.39	179.17	3919.1	0	23.61	0	0		124	0	222	0		0												25	2500	15	0	100	0	0	40	15	0	0/10	15	0.2	4/8 / 10 / 15	Feb-00	4	08-Apr	10	0/10	0/4	0.2	0	0		04-May	0	4	0		0												25	25	15	0	100	0.2	0.2	40	14.8	0	9.49	15	0.2	1.57	2	3.67	7	10	5.36	0	0.2	0	0		4	0	4	0		0													14.87	14.87	8.92	0	59.49	0.12	0.12	23.79	8.8	0	5.64	8.92	0.12	0.94	2	3.67	7	5.95	3.19	0	0.12	0	0		4	0	4	0		0													2.64	0.27	1	-	1.01	4.27	3.06	1.47	0.22	-	0.18	0.03	0.08	0.1	0.8	1.3	0.2	0.09	1.04	-	2.81	-	-	-	0.04	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.69	2.64	0.27	1	-	1.01	4.27	3.06	1.47	0.22	-	0.18	0.03	0.08	0.1	0.8	1.3	0.2	0.09	1.04	-	2.81	-	-	-	0.04	-	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.69
H5253_801_0	2006											3600											D	D	D	Coin	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	1775.33	9.02	872.71		173.9	6.55	3.48	233.55	80.17	8411.4	53.91		5.03	0.94	3521.32	2981.87	5.11	1.83			17.78	801.42			0		213.92															265	17500	150	0	150	0	0	50	0	20	20 / 30	30 (included in G)	0.3	30.0 / 40 / 30	35 / 0	35	40 / 30	0	0	0	0.3	0 / 35			35		35															265	175	150		150	0.3	0.3	50	0.3	20	20 / 30		0.3	30.0 / 40 / 30	35	35	40 / 30	0.3			0.3	0 / 35					35																144.97	95.74	82.06		82.06	0.16	0.22	27.35	0.16	4.38	0.11		0.16	0.16	35	35	37.5	0.16			0.16	35					35																21.45	0.07	5.97	-	1.19	1.07	0.77	0.53	13.16	3.07	5.93	-	0.83	0.15	10.27	8.7	0.02	0.3	-	-	2.92	2.34	-	-	-	-	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.35	21.45	0.07	5.97	-	1.19	1.07	0.77	0.53	13.16	3.07	5.93	-	0.83	0.15	10.27	8.7	0.02	0.3	-	-	2.92	2.34	-	-	-	-	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	79.35
H5253_802_0	2006											4800											D	D	D	Coin	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	V	V	V																																																					-	1775.33	9.02	872.71		173.9	6.55	3.48	233.55	80.17	8411.4	53.91		5.03	0.94	3521.32	2981.87	5.11	1.83			17.78	801.42			0		213.92															265	17500	150	0	150	0	0	50	0	10	20-Oct	20 (included in G)	0.3	20.0 / 40 / 30	35 / 0	35	40 / 30	0	0	0	0.3	0 / 35			35		35															265	175	150		150	0.3	0.3	50	0.2	10	20-Oct		0.3	20.0 / 40 / 30	35	35	40 / 30	0.2			0.3	0 / 35					35																173.55	114.61	98.24		98.24	0.2	0.24	32.75	0.13	2.62	0.09		0.2	0.13	35	35	37.5	0.13			0.2	35					35																25.68	0.09	7.14	-	1.42	1.29	0.84	0.64	10.5	1.84	4.73	-	0.99	0.12	10.27	8.7	0.02	0.24	-	-	3.49	2.34	-	-	-	-	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.95	25.68	0.09	7.14	-	1.42	1.29	0.84	0.64	10.5	1.84	4.73	-	0.99	0.12	10.27	8.7	0.02	0.24	-	-	3.49	2.34	-	-	-	-	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.95
H5253_803_0	2006											2400											D	D	D	Coin	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V	V		V		V			P																																																						-	1293.03	65.5	428.91	0	92.87	14.16	14.13	293.83	35.56	0	16.33	2	0.11	13.83	4148.18	5249.6	138.91	2.22	21.57	0	21.34	0			124		222			0												265	175	150	0	150	30	30	50	30	20	20/30	30	30	30/40/30	35/0	35	40/30	30	20/30	0/35	30	0			35		35			0												265	175	150	0	150	0.3	0.3	50	0.3	0	0.24	0.3	0.3	0.29	35	32.97	37.5	0.3	0.29	0	0.3	0			35		35			0													141.36	93.35	80.01	0	80.01	0.16	0.16	26.67	0.16	0	0.13	0.16	0.16	0.16	35	32.97	37.5	0.16	0.15	0	0.16	0			35		35			0													15.23	0.51	2.86	-	0.62	2.27	2.26	0.65	5.69	-	2.11	0.32	0.02	2.16	12.1	14.42	0.43	0.36	3.32	-	3.42	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.76	15.23	0.51	2.86	-	0.62	2.27	2.26	0.65	5.69	-	2.11	0.32	0.02	2.16	12.1	14.42	0.43	0.36	3.32	-	3.42	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	69.76
H5253_804_0	2006											3200											D	D	D	Coin	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	V	V		V		V			P																																																						-	1293.03	65.5	428.91	0	92.87	14.16	14.13	293.83	35.56	0	16.33	2	0.11	13.83	4148.18	5249.6	138.91	2.22	21.57	0	21.34	0			124	0	222			0												265	175	150	0	150	30	30	50	20	10	20-Oct	20	30	20/40/30	35/0	35	40/30	20	20-Oct	0/35	30	0			35		35			0												265	175	150	0	150	0.3	0.3	50	0.2	0	0.16	0.2	0.3	0.2	35	32.97	37.5	0.2	0.17	0	0.3	0			35	0	35			0													168.71	111.41	95.5	0	95.5	0.19	0.19	31.83	0.13	0	0.1	0.13	0.19	0.12	35	32.97	37.5	0.13	0.11	0	0.19	0			35	0	35			0													18.18	0.61	3.41	-	0.74	2.7	2.7	0.78	4.53	-	1.64	0.25	0.02	1.72	12.1	14.42	0.43	0.28	2.35	-	4.08	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.97	18.18	0.61	3.41	-	0.74	2.7	2.7	0.78	4.53	-	1.64	0.25	0.02	1.72	12.1	14.42	0.43	0.28	2.35	-	4.08	-	-	-	0.36	-	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.97
H5262_001_0	2006											1250																Coin		V							V	V	V	V		V					V																																																											-						12.44		215							2423.39	2681.13	105.3	355.71		971.86					393.26																						10 coins		50 per visit							15 per visit	15 per visit	15 per visit	10 to 15 per visit		15 per visit					15 per visit																						0.1		50							15	15	15	13.8		15					15																							0.1		49.99							15	15	15	13.79		15					15																		-	-	-	-	-	1.24	-	0.9	-	-	-	-	-	-	3.03	3.35	0.13	0.41	-	1.21	-	-	-	-	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.76	-	-	-	-	-	1.24	-	0.9	-	-	-	-	-	-	3.03	3.35	0.13	0.41	-	1.21	-	-	-	-	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.76
H5262_003_0	2006											2500											A	A	D			Coin		V	P	Coin	Coin				V	V	V	V	Coin	V					V																																																											-	267.9	4.4	636.89			12.42		215	606.39	10.57	3.31				2423.39	2681.13	105.3	355.71	29.84	971.86					393.26																	200 per admit	200 per admit	50 per days 1-20			20 coins		50 per visit	75 per visit	10 coins	10 coins				30 per visit	30 per visit	30 per visit	15 - 30 per visit	10 coins	30 per visit					30 per visit																	200	200	50			0.2		50	75	0.1	0.1				30	30	30	26.39	0.1	30					30																		199.17	199.17	49.79			0.2		49.79	74.69	0.1	0.1				29.88	29.88	29.88	26.28	0.1	29.88					29.88																		4.45	0.07	2.64	-	-	2.47	-	0.89	3.77	1.05	0.33	-	-	-	6.03	6.67	0.26	0.78	2.97	2.42	-	-	-	-	0.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.8	4.45	0.07	2.64	-	-	2.47	-	0.89	3.77	1.05	0.33	-	-	-	6.03	6.67	0.26	0.78	2.97	2.42	-	-	-	-	0.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.8
H5262_004_0	2006											2500											A	A	D			Coin		V	P	Coin	Coin				V	V	V	V	Coin	V					V																																																											-	267.9	4.4	636.89			12.42		215	606.39	10.57	3.31				2423.39	2681.13	105.3	355.71	29.84	971.86					393.26																	200 per admit	200 per admit	50 per days 1-20			20 coins		50 per visit	75 per visit	10 coins	10 coins				30 per visit	30 per visit	30 per visit	15 - 30 per visit	10 coins	30 per visit					30 per visit																	200	200	50			0.2		50	75	0.1	0.1				30	30	30	26.39	0.1	30					30																		199.17	199.17	49.79			0.2		49.79	74.69	0.1	0.1				29.88	29.88	29.88	26.28	0.1	29.88					29.88																		4.45	0.07	2.64	-	-	2.47	-	0.89	3.77	1.05	0.33	-	-	-	6.03	6.67	0.26	0.78	2.97	2.42	-	-	-	-	0.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.8	4.45	0.07	2.64	-	-	2.47	-	0.89	3.77	1.05	0.33	-	-	-	6.03	6.67	0.26	0.78	2.97	2.42	-	-	-	-	0.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.8
H5262_005_0	2006											1250																Coin		V							V	V	V	V		V					V																																																											-						12.44		215							2423.39	2681.13	105.3	355.71		971.86					393.26																						10 coins		50 per visit							15 per visit	15 per visit	15 per visit	10 to 15 per visit		15 per visit					15 per visit																						0.1		50							15	15	15	13.8		15					15																							0.1		49.99							15	15	15	13.79		15					15																		-	-	-	-	-	1.24	-	0.9	-	-	-	-	-	-	3.03	3.35	0.13	0.41	-	1.21	-	-	-	-	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.76	-	-	-	-	-	1.24	-	0.9	-	-	-	-	-	-	3.03	3.35	0.13	0.41	-	1.21	-	-	-	-	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.76
H5402_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V					P	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	1081.19	69.01	143.78	2045.8	134.4	3.91	0.65	129.16	95.95	1683.29	701.37	140.27	140.27	140.27	2478.32	2478.32	413.05	826.11	413.05	0	0	0	0	627.76	154	66	45.5	19.5	0	0	0	215.03	3.7	165.22	247.83	1239.16						50 1-5	50 1-5	0 1-7; 50 8-100	0	100	0	20	60 * 50 + 40 * 15	50	5	35	50	50	0	0	10	15	15	20	0	0	0	0	0	10	10	15	0	0	0	0	0	0	15	15	5						34.72	34.72	26.28	0	100	0	0.2	36	50	5	35	50	50	0	0	10	15	15	20	0	0	0	0	0	10	10	15	0	0	0	0	0	0	15	15	5						N/A	34.31	34.31	25.96	0	98.8	0	0.2	35.57	49.4	4.94	34.58	49.4	49.4	0	0	9.88	14.82	14.82	19.76	0	0	0	0	0	9.88	9.88	14.82	0	0	0	0	0	0	14.82	14.82	4.94						0	3.09	0.2	0.31	-	1.11	-	0.13	0.38	0.39	0.69	2.02	0.58	0.58	-	-	2.04	0.51	1.02	0.68	-	-	-	-	-	0.13	0.05	0.06	-	-	-	-	-	-	0.2	0.31	0.51	-	-	-	-	-	14.99	3.09	0.2	0.31	-	1.11	-	0.13	0.38	0.39	0.69	2.02	0.58	0.58	-	-	2.04	0.51	1.02	0.68	-	-	-	-	-	0.13	0.05	0.06	-	-	-	-	-	-	0.2	0.31	0.51	-	-	-	-	-	14.99
H5402_002_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V	V				P	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	1081.19	69.01	143.78	2045.8	134.4	3.58	0.6	129.16	95.95	1683.29	701.37	140.27	140.27	140.27	2478.32	2478.32	413.05	826.11	413.05	0	0	0	0	627.76	154	66	45.5	19.5	0	0	0	215.03	3.39	165.22	247.83	1239.16						100 1; 0 2-90	100 1-3	0 1-14; 100 15-100	0	100	10	20	60 * 50 + 40 * 10	50	50	0	50	50	0	0	10	10	20	0	0	0	0	0	0	10	10	10	10	0	0	0	0	0	15	15	0						21.49	52.33	28	0	100	0.1	0.2	34	50	50	0	50	50	0	0	10	10	20	0	0	0	0	0	0	10	10	10	10	0	0	0	0	0	15	15	0						N/A	21.23	51.7	27.67	0	98.8	0.1	0.2	33.59	49.4	49.4	0	49.4	49.4	0	0	9.88	9.88	19.76	0	0	0	0	0	0	9.88	9.88	9.88	9.88	0	0	0	0	0	14.82	14.82	0						0	1.91	0.3	0.33	-	1.11	0.35	0.12	0.36	0.39	6.93	-	0.58	0.58	-	-	2.04	0.34	1.36	-	-	-	-	-	-	0.13	0.05	0.04	0.02	-	-	-	-	-	0.2	0.31	-	-	-	-	-	-	17.45	1.91	0.3	0.33	-	1.11	0.35	0.12	0.36	0.39	6.93	-	0.58	0.58	-	-	2.04	0.34	1.36	-	-	-	-	-	-	0.13	0.05	0.04	0.02	-	-	-	-	-	0.2	0.31	-	-	-	-	-	-	17.45
H5402_006_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V					P	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	1081.19	69.01	143.78	2045.8	134.4	3.68	0.61	129.16	95.95	1683.29	701.37	140.27	140.27	140.27	2478.32	2478.32	413.05	826.11	413.05	0	0	0	0	627.76	154	66	45.5	19.5	0	0	0	215.03	3.48	165.22	247.83	1239.16						100 1-5; 0 6-90	150 1-5; 0 6-90	0 1-14; 100 15-100	0	100	5	20	60 * 50 + 40 * 10	75	12	5	50	50	0	0	10	25	15	5	0	0	0	0	0	10	10	25	25	0	0	0	0	0	10	10	12						34.72	52.08	28	0	100	0.05	0.2	34	75	12	5	50	50	0	0	10	25	15	5	0	0	0	0	0	10	10	25	25	0	0	0	0	0	10	10	12						N/A	34.72	52.08	28	0	100	0.05	0.2	34	75	12	5	50	50	0	0	10	25	15	5	0	0	0	0	0	10	10	25	25	0	0	0	0	0	10	10	12						0	3.13	0.3	0.34	-	1.12	0.18	0.12	0.37	0.6	1.68	0.29	0.58	0.58	-	-	2.07	0.86	1.03	0.17	-	-	-	-	-	0.13	0.06	0.09	0.04	-	-	-	-	-	0.14	0.21	1.24	-	-	-	-	-	15.33	3.13	0.3	0.34	-	1.12	0.18	0.12	0.37	0.6	1.68	0.29	0.58	0.58	-	-	2.07	0.86	1.03	0.17	-	-	-	-	-	0.13	0.06	0.09	0.04	-	-	-	-	-	0.14	0.21	1.24	-	-	-	-	-	15.33
H5402_007_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V					P	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	1081.19	69.01	143.78	2045.8	134.4	3.66	0.61	129.16	95.95	1683.29	701.37	140.27	140.27	140.27	2478.32	2478.32	413.05	826.11	413.05	0	0	0	0	627.76	154	66	45.5	19.5	0	0	0	215.03	38.38	165.22	247.83	1239.16						100 1-3; 0 4-90	100 1-5; 0 6-90	0 1-10; 75 11-100	0	100	0	20	60 * 50 + 40 * 20	75	12	0	50	50	0	0	0	21	15	0	0	0	0	0	7	0	10	0	0	0	0	0	0	25	0	0	0						52.33	69.4	29.77	0	100	0	0.2	38	75	12	0	50	50	0	0	0	21	15	0	0	0	0	0	7	0	10	0	0	0	0	0	0	25	0	0	0						N/A	51.7	68.57	29.42	0	98.8	0	0.2	37.54	74.1	11.86	0	49.4	49.4	0	0	0	20.75	14.82	0	0	0	0	0	6.92	0	9.88	0	0	0	0	0	0	24.7	0	0	0						0	4.66	0.39	0.35	-	1.11	-	0.12	0.4	0.59	1.66	-	0.58	0.58	-	-	-	0.71	1.02	-	-	-	-	-	0.36	-	0.05	-	-	-	-	-	-	0.08	-	-	-	-	-	-	-	-	12.68	4.66	0.39	0.35	-	1.11	-	0.12	0.4	0.59	1.66	-	0.58	0.58	-	-	-	0.71	1.02	-	-	-	-	-	0.36	-	0.05	-	-	-	-	-	-	0.08	-	-	-	-	-	-	-	-	12.68
H5402_008_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V					P	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	1081.19	69.01	143.78	2045.8	134.4	3.91	0.65	129.16	95.95	1683.29	701.37	140.27	140.27	140.27	2478.32	2478.32	413.05	826.11	413.05	0	0	0	0	627.76	154	66	65	0	0	0	0	215.03	3.7	165.22	247.83	1239.16						75 1-3; 0 6-90	100 1-5; 0 6-90	0 1-7; 75 8-100	0	100	0	20	60 * 50 + 40 * 20	100	50	35	50	50	0	0	10	25	15	0	0	0	0	0	0	10	10	10	0	0	0	0	0	0	10	10	0						39.25	69.4	39.42	0	100	0	0.2	113.6	100	50	35	50	50	0	0	10	25	15	0	0	0	0	0	0	10	10	10	0	0	0	0	0	0	10	10	0						N/A	39.25	69.4	39.42	0	100	0	0.2	113.6	100	50	35	50	50	0	0	10	25	15	0	0	0	0	0	0	10	10	10	0	0	0	0	0	0	10	10	0						0	3.54	0.4	0.47	-	1.12	-	0.13	1.22	0.8	7.01	2.05	0.58	0.58	-	-	2.07	0.86	1.03	-	-	-	-	-	-	0.13	0.06	0.05	-	-	-	-	-	-	0.14	0.21	-	-	-	-	-	-	22.45	3.54	0.4	0.47	-	1.12	-	0.13	1.22	0.8	7.01	2.05	0.58	0.58	-	-	2.07	0.86	1.03	-	-	-	-	-	-	0.13	0.06	0.05	-	-	-	-	-	-	0.14	0.21	-	-	-	-	-	-	22.45
H5402_009_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V					P	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	1081.19	69.01	9.63	2045.8	3.68	3.68	0.61	129.16	95.95	1683.29	701.37	140.27	140.27	140.27	2478.32	2478.32	413.05	14.98	413.05	0	0	0	0	627.76	154	66	45.5	19.5	0	0	0	215.03	3.48	165.22	247.83	1239.16						75 1-3; 0 6-90	100 1-5; 0 6-90	0 1-10; 75 11-100	0	100	0	20	60 * 50 + 40 * 35	75	50	35	50	50	0	0	0	10	10	0	0	0	0	0	0	5	10	10	0	0	0	0	0	0	10	10	0						39.25	69.4	29.77	0	100	0	0.2	44	75	50	35	50	50	0	0	0	10	10	0	0	0	0	0	0	5	10	10	0	0	0	0	0	0	10	10	0						N/A	39.25	69.4	29.77	0	100	0	0.2	44	75	50	35	50	50	0	0	0	10	10	0	0	0	0	0	0	5	10	10	0	0	0	0	0	0	10	10	0						0	3.54	0.4	0.02	-	0.03	-	0.12	0.47	0.6	7.01	2.05	0.58	0.58	-	-	-	0.34	0.01	-	-	-	-	-	-	0.06	0.06	0.04	-	-	-	-	-	-	0.14	0.21	-	-	-	-	-	-	16.27	3.54	0.4	0.02	-	0.03	-	0.12	0.47	0.6	7.01	2.05	0.58	0.58	-	-	-	0.34	0.01	-	-	-	-	-	-	0.06	0.06	0.04	-	-	-	-	-	-	0.14	0.21	-	-	-	-	-	-	16.27
H5402_010_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						N/A	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	Coin	V	V	V	V					P	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						-	1081.19	69.01	143.78	2045.8	134.4	3.68	0.61	129.16	95.95	1683.29	701.37	140.27	140.27	140.27	2478.32	2478.32	413.05	826.11	413.05	0	0	0	0	627.76	154	66	45.5	19.5	0	0	0	215.03	38.38	165.22	247.83	1239.16						100 1-3; 0 4-90	100 1-5; 0 6-90	0 1-10; 75 11-100	0	100	5	20	60*50 + 40*20	100	12	0	50	50	0	0	10	21	25	0	0	0	0	0	7	10	10	10	10	0	0	0	0	25	10	10	0						52.33	69.4	29.77	0	100	0.05	0.2	38	100	12	0	50	50	0	0	10	21	25	0	0	0	0	0	7	10	10	10	10	0	0	0	0	25	10	10	0						N/A	51.7	68.57	29.42	0	98.8	0.05	0.2	37.54	98.8	11.86	0	49.4	49.4	0	0	9.88	20.75	24.7	0	0	0	0	0	6.92	9.88	9.88	9.88	9.88	0	0	0	0	24.7	9.88	9.88	0						0	4.66	0.39	0.35	-	1.11	0.18	0.12	0.4	0.79	1.66	-	0.58	0.58	-	-	2.04	0.71	1.7	-	-	-	-	-	0.36	0.13	0.05	0.04	0.02	-	-	-	-	0.08	0.14	0.2	-	-	-	-	-	-	16.3	4.66	0.39	0.35	-	1.11	0.18	0.12	0.4	0.79	1.66	-	0.58	0.58	-	-	2.04	0.71	1.7	-	-	-	-	-	0.36	0.13	0.05	0.04	0.02	-	-	-	-	0.08	0.14	0.2	-	-	-	-	-	-	16.3
H5404_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1700	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	V	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1359.19	86.76	437.5	4730.77	56.12	302.44	0.1	420.27	17.81	2680.11	1116.71	223.34	223.34	223.34	1592.5	1592.5	265.42	9.66	265.42	0	4.46	0	0	0	1054.63	451.98	0	0	0	0	0	0.31	148.22	106.17	159.25	796.25						250 for 1st 7 days	250 for 1st 7 days	100 for days 11-100	30	10000	0	20	50	20	0	12	0	0	0	0	10	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	15	15	0						202.64	202.64	39.7	30	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	15	15	0						1700	198.99	198.99	38.98	29.46	98.2	0	0.2	49.1	0.2	0	11.33	0	0	0	0	9.82	19.64	19.64	0	0	0.2	0.2	0	2.19	9.82	9.82	9.82	0	0	0	0	0.2	9.82	14.73	14.73	0						0	22.54	1.44	1.42	11.61	0.46	-	0.02	1.72	3.5	-	1.05	-	-	-	-	1.3	0.43	0.02	-	-	0.88	-	-	-	0.86	0.37	-	-	-	-	-	0.06	0.12	0.13	0.2	-	-	-	-	-	-	48.14	22.54	1.44	1.42	11.61	0.46	-	0.02	1.72	3.5	-	1.05	-	-	-	-	1.3	0.43	0.02	-	-	0.88	-	-	-	0.86	0.37	-	-	-	-	-	0.06	0.12	0.13	0.2	-	-	-	-	-	-	48.14
H5404_002_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1700	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	Coin	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1279.29	81.66	411.79	4452.66	52.82	284.66	0.1	395.56	16.7	2522.55	1051.06	210.21	210.21	210.21	1498.88	1498.88	249.81	9.09	249.81	0	4.2	0	0	0	992.63	425.41	0	0	0	0	0	0.29	11.13	99.93	149.89	749.44						250 for 1st 7 days	250 for 1st 7 days	100 for days 11-100	40	10000	0	20	50	20	0	12	0	0	0	0	20	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	10	15	15	0						194.71	194.71	39.7	40	100	0	0.2	50	0.2	0	11.54	0	0	0	0	20	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	0.1	15	15	0						1700	191.21	191.21	38.98	39.28	98.2	0	0.2	49.1	0.2	0	11.33	0	0	0	0	19.64	19.64	19.64	0	0	0.2	0.2	0	2.19	9.82	9.82	9.82	0	0	0	0	0.2	0.1	14.73	14.73	0						0	20.38	1.3	1.34	14.58	0.43	-	0.02	1.62	3.28	-	0.99	-	-	-	-	2.45	0.41	0.01	-	-	0.82	-	-	-	0.81	0.35	-	-	-	-	-	0.06	1.09	0.12	0.18	-	-	-	-	-	-	50.26	20.38	1.3	1.34	14.58	0.43	-	0.02	1.62	3.28	-	0.99	-	-	-	-	2.45	0.41	0.01	-	-	0.82	-	-	-	0.81	0.35	-	-	-	-	-	0.06	1.09	0.12	0.18	-	-	-	-	-	-	50.26
H5404_003_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1700	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	Coin	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1299.89	82.97	418.41	4524.35	53.67	289.24	0.1	401.93	16.97	2563.16	1067.98	213.6	213.6	213.6	1523.01	1523.01	253.84	9.24	253.84	0	4.27	0	0	0	1008.61	432.26	0	0	0	0	0	0.3	11.31	101.53	152.3	761.51						250 for 1st 7 days	250 for 1st 7 days	100 for days 11-100	40	10000	0	20	50	20	0	12	0	0	0	0	20	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	10	15	15	0						190.32	190.32	39.7	40	100	0	0.2	50	0.2	0	11.54	0	0	0	0	20	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	0.1	15	15	0						1700	186.9	186.9	38.98	39.28	98.2	0	0.2	49.1	0.2	0	11.33	0	0	0	0	19.64	19.64	19.64	0	0	0.2	0.2	0	2.19	9.82	9.82	9.82	0	0	0	0	0.2	0.1	14.73	14.73	0						0	20.25	1.29	1.36	14.81	0.44	-	0.02	1.64	3.33	-	1.01	-	-	-	-	2.49	0.42	0.02	-	-	0.84	-	-	-	0.83	0.35	-	-	-	-	-	0.06	1.11	0.12	0.19	-	-	-	-	-	-	50.57	20.25	1.29	1.36	14.81	0.44	-	0.02	1.64	3.33	-	1.01	-	-	-	-	2.49	0.42	0.02	-	-	0.84	-	-	-	0.83	0.35	-	-	-	-	-	0.06	1.11	0.12	0.19	-	-	-	-	-	-	50.57
H5404_004_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						NONE	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						NONE	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1297.74	82.83	12.26	4516.88	2.46	0.71	0.12	401.26	212.27	2558.93	1066.22	213.24	213.24	213.24	1520.5	1520.5	253.42	10.94	253.42	0	5.05	0	0	1955.14	1006.94	431.55	250.33	107.28	0	0	0	0.35	141.51	101.37	152.05	760.25						250 for 1st 7 days	250 for 1st 7 days	100 for days 6-100	10	10000	0	20	50	20000	0	12	0	0	0	0	20	25	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	25	25	0						194.88	194.88	63.85	10	100	0	0.2	50	200	0	11.54	0	0	0	0	20	25	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	25	25	0						NONE	194.88	194.88	63.85	10	100	0	0.2	50	200	0	11.54	0	0	0	0	20	25	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	25	25	0						0	21.07	1.35	0.07	3.76	0.02	-	0.02	1.67	3.54	-	1.03	-	-	-	-	2.53	0.53	0.02	-	-	1.01	-	-	0.36	0.84	0.36	0.21	-	-	-	-	0.07	0.12	0.21	0.32	-	-	-	-	-	-	39.11	21.07	1.35	0.07	3.76	0.02	-	0.02	1.67	3.54	-	1.03	-	-	-	-	2.53	0.53	0.02	-	-	1.01	-	-	0.36	0.84	0.36	0.21	-	-	-	-	0.07	0.12	0.21	0.32	-	-	-	-	-	-	39.11
H5404_005_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1700	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1635.24	104.38	526.36	5691.58	67.52	363.86	0.12	505.62	22.08	3224.43	1343.51	268.7	268.7	268.7	1915.93	1915.93	319.32	11.62	319.32	0	5.37	0	0	2463.61	1268.82	543.78	315.43	135.18	0	0	0	0.37	178.32	127.73	191.59	957.97						100 for 1st 11 days	100 for 1st 11 days	50 for days 11-100	45	10000	0	20	50	20	0	12	0	0	0	0	5	5	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	500	5	5	0						89	89	19.85	45	100	0	0.2	50	0.2	0	11.54	0	0	0	0	5	5	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	5	5	5	0						1700	87.39	87.39	19.49	44.19	98.2	0	0.2	49.1	0.2	0	11.33	0	0	0	0	4.91	4.91	19.64	0	0	0.2	0.2	0	2.19	9.82	9.82	9.82	0	0	0	0	0.2	4.91	4.91	4.91	0						0	11.91	0.76	0.85	20.96	0.55	-	0.02	2.07	4.34	-	1.27	-	-	-	-	0.78	0.13	0.02	-	-	1.05	-	-	0.45	1.04	0.44	0.26	-	-	-	-	0.07	0.07	0.05	0.08	-	-	-	-	-	-	47.19	11.91	0.76	0.85	20.96	0.55	-	0.02	2.07	4.34	-	1.27	-	-	-	-	0.78	0.13	0.02	-	-	1.05	-	-	0.45	1.04	0.44	0.26	-	-	-	-	0.07	0.07	0.05	0.08	-	-	-	-	-	-	47.19
H5404_006_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1700	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1543.95	98.55	496.98	5373.84	63.75	343.55	0.12	477.39	20.84	3044.42	1268.51	253.7	253.7	253.7	1808.97	1808.97	301.5	10.97	301.5	0	5.07	0	0	2326.08	1197.99	513.42	297.82	127.64	0	0	0	0.35	168.36	120.6	180.9	904.49						150 for 1st 7 days	150 for 1st 7 days	50 for days 11-100	45	10000	0	20	50	20	0	12	0	0	0	0	10	5	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	500	5	5	0						120.2	120.2	19.85	45	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	5	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	5	5	5	0						1700	118.04	118.04	19.49	44.19	98.2	0	0.2	49.1	0.2	0	11.33	0	0	0	0	9.82	4.91	19.64	0	0	0.2	0.2	0	2.19	9.82	9.82	9.82	0	0	0	0	0.2	4.91	4.91	4.91	0						0	15.19	0.97	0.81	19.79	0.52	-	0.02	1.95	4.09	-	1.2	-	-	-	-	1.48	0.12	0.02	-	-	1	-	-	0.42	0.98	0.42	0.24	-	-	-	-	0.07	0.07	0.05	0.07	-	-	-	-	-	-	49.49	15.19	0.97	0.81	19.79	0.52	-	0.02	1.95	4.09	-	1.2	-	-	-	-	1.48	0.12	0.02	-	-	1	-	-	0.42	0.98	0.42	0.24	-	-	-	-	0.07	0.07	0.05	0.07	-	-	-	-	-	-	49.49
H5404_007_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1700	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1563.11	99.77	503.14	5440.51	64.54	347.81	0.12	483.32	21.1	3082.19	1284.25	256.85	256.85	256.85	1831.41	1831.41	305.24	11.11	305.24	0	5.13	0	0	2354.93	1212.85	519.79	301.52	129.22	0	0	0	0.36	170.45	122.09	183.14	915.71						150 for 1st 7 days	150 for 1st 7 days	50 for days 11-100	45	10000	0	20	50	20	0	12	0	0	0	0	10	5	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	500	5	5	0						117.19	117.19	19.85	45	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	5	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	5	5	5	0						1700	115.08	115.08	19.49	44.19	98.2	0	0.2	49.1	0.2	0	11.33	0	0	0	0	9.82	4.91	19.64	0	0	0.2	0.2	0	2.19	9.82	9.82	9.82	0	0	0	0	0.2	4.91	4.91	4.91	0						0	14.99	0.96	0.82	20.03	0.53	-	0.02	1.98	4.14	-	1.21	-	-	-	-	1.5	0.12	0.02	-	-	1.01	-	-	0.43	0.99	0.43	0.25	-	-	-	-	0.07	0.07	0.05	0.07	-	-	-	-	-	-	49.69	14.99	0.96	0.82	20.03	0.53	-	0.02	1.98	4.14	-	1.21	-	-	-	-	1.5	0.12	0.02	-	-	1.01	-	-	0.43	0.99	0.43	0.25	-	-	-	-	0.07	0.07	0.05	0.07	-	-	-	-	-	-	49.69
H5404_008_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1575.35	100.55	507.08	5483.11	65.04	350.53	0.14	487.1	24.44	3106.33	1294.3	258.86	258.86	258.86	1845.76	1845.76	307.63	13.25	307.63	0	6.12	0	0	2373.37	1222.35	523.86	303.88	130.23	0	0	0	0.43	171.79	123.05	184.58	922.88						200 for 1st 7 days	200 for 1st 7 days	50 for days 11-100	45	10000	0	20	50	20	0	12	0	0	0	10	10	10	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	500	5	10	0						161.94	161.94	19.85	45	100	0	0.2	50	0.2	0	11.54	0	0	0	10	10	10	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	5	5	10	0						2500	160.5	160.5	19.67	44.6	99.11	0	0.2	49.56	0.2	0	11.44	0	0	0	9.91	9.91	9.91	19.82	0	0	0.2	0.2	0	2.21	9.91	9.91	9.91	0	0	0	0	0.2	4.96	4.96	9.91	0						0	21.07	1.34	0.83	20.38	0.54	-	0.03	2.01	4.84	-	1.23	-	-	-	1.52	1.52	0.25	0.02	-	-	1.21	-	-	0.44	1.01	0.43	0.25	-	-	-	-	0.08	0.07	0.05	0.15	-	-	-	-	-	-	59.31	21.07	1.34	0.83	20.38	0.54	-	0.03	2.01	4.84	-	1.23	-	-	-	1.52	1.52	0.25	0.02	-	-	1.21	-	-	0.44	1.01	0.43	0.25	-	-	-	-	0.08	0.07	0.05	0.15	-	-	-	-	-	-	59.31
H5404_009_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1700	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1517.66	96.87	488.51	5282.34	62.66	337.7	0.12	469.27	20.49	2992.59	1246.91	249.38	249.38	249.38	1778.17	1778.17	296.36	10.79	296.36	0	4.98	0	0	2286.47	1177.59	504.68	292.75	125.46	0	0	0	0.35	13.66	118.54	177.82	889.09						50 for 1st 5 days	50 for 1st 5 days	50 for days 11-100	0	10000	0	20	50	5000	0	12	0	0	0	0	5	5	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	0	5	5	0						34.51	34.51	19.85	0	100	0	0.2	50	50	0	11.54	0	0	0	0	5	5	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	0	5	5	0						1700	33.89	33.89	19.49	0	98.2	0	0.2	49.1	49.1	0	11.33	0	0	0	0	4.91	4.91	19.64	0	0	0.2	0.2	0	2.19	9.82	9.82	9.82	0	0	0	0	0.2	0	4.91	4.91	0						0	4.29	0.27	0.79	-	0.51	-	0.02	1.92	0.08	-	1.18	-	-	-	-	0.73	0.12	0.02	-	-	0.98	-	-	0.42	0.96	0.41	0.24	-	-	-	-	0.07	-	0.05	0.07	-	-	-	-	-	-	13.14	4.29	0.27	0.79	-	0.51	-	0.02	1.92	0.08	-	1.18	-	-	-	-	0.73	0.12	0.02	-	-	0.98	-	-	0.42	0.96	0.41	0.24	-	-	-	-	0.07	-	0.05	0.07	-	-	-	-	-	-	13.14
H5404_010_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1700	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1635.21	104.37	526.35	5691.47	67.52	363.85	0.12	505.61	22.08	3224.36	1343.49	268.7	268.7	268.7	1915.89	1915.89	319.32	11.62	319.32	0	5.37	0	0	2463.56	1268.8	543.77	315.42	135.18	0	0	0	0.37	14.72	127.73	191.59	957.95						75 for 1st 7 days	75 for 1st 7 days	50 for days 11-100	0	10000	0	20	50	5000	0	12	0	0	0	0	10	5	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	5	5	0						59.78	59.78	19.85	0	100	0	0.2	50	50	0	11.54	0	0	0	0	10	5	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	5	5	0						1700	58.7	58.7	19.49	0	98.2	0	0.2	49.1	49.1	0	11.33	0	0	0	0	9.82	4.91	19.64	0	0	0.2	0.2	0	2.19	0	0	0	0	0	0	0	0.2	0	4.91	4.91	0						0	8	0.51	0.85	-	0.55	-	0.02	2.07	0.09	-	1.27	-	-	-	-	1.57	0.13	0.02	-	-	1.05	-	-	0.45	-	-	-	-	-	-	-	0.07	-	0.05	0.08	-	-	-	-	-	-	16.79	8	0.51	0.85	-	0.55	-	0.02	2.07	0.09	-	1.27	-	-	-	-	1.57	0.13	0.02	-	-	1.05	-	-	0.45	-	-	-	-	-	-	-	0.07	-	0.05	0.08	-	-	-	-	-	-	16.79
H5404_011_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1700	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1634.48	104.33	526.12	5688.95	67.49	363.69	0.12	505.39	22.07	3222.94	1342.89	268.58	268.58	268.58	1915.04	1915.04	319.17	11.62	319.17	0	5.36	0	0	2462.47	1268.23	543.53	315.28	135.12	0	0	0	0.37	14.71	127.67	191.5	957.52						75 for 1st 5 days	75 for 1st 5 days	50 for days 11-100	0	10000	0	20	50	5000	0	12	0	0	0	0	10	5	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	5	5	0						52.08	52.08	19.85	0	100	0	0.2	50	50	0	11.54	0	0	0	0	10	5	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	5	5	0						1700	51.15	51.15	19.49	0	98.2	0	0.2	49.1	49.1	0	11.33	0	0	0	0	9.82	4.91	19.64	0	0	0.2	0.2	0	2.19	0	0	0	0	0	0	0	0.2	0	4.91	4.91	0						0	6.97	0.44	0.85	-	0.55	-	0.02	2.07	0.09	-	1.27	-	-	-	-	1.57	0.13	0.02	-	-	1.05	-	-	0.45	-	-	-	-	-	-	-	0.07	-	0.05	0.08	-	-	-	-	-	-	15.69	6.97	0.44	0.85	-	0.55	-	0.02	2.07	0.09	-	1.27	-	-	-	-	1.57	0.13	0.02	-	-	1.05	-	-	0.45	-	-	-	-	-	-	-	0.07	-	0.05	0.08	-	-	-	-	-	-	15.69
H5404_012_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1653.58	105.55	532.27	5755.42	68.28	367.94	0.15	511.29	27.05	3260.6	1358.58	271.72	271.72	271.72	1937.42	1937.42	322.9	13.88	322.9	0	6.41	0	0	2491.24	1283.05	549.88	318.97	136.7	0	0	0	0.45	18.03	129.16	193.74	968.71						150 for 1st 5 days	150 for 1st 5 days	50 for days 11-100	0	10000	0	20	50	5000	0	12	0	0	0	10	10	10	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						104.17	104.17	19.85	0	100	0	0.2	50	50	0	11.54	0	0	0	10	10	10	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						2500	103.24	103.24	19.67	0	99.11	0	0.2	49.56	49.56	0	11.44	0	0	0	9.91	9.91	9.91	19.82	0	0	0.2	0.2	0	2.21	0	0	0	0	0	0	0	0.2	0	9.91	9.91	0						0	14.23	0.91	0.87	-	0.56	-	0.03	2.11	0.11	-	1.3	-	-	-	1.6	1.6	0.27	0.02	-	-	1.27	-	-	0.46	-	-	-	-	-	-	-	0.09	-	0.11	0.16	-	-	-	-	-	-	25.69	14.23	0.91	0.87	-	0.56	-	0.03	2.11	0.11	-	1.3	-	-	-	1.6	1.6	0.27	0.02	-	-	1.27	-	-	0.46	-	-	-	-	-	-	-	0.09	-	0.11	0.16	-	-	-	-	-	-	25.69
H5404_013_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1800	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1393.71	88.96	448.62	4850.92	57.55	310.12	0.11	430.94	18.82	2748.17	1145.07	229.01	229.01	229.01	1632.94	1632.94	272.16	9.9	272.16	0	4.57	0	0	0	1081.41	463.46	0	0	0	0	0	0.32	151.98	108.86	163.29	816.47						225 for 1st 7 days	225 for 1st 7 days	100 for days 11-100	35	10000	0	20	50	20	0	12	0	0	0	0	20	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	20	20	0						177.96	177.96	39.7	35	100	0	0.2	50	0.2	0	11.54	0	0	0	0	20	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	20	20	0						1800	175.83	175.83	39.22	34.58	98.8	0	0.2	49.4	0.2	0	11.4	0	0	0	0	19.76	19.76	19.76	0	0	0.2	0.2	0	2.2	9.88	9.88	9.88	0	0	0	0	0.2	9.88	19.76	19.76	0						0	20.42	1.3	1.47	13.98	0.47	-	0.02	1.77	3.72	-	1.09	-	-	-	-	2.69	0.45	0.02	-	-	0.9	-	-	-	0.89	0.38	-	-	-	-	-	0.06	0.13	0.18	0.27	-	-	-	-	-	-	50.21	20.42	1.3	1.47	13.98	0.47	-	0.02	1.77	3.72	-	1.09	-	-	-	-	2.69	0.45	0.02	-	-	0.9	-	-	-	0.89	0.38	-	-	-	-	-	0.06	0.13	0.18	0.27	-	-	-	-	-	-	50.21
H5404_014_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1800	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1490.4	95.13	479.74	5187.44	61.54	331.63	0.13	460.83	22.85	2938.82	1224.51	244.9	244.9	244.9	1746.22	1746.22	291.04	12.03	291.04	0	5.55	0	0	2245.39	1156.43	495.61	287.49	123.21	0	0	0	0.39	162.52	116.41	174.62	873.11						150 for 1st 7 days	150 for 1st 7 days	50 for days 11-100	40	10000	0	20	50	20	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	500	10	10	0						122.28	122.28	19.85	40	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	5	10	10	0						1800	120.81	120.81	19.61	39.52	98.8	0	0.2	49.4	0.2	0	11.4	0	0	0	0	9.88	9.88	19.76	0	0	0.2	0.2	0	2.2	9.88	9.88	9.88	0	0	0	0	0.2	4.94	9.88	9.88	0						0	15	0.96	0.78	17.08	0.51	-	0.03	1.9	4.51	-	1.16	-	-	-	-	1.44	0.24	0.02	-	-	1.1	-	-	0.41	0.95	0.41	0.24	-	-	-	-	0.08	0.07	0.1	0.14	-	-	-	-	-	-	47.12	15	0.96	0.78	17.08	0.51	-	0.03	1.9	4.51	-	1.16	-	-	-	-	1.44	0.24	0.02	-	-	1.1	-	-	0.41	0.95	0.41	0.24	-	-	-	-	0.08	0.07	0.1	0.14	-	-	-	-	-	-	47.12
H5404_015_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1800	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1525.23	97.36	490.95	5308.69	62.98	339.38	0.13	471.61	23.38	3007.51	1253.13	250.63	250.63	250.63	1787.04	1787.04	297.84	12.31	297.84	0	5.68	0	0	2297.87	1183.46	507.2	294.21	126.09	0	0	0	0.4	15.59	119.14	178.7	893.52						50 for 1st 5 days	50 for 1st 5 days	50 for days 11-100	0	10000	0	20	50	5000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2	10	10	10	0	0	0	0	20	0	10	10	0						34.72	34.72	19.85	0	100	0	0.2	50	50	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2	10	10	10	0	0	0	0	0.2	0	10	10	0						1800	34.31	34.31	19.61	0	98.8	0	0.2	49.4	49.4	0	11.4	0	0	0	0	9.88	9.88	19.76	0	0	0.2	0.2	0	1.98	9.88	9.88	9.88	0	0	0	0	0.2	0	9.88	9.88	0						0	4.36	0.28	0.8	-	0.52	-	0.03	1.94	0.1	-	1.19	-	-	-	-	1.47	0.25	0.02	-	-	1.12	-	-	0.38	0.97	0.42	0.24	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	14.41	4.36	0.28	0.8	-	0.52	-	0.03	1.94	0.1	-	1.19	-	-	-	-	1.47	0.25	0.02	-	-	1.12	-	-	0.38	0.97	0.42	0.24	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	14.41
H5404_016_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2450	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1497.57	95.59	482.05	5212.41	61.83	333.23	0.11	463.05	20.22	2952.97	1230.4	246.08	246.08	246.08	1754.63	1754.63	292.44	10.64	292.44	0	4.91	0	0	0	1162	498	0	0	0	0	0	0.34	163.31	116.98	175.46	877.31						200 for 1st 7 days	200 for 1st 7 days	100 for days 11-100	35	10000	0	20	50	20	0	12	0	0	0	0	15	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	15	15	0						158.45	158.45	39.7	35	100	0	0.2	50	0.2	0	11.54	0	0	0	0	15	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	15	15	0						2450	158.07	158.07	39.6	34.92	99.76	0	0.2	49.88	0.2	0	11.51	0	0	0	0	14.96	19.95	19.95	0	0	0.2	0.2	0	2.22	9.98	9.98	9.98	0	0	0	0	0.2	9.98	14.96	14.96	0						0	19.73	1.26	1.59	15.17	0.51	-	0.02	1.92	4.03	-	1.18	-	-	-	-	2.19	0.49	0.02	-	-	0.98	-	-	-	0.97	0.41	-	-	-	-	-	0.07	0.14	0.15	0.22	-	-	-	-	-	-	51.04	19.73	1.26	1.59	15.17	0.51	-	0.02	1.92	4.03	-	1.18	-	-	-	-	2.19	0.49	0.02	-	-	0.98	-	-	-	0.97	0.41	-	-	-	-	-	0.07	0.14	0.15	0.22	-	-	-	-	-	-	51.04
H5404_018_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2450	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1536.52	98.08	494.58	5347.97	63.44	341.89	0.14	475.1	25.01	3029.77	1262.4	252.48	252.48	252.48	1800.26	1800.26	300.04	13.17	300.04	0	6.08	0	0	2314.88	1192.22	510.95	296.39	127.02	0	0	0	0.42	16.67	120.02	180.03	900.13						100 for 1st 5 days	100 for 1st 5 days	100 for days 11-100	0	10000	0	20	50	5000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	0	10	10	0						69.44	69.44	39.7	0	100	0	0.2	50	50	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	0	10	10	0						2450	69.28	69.28	39.6	0	99.76	0	0.2	49.88	49.88	0	11.51	0	0	0	0	9.98	9.98	19.95	0	0	0.2	0.2	0	2.22	9.98	9.98	9.98	0	0	0	0	0.2	0	9.98	9.98	0						0	8.87	0.57	1.63	-	0.53	-	0.03	1.97	0.1	-	1.21	-	-	-	-	1.5	0.25	0.02	-	-	1.21	-	-	0.43	0.99	0.42	0.25	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	20.32	8.87	0.57	1.63	-	0.53	-	0.03	1.97	0.1	-	1.21	-	-	-	-	1.5	0.25	0.02	-	-	1.21	-	-	0.43	0.99	0.42	0.25	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	20.32
H5404_022_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2450	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1584.82	101.16	510.13	5516.07	65.44	352.64	0.12	490.03	21.45	3125	1302.08	260.42	260.42	260.42	1856.85	1856.85	309.48	11.26	309.48	0	5.2	0	0	0	1229.69	527.01	0	0	0	0	0	0.36	172.82	123.79	185.69	928.43						200 for 1st 7 days	200 for 1st 7 days	100 for days 11-100	30	10000	0	20	50	20	0	12	0	0	0	0	15	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	15	15	0						161.74	161.74	39.7	30	100	0	0.2	50	0.2	0	11.54	0	0	0	0	15	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	15	15	0						2450	161.35	161.35	39.6	29.93	99.76	0	0.2	49.88	0.2	0	11.51	0	0	0	0	14.96	19.95	19.95	0	0	0.2	0.2	0	2.22	9.98	9.98	9.98	0	0	0	0	0.2	9.98	14.96	14.96	0						0	21.31	1.36	1.68	13.76	0.54	-	0.02	2.04	4.28	-	1.25	-	-	-	-	2.32	0.51	0.02	-	-	1.04	-	-	-	1.02	0.44	-	-	-	-	-	0.07	0.14	0.15	0.23	-	-	-	-	-	-	52.19	21.31	1.36	1.68	13.76	0.54	-	0.02	2.04	4.28	-	1.25	-	-	-	-	2.32	0.51	0.02	-	-	1.04	-	-	-	1.02	0.44	-	-	-	-	-	0.07	0.14	0.15	0.23	-	-	-	-	-	-	52.19
H5404_024_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2450	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1560.08	99.58	502.17	5429.98	64.41	347.14	0.15	482.38	26.14	3076.22	1281.76	256.35	256.35	256.35	1827.87	1827.87	304.64	13.72	304.64	0	6.34	0	0	2350.37	1210.5	518.79	300.93	128.97	0	0	0	0.44	17.43	121.86	182.79	913.93						100 for 1st 5 days	100 for 1st 5 days	100 for days 11-100	0	10000	0	20	50	5000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						69.44	69.44	39.7	0	100	0	0.2	50	50	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						2450	69.28	69.28	39.6	0	99.76	0	0.2	49.88	49.88	0	11.51	0	0	0	0	9.98	9.98	19.95	0	0	0.2	0.2	0	2.22	0	0	0	0	0	0	0	0.2	0	9.98	9.98	0						0	9.01	0.57	1.66	-	0.54	-	0.03	2.01	0.11	-	1.23	-	-	-	-	1.52	0.25	0.02	-	-	1.26	-	-	0.44	-	-	-	-	-	-	-	0.09	-	0.1	0.15	-	-	-	-	-	-	18.98	9.01	0.57	1.66	-	0.54	-	0.03	2.01	0.11	-	1.23	-	-	-	-	1.52	0.25	0.02	-	-	1.26	-	-	0.44	-	-	-	-	-	-	-	0.09	-	0.1	0.15	-	-	-	-	-	-	18.98
H5404_025_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						NONE	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	Coin	V	V	V						NONE	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1304.82	83.29	420	4541.54	53.88	290.34	0.11	403.46	19.47	2572.9	1072.04	214.41	214.41	214.41	1528.8	1528.8	254.8	10.27	254.8	0	4.74	0	0	0	1012.44	433.9	0	0	0	0	0	0.33	12.98	101.92	152.88	764.4						300 for 1st 7 days	300 for 1st 7 days	100 for days 6-100	45	10000	0	20	50	20	0	12	0	0	0	0	10	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	10	20	20	0						241.75	241.75	63.85	45	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	0.1	20	20	0						NONE	241.75	241.75	63.85	45	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	0.1	20	20	0						0	26.29	1.68	2.23	17.03	0.45	-	0.02	1.68	3.89	-	1.03	-	-	-	-	1.27	0.42	0.02	-	-	0.95	-	-	-	0.84	0.36	-	-	-	-	-	0.07	1.3	0.17	0.25	-	-	-	-	-	-	59.96	26.29	1.68	2.23	17.03	0.45	-	0.02	1.68	3.89	-	1.03	-	-	-	-	1.27	0.42	0.02	-	-	0.95	-	-	-	0.84	0.36	-	-	-	-	-	0.07	1.3	0.17	0.25	-	-	-	-	-	-	59.96
H5404_027_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2800	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1664.89	106.27	535.9	5794.78	68.74	370.46	0.14	514.79	24.84	3282.89	1367.87	273.57	273.57	273.57	1950.67	1950.67	325.11	13.1	325.11	0	6.05	0	0	2508.28	1291.83	553.64	321.15	137.64	0	0	0	0.42	16.56	130.04	195.07	975.34						200 for 1st 7 days	200 for 1st 7 days	100 for days 6-100	0	10000	0	20	50	10000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	20	0	10	10	0						158.6	158.6	63.85	0	100	0	0.2	50	100	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0.2	0	10	10	0						2800	154.8	154.8	62.32	0	97.6	0	0.2	48.8	97.6	0	11.27	0	0	0	0	9.76	9.76	19.52	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0.2	0	9.76	9.76	0						0	21.48	1.37	2.78	-	0.56	-	0.03	2.09	0.2	-	1.28	-	-	-	-	1.59	0.26	0.02	-	-	1.18	-	-	-	-	-	-	-	-	-	-	0.08	-	0.11	0.16	-	-	-	-	-	-	33.2	21.48	1.37	2.78	-	0.56	-	0.03	2.09	0.2	-	1.28	-	-	-	-	1.59	0.26	0.02	-	-	1.18	-	-	-	-	-	-	-	-	-	-	0.08	-	0.11	0.16	-	-	-	-	-	-	33.2
H5404_028_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						NONE	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						NONE	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1412.99	90.19	454.82	4918.03	58.34	314.41	0.12	436.9	20.44	2786.19	1160.91	232.18	232.18	232.18	1655.53	1655.53	275.92	10.76	275.92	0	4.97	0	0	0	1096.37	469.87	0	0	0	0	0	0.35	154.08	110.37	165.55	827.77						300 for 1st 7 days	300 for 1st 7 days	100 for days 6-100	15	10000	0	20	50	20	0	12	0	0	0	0	10	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	20	20	0						241.99	241.99	63.85	15	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	20	20	0						NONE	241.99	241.99	63.85	15	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	20	20	0						0	28.49	1.82	2.42	6.15	0.49	-	0.02	1.82	4.09	-	1.12	-	-	-	-	1.38	0.46	0.02	-	-	0.99	-	-	-	0.91	0.39	-	-	-	-	-	0.07	0.13	0.18	0.28	-	-	-	-	-	-	51.23	28.49	1.82	2.42	6.15	0.49	-	0.02	1.82	4.09	-	1.12	-	-	-	-	1.38	0.46	0.02	-	-	0.99	-	-	-	0.91	0.39	-	-	-	-	-	0.07	0.13	0.18	0.28	-	-	-	-	-	-	51.23
H5404_030_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2800	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1565.39	99.92	503.88	5448.46	64.63	348.32	0.14	484.02	25.16	3086.69	1286.12	257.22	257.22	257.22	1834.09	1834.09	305.68	13.24	305.68	0	6.12	0	0	2358.37	1214.62	520.55	301.96	129.41	0	0	0	0.43	16.77	122.27	183.41	917.05						150 for 1st 7 days	150 for 1st 7 days	50 for days 6-100	0	10000	0	20	50	10000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	0	10	10	0						118.95	118.95	31.93	0	100	0	0.2	50	100	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	0	10	10	0						2800	116.1	116.1	31.16	0	97.6	0	0.2	48.8	97.6	0	11.27	0	0	0	0	9.76	9.76	19.52	0	0	0.2	0.2	0	2.18	9.76	9.76	9.76	0	0	0	0	0.2	0	9.76	9.76	0						0	15.14	0.97	1.31	-	0.53	-	0.03	1.97	0.2	-	1.21	-	-	-	-	1.49	0.25	0.02	-	-	1.19	-	-	0.43	0.99	0.42	0.25	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	26.73	15.14	0.97	1.31	-	0.53	-	0.03	1.97	0.2	-	1.21	-	-	-	-	1.49	0.25	0.02	-	-	1.19	-	-	0.43	0.99	0.42	0.25	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	26.73
H5404_031_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	Coin	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1315.14	83.95	423.32	4577.44	54.3	292.63	0.11	406.65	19.43	2593.24	1080.52	216.1	216.1	216.1	1540.88	1540.88	256.81	10.25	256.81	0	4.73	0	0	0	1020.45	437.33	0	0	0	0	0	0.33	12.96	102.73	154.09	770.44						300 for 1st 7 days	300 for 1st 7 days	100 for days 6-100	35	10000	0	20	50	20	0	12	0	0	0	0	25	25	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	10	25	25	0						233.77	233.77	63.85	35	100	0	0.2	50	0.2	0	11.54	0	0	0	0	25	25	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	0.1	25	25	0						3200	231.37	231.37	63.2	34.64	98.97	0	0.2	49.49	0.2	0	11.42	0	0	0	0	24.74	24.74	19.79	0	0	0.2	0.2	0	2.21	9.9	9.9	9.9	0	0	0	0	0.2	0.1	24.74	24.74	0						0	25.36	1.62	2.23	13.21	0.45	-	0.02	1.68	3.85	-	1.03	-	-	-	-	3.18	0.53	0.02	-	-	0.94	-	-	-	0.84	0.36	-	-	-	-	-	0.07	1.28	0.21	0.32	-	-	-	-	-	-	57.18	25.36	1.62	2.23	13.21	0.45	-	0.02	1.68	3.85	-	1.03	-	-	-	-	3.18	0.53	0.02	-	-	0.94	-	-	-	0.84	0.36	-	-	-	-	-	0.07	1.28	0.21	0.32	-	-	-	-	-	-	57.18
H5404_033_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1661.5	106.05	534.81	5782.98	68.6	369.7	0.14	513.74	24.55	3276.21	1365.09	273.02	273.02	273.02	1946.7	1946.7	324.45	12.95	324.45	0	5.98	0	0	2503.17	1289.2	552.51	320.5	137.36	0	0	0	0.42	16.37	129.78	194.67	973.35						200 for 1st 5 days	200 for 1st 5 days	100 for days 6-100	0	10000	0	20	50	10000	0	12	0	0	0	0	20	20	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	2500	20	20	0						138.89	138.89	63.85	0	100	0	0.2	50	100	0	11.54	0	0	0	0	20	20	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	25	20	20	0						2500	134.13	134.13	61.66	0	96.57	0	0.19	48.29	96.57	0	11.15	0	0	0	0	19.31	19.31	19.31	0	0	0.19	0.19	0	2.15	0	0	0	0	0	0	0	0.19	24.14	19.31	19.31	0						0	18.57	1.19	2.75	-	0.55	-	0.03	2.07	0.2	-	1.27	-	-	-	-	3.13	0.52	0.02	-	-	1.15	-	-	0.45	-	-	-	-	-	-	-	0.08	0.03	0.21	0.31	-	-	-	-	-	-	32.53	18.57	1.19	2.75	-	0.55	-	0.03	2.07	0.2	-	1.27	-	-	-	-	3.13	0.52	0.02	-	-	1.15	-	-	0.45	-	-	-	-	-	-	-	0.08	0.03	0.21	0.31	-	-	-	-	-	-	32.53
H5404_034_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						NONE	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	V	V	V	V						NONE	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1291.08	82.41	415.58	4493.71	53.31	287.28	0.14	399.21	24.39	2545.8	1060.75	212.15	212.15	212.15	1512.7	1512.7	252.12	12.86	252.12	0	5.94	0	0	0	1001.78	429.33	0	0	0	0	0	0.41	140.79	100.85	151.27	756.35						175 for 1st 5 days	175 for 1st 5 days	100 for days 6-100	0	10000	0	20	50	20	0	12	0	0	0	0	10	25	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	25	25	0						121.53	121.53	63.85	0	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	25	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	25	25	0						NONE	121.53	121.53	63.85	0	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	25	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	25	25	0						0	13.08	0.83	2.21	-	0.44	-	0.03	1.66	4.88	-	1.02	-	-	-	-	1.26	0.53	0.02	-	-	1.19	-	-	-	0.83	0.36	-	-	-	-	-	0.08	0.12	0.21	0.32	-	-	-	-	-	-	29.07	13.08	0.83	2.21	-	0.44	-	0.03	1.66	4.88	-	1.02	-	-	-	-	1.26	0.53	0.02	-	-	1.19	-	-	-	0.83	0.36	-	-	-	-	-	0.08	0.12	0.21	0.32	-	-	-	-	-	-	29.07
H5404_036_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1634.74	104.35	526.2	5689.84	67.5	363.75	0.18	505.47	31.02	3223.44	1343.1	268.62	268.62	268.62	1915.34	1915.34	319.22	16.28	319.22	0	7.52	0	0	2462.85	1268.43	543.61	315.33	135.14	0	0	0	0.53	20.68	127.69	191.53	957.67						200 for 1st 5 days	200 for 1st 5 days	100 for days 6-100	0	10000	0	20	50	10000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	20	0	10	10	0						138.89	138.89	63.85	0	100	0	0.2	50	100	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0.2	0	10	10	0						3200	137.46	137.46	63.2	0	98.97	0	0.2	49.49	98.97	0	11.42	0	0	0	0	9.9	9.9	19.79	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0.2	0	9.9	9.9	0						0	18.73	1.2	2.77	-	0.56	-	0.03	2.08	0.26	-	1.28	-	-	-	-	1.58	0.26	0.03	-	-	1.49	-	-	-	-	-	-	-	-	-	-	0.1	-	0.11	0.16	-	-	-	-	-	-	30.63	18.73	1.2	2.77	-	0.56	-	0.03	2.08	0.26	-	1.28	-	-	-	-	1.58	0.26	0.03	-	-	1.49	-	-	-	-	-	-	-	-	-	-	0.1	-	0.11	0.16	-	-	-	-	-	-	30.63
H5404_037_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2450	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1539.79	98.28	495.64	5359.37	63.58	342.62	0.12	476.11	20.85	3036.22	1265.09	253.02	253.02	253.02	1804.1	1804.1	300.68	10.94	300.68	0	5.05	0	0	0	1194.76	512.04	0	0	0	0	0	0.35	167.91	120.27	180.41	902.05						200 for 1st 7 days	200 for 1st 7 days	100 for days 11-100	30	10000	0	20	50	20	0	12	0	0	0	0	15	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	15	15	0						167.31	167.31	39.7	30	100	0	0.2	50	0.2	0	11.54	0	0	0	0	15	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	15	15	0						2450	167.31	167.31	39.7	30	100	0	0.2	50	0.2	0	11.54	0	0	0	0	15	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	15	15	0						0	21.47	1.37	1.64	13.4	0.53	-	0.02	1.98	4.17	-	1.22	-	-	-	-	2.26	0.5	0.02	-	-	1.01	-	-	-	1	0.43	-	-	-	-	-	0.07	0.14	0.15	0.23	-	-	-	-	-	-	51.59	21.47	1.37	1.64	13.4	0.53	-	0.02	1.98	4.17	-	1.22	-	-	-	-	2.26	0.5	0.02	-	-	1.01	-	-	-	1	0.43	-	-	-	-	-	0.07	0.14	0.15	0.23	-	-	-	-	-	-	51.59
H5404_039_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2450	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1565.99	99.96	504.07	5450.54	64.66	348.45	0.14	484.21	25.59	3087.87	1286.61	257.32	257.32	257.32	1834.79	1834.79	305.8	13.43	305.8	0	6.2	0	0	2359.27	1215.09	520.75	302.07	129.46	0	0	0	0.43	17.06	122.32	183.48	917.4						100 for 1st 5 days	100 for 1st 5 days	100 for days 11-100	0	10000	0	20	50	5000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						69.44	69.44	39.7	0	100	0	0.2	50	50	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						2450	69.28	69.28	39.6	0	99.76	0	0.2	49.88	49.88	0	11.51	0	0	0	0	9.98	9.98	19.95	0	0	0.2	0.2	0	2.22	0	0	0	0	0	0	0	0.2	0	9.98	9.98	0						0	9.04	0.58	1.66	-	0.54	-	0.03	2.01	0.11	-	1.23	-	-	-	-	1.53	0.25	0.02	-	-	1.24	-	-	0.44	-	-	-	-	-	-	-	0.09	-	0.1	0.15	-	-	-	-	-	-	19.02	9.04	0.58	1.66	-	0.54	-	0.03	2.01	0.11	-	1.23	-	-	-	-	1.53	0.25	0.02	-	-	1.24	-	-	0.44	-	-	-	-	-	-	-	0.09	-	0.1	0.15	-	-	-	-	-	-	19.02
H5404_043_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	Coin	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1450.78	92.6	466.98	5049.54	59.9	322.82	0.12	448.58	21.43	2860.7	1191.96	238.39	238.39	238.39	1699.81	1699.81	283.3	11.28	283.3	0	5.21	0	0	0	1125.69	482.44	0	0	0	0	0	0.36	14.28	113.32	169.98	849.9						175 for 1st 7 days	175 for 1st 7 days	75 for days 7-100	25	10000	0	20	50	20	0	12	0	0	0	0	10	20	2000	0	0	0.2	0.2	0	2.23	10	10	0	0	0	0	0	20	10	20	20	0						140.49	140.49	43.4	25	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	0	0	0	0	0	0.2	0.1	20	20	0						3200	145.21	145.21	44.86	25.84	103.36	0	0.21	51.68	0.21	0	11.93	0	0	0	0	10.34	20.67	20.67	0	0	0.21	0.21	0	2.3	10.34	10.34	0	0	0	0	0	0.21	0.1	20.67	20.67	0						0	17.56	1.12	1.75	10.87	0.52	-	0.03	1.93	4.43	-	1.18	-	-	-	-	1.46	0.49	0.02	-	-	1.08	-	-	-	0.97	0.42	-	-	-	-	-	0.08	1.48	0.2	0.29	-	-	-	-	-	-	45.86	17.56	1.12	1.75	10.87	0.52	-	0.03	1.93	4.43	-	1.18	-	-	-	-	1.46	0.49	0.02	-	-	1.08	-	-	-	0.97	0.42	-	-	-	-	-	0.08	1.48	0.2	0.29	-	-	-	-	-	-	45.86
H5404_045_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2800	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1664.34	106.23	535.73	5792.87	68.72	370.34	0.14	514.62	24.58	3281.81	1367.42	273.48	273.48	273.48	1950.03	1950.03	325	12.94	325	0	5.97	0	0	2507.45	1291.4	553.46	321.04	137.59	0	0	0	0.42	16.39	130	195	975.01						50 for 1st 5 days	50 for 1st 5 days	50 for days 7-100	0	10000	0	20	50	10000	0	12	0	0	0	0	5	10	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						34.72	34.72	28.93	0	100	0	0.2	50	100	0	11.54	0	0	0	0	5	10	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						2800	35.22	35.22	29.35	0	101.44	0	0.2	50.72	101.44	0	11.71	0	0	0	0	5.07	10.14	20.29	0	0	0.2	0.2	0	2.26	0	0	0	0	0	0	0	0.2	0	10.14	10.14	0						0	4.89	0.31	1.31	-	0.58	-	0.03	2.18	0.21	-	1.33	-	-	-	-	0.82	0.27	0.02	-	-	1.21	-	-	0.47	-	-	-	-	-	-	-	0.08	-	0.11	0.16	-	-	-	-	-	-	14	4.89	0.31	1.31	-	0.58	-	0.03	2.18	0.21	-	1.33	-	-	-	-	0.82	0.27	0.02	-	-	1.21	-	-	0.47	-	-	-	-	-	-	-	0.08	-	0.11	0.16	-	-	-	-	-	-	14
H5404_053_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1468.45	93.73	472.67	5111.04	60.63	326.75	0.16	454.05	27.92	2895.54	1206.47	241.29	241.29	241.29	1720.51	1720.51	286.75	14.7	286.75	0	6.79	0	0	0	1139.4	488.31	0	0	0	0	0	0.47	2294.01	114.7	172.05	860.25						75 for 1st 7 days	75 for 1st 7 days	0 for days 8-100	21	5000	0	0	25	20	0	12	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	1000	0	0	0						60.22	60.22	0	21	50	0	0	25	0.2	0	11.54	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	10	0	0	0						2500	58.16	58.16	0	20.28	48.29	0	0	24.14	0.19	0	11.15	0	0	0	0	0	0	0	0	0	0.19	0.19	0	0	0	0	0	0	0	0	0	0	9.66	0	0	0						0	7.12	0.45	-	8.64	0.24	-	-	0.91	5.39	-	1.12	-	-	-	-	-	-	-	-	-	1.31	-	-	-	-	-	-	-	-	-	-	-	1.85	-	-	-	-	-	-	-	-	27.04	7.12	0.45	-	8.64	0.24	-	-	0.91	5.39	-	1.12	-	-	-	-	-	-	-	-	-	1.31	-	-	-	-	-	-	-	-	-	-	-	1.85	-	-	-	-	-	-	-	-	27.04
H5404_056_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1458.72	93.11	469.54	5077.19	60.23	324.58	0.13	451.04	22.09	2876.36	1198.48	239.7	239.7	239.7	1709.11	1709.11	284.85	11.63	284.85	0	5.37	0	0	0	1131.86	485.08	0	0	0	0	0	0.38	159.07	113.94	170.91	854.56						150 for 1st 7 days	150 for 1st 7 days	50 for days 7-100	30	10000	0	20	50	20	0	12	0	0	0	0	10	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	20	20	0						109.36	109.36	28.93	30	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	20	20	0						2500	105.61	105.61	27.94	28.97	96.57	0	0.19	48.29	0.19	0	11.15	0	0	0	0	9.66	19.31	19.31	0	0	0.19	0.19	0	2.15	9.66	9.66	9.66	0	0	0	0	0.19	9.66	19.31	19.31	0						0	12.84	0.82	1.09	12.26	0.48	-	0.02	1.81	4.27	-	1.11	-	-	-	-	1.38	0.46	0.02	-	-	1.04	-	-	-	0.91	0.39	-	-	-	-	-	0.07	0.13	0.18	0.28	-	-	-	-	-	-	39.56	12.84	0.82	1.09	12.26	0.48	-	0.02	1.81	4.27	-	1.11	-	-	-	-	1.38	0.46	0.02	-	-	1.04	-	-	-	0.91	0.39	-	-	-	-	-	0.07	0.13	0.18	0.28	-	-	-	-	-	-	39.56
H5404_058_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1450	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1646.85	105.12	530.1	5732	68	366.44	0.14	509.21	24.94	3247.33	1353.05	270.61	270.61	270.61	1929.54	1929.54	321.59	13.13	321.59	0	6.06	0	0	2481.1	1277.83	547.64	317.67	136.14	0	0	0	0.42	16.63	128.64	192.95	964.77						50 for 1st 5 days	50 for 1st 5 days	50 for days 7-100	0	10000	0	20	50	5000	0	12	0	0	0	0	5	10	2000	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	20	0	10	10	0						34.72	34.72	28.93	0	100	0	0.2	50	50	0	11.54	0	0	0	0	5	10	20	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0.2	0	10	10	0						1450	32.34	32.34	26.95	0	93.14	0	0.19	46.57	46.57	0	10.75	0	0	0	0	4.66	9.31	18.63	0	0	0.19	0.19	0	0	0	0	0	0	0	0	0	0.19	0	9.31	9.31	0						0	4.44	0.28	1.19	-	0.53	-	0.03	1.98	0.1	-	1.21	-	-	-	-	0.75	0.25	0.02	-	-	1.13	-	-	-	-	-	-	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	12.23	4.44	0.28	1.19	-	0.53	-	0.03	1.98	0.1	-	1.21	-	-	-	-	0.75	0.25	0.02	-	-	1.13	-	-	-	-	-	-	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	12.23
H5404_059_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						2500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1520.88	97.08	489.55	5293.55	62.8	338.41	0.14	470.26	25.11	2998.93	1249.56	249.91	249.91	249.91	1781.94	1781.94	296.99	13.22	296.99	0	6.1	0	0	0	1180.09	505.75	0	0	0	0	0	0.43	165.85	118.8	178.19	890.97						125 for 1st 7 days	125 for 1st 7 days	50 for days 7-100	28	10000	0	20	50	20	0	12	0	0	0	0	10	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	20	20	0						98.05	98.05	28.93	28	100	0	0.2	50	0.2	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	20	20	0						2500	94.69	94.69	27.94	27.04	96.57	0	0.19	48.29	0.19	0	11.15	0	0	0	0	9.66	19.31	19.31	0	0	0.19	0.19	0	2.15	9.66	9.66	9.66	0	0	0	0	0.19	9.66	19.31	19.31	0						0	12	0.77	1.14	11.93	0.51	-	0.03	1.89	4.85	-	1.16	-	-	-	-	1.43	0.48	0.02	-	-	1.18	-	-	-	0.95	0.41	-	-	-	-	-	0.08	0.13	0.19	0.29	-	-	-	-	-	-	39.43	12	0.77	1.14	11.93	0.51	-	0.03	1.89	4.85	-	1.16	-	-	-	-	1.43	0.48	0.02	-	-	1.18	-	-	-	0.95	0.41	-	-	-	-	-	0.08	0.13	0.19	0.29	-	-	-	-	-	-	39.43
H5404_061_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1689.61	107.85	543.86	5880.81	69.76	375.96	0.16	522.43	27.89	3331.63	1388.18	277.64	277.64	277.64	1979.63	1979.63	329.94	14.68	329.94	0	6.78	0	0	2545.52	1311.01	561.86	325.92	139.68	0	0	0	0.47	18.59	131.98	197.96	989.82						50 for 1st 5 days	50 for 1st 5 days	50 for days 7-100	0	10000	0	20	50	5000	0	12	0	0	0	0	5	10	2000	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	20	0	10	10	0						34.72	34.72	28.93	0	100	0	0.2	50	50	0	11.54	0	0	0	0	5	10	20	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0.2	0	10	10	0						1500	32.34	32.34	26.95	0	93.14	0	0.19	46.57	46.57	0	10.75	0	0	0	0	4.66	9.31	18.63	0	0	0.19	0.19	0	0	0	0	0	0	0	0	0	0.19	0	9.31	9.31	0						0	4.55	0.29	1.22	-	0.54	-	0.03	2.03	0.11	-	1.24	-	-	-	-	0.77	0.26	0.02	-	-	1.26	-	-	-	-	-	-	-	-	-	-	0.09	-	0.1	0.15	-	-	-	-	-	-	12.67	4.55	0.29	1.22	-	0.54	-	0.03	2.03	0.11	-	1.24	-	-	-	-	0.77	0.26	0.02	-	-	1.26	-	-	-	-	-	-	-	-	-	-	0.09	-	0.1	0.15	-	-	-	-	-	-	12.67
H5404_062_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1950	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	Coin	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1474.73	94.13	474.69	5132.9	60.89	328.14	0.13	455.99	22.09	2907.92	1211.63	242.33	242.33	242.33	1727.86	1727.86	287.98	11.63	287.98	0	5.37	0	0	0	1144.27	490.4	0	0	0	0	0	0.38	14.73	115.19	172.79	863.93						250 for 1st 7 days	250 for 1st 7 days	100 for days 6-100	30	10000	0	20	50	20	0	12	0	0	0	0	15	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	10	20	20	0						201.64	201.64	63.85	30	100	0	0.2	50	0.2	0	11.54	0	0	0	0	15	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	0.1	20	20	0						1950	196.31	196.31	62.17	29.21	97.36	0	0.19	48.68	0.19	0	11.24	0	0	0	0	14.6	19.47	19.47	0	0	0.19	0.19	0	2.17	9.74	9.74	9.74	0	0	0	0	0.19	0.1	19.47	19.47	0						0	24.13	1.54	2.46	12.49	0.49	-	0.02	1.85	4.3	-	1.13	-	-	-	-	2.1	0.47	0.02	-	-	1.05	-	-	-	0.93	0.4	-	-	-	-	-	0.07	1.43	0.19	0.28	-	-	-	-	-	-	55.36	24.13	1.54	2.46	12.49	0.49	-	0.02	1.85	4.3	-	1.13	-	-	-	-	2.1	0.47	0.02	-	-	1.05	-	-	-	0.93	0.4	-	-	-	-	-	0.07	1.43	0.19	0.28	-	-	-	-	-	-	55.36
H5404_064_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1450	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1687.47	107.71	543.17	5873.36	69.67	375.48	0.14	521.77	25.28	3327.41	1386.42	277.28	277.28	277.28	1977.12	1977.12	329.52	13.31	329.52	0	6.14	0	0	2542.29	1309.34	561.15	325.5	139.5	0	0	0	0.43	16.85	131.81	197.71	988.56						150 for 1st 5 days	150 for 1st 5 days	75 for days 6-100	0	10000	0	20	50	10000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						104.17	104.17	47.89	0	100	0	0.2	50	100	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						1450	98.92	98.92	45.48	0	94.96	0	0.19	47.48	94.96	0	10.96	0	0	0	0	9.5	9.5	18.99	0	0	0.19	0.19	0	2.12	0	0	0	0	0	0	0	0.19	0	9.5	9.5	0						0	13.91	0.89	2.06	-	0.55	-	0.03	2.06	0.2	-	1.27	-	-	-	-	1.56	0.26	0.02	-	-	1.17	-	-	0.45	-	-	-	-	-	-	-	0.08	-	0.1	0.16	-	-	-	-	-	-	24.77	13.91	0.89	2.06	-	0.55	-	0.03	2.06	0.2	-	1.27	-	-	-	-	1.56	0.26	0.02	-	-	1.17	-	-	0.45	-	-	-	-	-	-	-	0.08	-	0.1	0.16	-	-	-	-	-	-	24.77
H5404_086_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						0	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	Coin	Coin	Coin	Coin	V	O	O	O	Coin	P	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1448.45	92.45	12.13	5041.44	2.31	0.66	0.11	447.86	19.53	2856.11	1190.04	238.01	238.01	238.01	1697.08	1697.08	282.85	10.28	282.85	0	4.75	0	0	3.59	4.33	1.86	2.14	0.92	0	0	0	0.33	13.02	113.14	169.71	848.54						300 for 1st 7 days	300 for 1st 7 days	150 for 1st 100 days	5	10000	0	20	50	20000	0	12	0	0	0	0	10	25	2000	0	0	0.2	0.2	0	1	1	1	1	1	0	0	0	20	2500	25	25	0						237.88	237.88	150	5	100	0	0.2	50	200	0	11.54	0	0	0	0	10	25	20	0	0	0.2	0.2	0	1	1	1	1	1	0	0	0	0.2	25	25	25	0						0	237.88	237.88	150	5	100	0	0.2	50	200	0	11.54	0	0	0	0	10	25	20	0	0	0.2	0.2	0	1	1	1	1	1	0	0	0	0.2	25	25	25	0						0	28.71	1.83	0.15	2.1	0.02	-	0.02	1.87	0.33	-	1.14	-	-	-	-	1.41	0.59	0.02	-	-	0.95	-	-	3.59	4.33	1.86	2.14	0	-	-	-	0.07	0.03	0.24	0.35	-	-	-	-	-	-	51.75	28.71	1.83	0.15	2.1	0.02	-	0.02	1.87	0.33	-	1.14	-	-	-	-	1.41	0.59	0.02	-	-	0.95	-	-	3.59	4.33	1.86	2.14	0	-	-	-	0.07	0.03	0.24	0.35	-	-	-	-	-	-	51.75
H5404_087_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						0	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	Coin	Coin	Coin	Coin	V	O	O	O	Coin	Coin	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1439.35	91.87	18.8	5009.76	3.57	1.03	0.17	445.05	30.25	2838.16	1182.57	236.51	236.51	236.51	1686.41	1686.41	281.07	15.93	281.07	0	7.35	0	0	0	6.72	2.88	0	0	0	0	0	0.51	20.17	112.43	168.64	843.21						350 for 1st 7 days	350 for 1st 7 days	150 for 1st 100 days	50	10000	0	20	50	20	0	12	0	0	0	0	15	25	2000	0	0	0.2	0.2	0	1	1	1	1	1	0	0	0	20	10	25	25	0						272.85	272.85	150	50	100	0	0.2	50	0.2	0	11.54	0	0	0	0	15	25	20	0	0	0.2	0.2	0	1	1	1	1	1	0	0	0	0.2	0.1	25	25	0						0	272.85	272.85	150	50	100	0	0.2	50	0.2	0	11.54	0	0	0	0	15	25	20	0	0	0.2	0.2	0	1	1	1	1	1	0	0	0	0.2	0.1	25	25	0						0	32.73	2.09	0.23	20.87	0.03	-	0.03	1.85	6.05	-	1.14	-	-	-	-	2.11	0.59	0.03	-	-	1.47	-	-	-	6.72	2.88	-	-	-	-	-	0.1	2.02	0.23	0.35	-	-	-	-	-	-	81.52	32.73	2.09	0.23	20.87	0.03	-	0.03	1.85	6.05	-	1.14	-	-	-	-	2.11	0.59	0.03	-	-	1.47	-	-	-	6.72	2.88	-	-	-	-	-	0.1	2.02	0.23	0.35	-	-	-	-	-	-	81.52
H5407_001_0	2006											1900											D	D	D		T		Coin	V	V	V	V	V	P			V	V	V	V	V		P		P	V	P	V				V																																																					-	1325.48	44.58	400		50		1.38	500	250	100	200	5	50			2500	275	2050	1600	4205		195		50	500	150	240				25											125/day 1st 5 days	125/day 1st 5 days	100 day for days 7+		150 per trip		20 coinsurance	50 ER/35 Urgent	150 hosp/25 ASC	10 non contracted	25/150 ASC/Hosp	!50 per episode	150 per treatment			25 per visit	35 ind/25 group	15/visit	0 PCP/25 SCP	0 - 150		25/exam		35 exam/40 x-ray	10 /exam	30 /lenses	10 hearing/25 fitting				15 test											76.14	67.3	64.5		150		0.2	47.04	87.36	2.4	87.6	150	150			25	33.16	15	16.25	4.17		25		36	10	30	11.5				15											1900	62.83	51.15	57.3		136.8		0.2	43.44	72.96	2.4	78.6	150	129.6			22.9	33.16	15	16.25	4.17		25		36	10	30	11.5				15											0	6.94	0.19	1.91	-	0.57	-	0.28	1.81	1.52	0.02	1.31	0.06	0.54	-	-	4.77	0.76	2.56	2.17	1.46	-	0.41	-	0.15	0.42	0.38	0.23	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	28.48	6.94	0.19	1.91	-	0.57	-	0.28	1.81	1.52	0.02	1.31	0.06	0.54	-	-	4.77	0.76	2.56	2.17	1.46	-	0.41	-	0.15	0.42	0.38	0.23	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	28.48
H5407_004_0	2006											1900											D	D	D		T		coin	P	P	P	P	P	P			V	V	V	P	V		V		P		P	P				V																																																					-	1262.36	44.58	400		50		1.38	500	210	100	200	5	50			2500	275	2050	1600	4205		195		50		150	240				25											100/day to max of 500	150/day to max of 750	100/day for days 15-100		100 per trip		20 coinsurance	50 ER/30 Urgent Care	75 ASC/125 Hospital	0/10	20 FSF/125 Hospital	125 per encounter	125 per encounter			20 OV	25 group/35 individual	20 per visit	0 PCP/20 SCP	Various copays		Various copays		35 exam/40 xray		30 per lenses/frames	25 per exam				20 per speech exam											60.93	80.76	46.8		100		0.2	46.08	100	2.4	72.6	125	125			20	33.16	20	12.98	3.82		33.23		36		30	25				20											1900	46.99	64.61	39.9		86.4		0.2	42.72	84	2.4	67.8	125	125			17.57	33.16	20	12.98	3.82		33.23		36		30	25				20											0	4.94	0.24	1.33	-	0.36	-	0.28	1.78	1.47	0.02	1.13	0.05	0.52	-	-	3.66	0.76	3.42	1.73	1.34	-	0.54	-	0.15	-	0.38	0.5	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	24.64	4.94	0.24	1.33	-	0.36	-	0.28	1.78	1.47	0.02	1.13	0.05	0.52	-	-	3.66	0.76	3.42	1.73	1.34	-	0.54	-	0.15	-	0.38	0.5	-	-	-	0.04	-	-	-	-	-	-	-	-	-	-	24.64
H5407_005_0	2006											1900											D	D	D		T		coin	P	P	P	P	P	P		V	V	V	V	P	V		V		P		P	P				V																																																					-	1262.36	44.58	400	2200	50		1.38	500	210	100	200	5	50		6000	2500	275	2050	1600	4205		195		800		150	240				25											150/day to max of 750	150/day to max of 750	100/day for days 8-100	10 /visit	100 per trip		20 coinsurance	50 ER/30 Urgent Care	50 ASC/150 Hospital	0 / 10	50 ASC/150 Hospital	150 per encounter	150 per encounter		5 OV	25 OV	15 group/25 individual	25 per visit	5 PCP/25 SCP	Various copays		Various copays		10/35/40		10 per lenses/frames	10 per exam				25 per speech exam											91.35	80.76	62.1	10	100		0.2	46	100	2.4	70.2	150	150		5	25	22.69	25	18	4		19.69		11.7		10	10				25											1900	77.86	64.61	55.5	10	86.4		0.2	42.72	84	2.4	65.4	150	150		5	22.61	22.69	25	18	4		19.69		11.7		10	10				25											0	8.19	0.24	1.85	1.83	0.36	-	0.28	1.78	1.47	0.02	1.09	0.06	0.63	-	2.5	4.71	0.52	4.27	2.4	1.4	-	0.32	-	0.78	-	0.13	0.2	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	35.08	8.19	0.24	1.85	1.83	0.36	-	0.28	1.78	1.47	0.02	1.09	0.06	0.63	-	2.5	4.71	0.52	4.27	2.4	1.4	-	0.32	-	0.78	-	0.13	0.2	-	-	-	0.05	-	-	-	-	-	-	-	-	-	-	35.08
H5407_006_0	2006																							D	D					V																																																																												-		44.58	700					500																																			50/day 1st 5 days	25 day for days 7+					50 ER																																			32.3	16.11					50																																				32.3	16.11					50																																		0	-	0.12	0.94	-	-	-	-	2.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.14	-	0.12	0.94	-	-	-	-	2.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.14
H5407_007_0	2006																						D	D	D				Coin	V																																																																												-	1425	44.58	500				1.31	500	210		350									50																						100/day 1st 5 days	150/day 1st 5 days	25 day for days 7+				20 coinsurance	50 ER	25 ASC/100 Hosp		25 FSF/100 hosp									Colo Scr - Various																						60.88	80.76	16.08				0.2	50	62.86		43.89									40.8																							60.88	80.76	16.08				0.2	50	62.86		43.89									40.8																						0	7.23	0.3	0.67	-	-	-	0.26	2.08	1.1	-	1.28	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.1	7.23	0.3	0.67	-	-	-	0.26	2.08	1.1	-	1.28	-	-	-	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.1
H5407_008_0	2006																						D	D	D				Coin	V	V	V	V	V	P					V		V		P		V	V	P	V																																																									-	1262.36	44.58	400				1.38	500	210	150	225	5	50					2050		205		195		800	500	150	240															150/day 1st 5 days	150/day 1st 5 days	50 day for days 7+				20 coinsurance	50 ER/30 Urgent	150 hosp/75 ASC	150 hosp/75 ASC	150 hosp/75 ASC	150	150					15/visit		10 exam/20 supplies		Various copays		10/visit	10 /exam	10 /lenses	10 hearing/fitting															91.35	80.76	32.1				0.2	46	112.57	90.4	90.13	150	150					15		10.54		16.62		10	10	10	10																91.35	80.76	32.1				0.2	46	112.57	90.4	90.13	150	150					15		10.54		16.62		10	10	10	10															0	9.61	0.3	1.07	-	-	-	0.28	1.92	1.97	1.13	1.69	0.06	0.63	-	-	-	-	2.56	-	0.18	-	0.27	-	0.67	0.42	0.13	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.07	9.61	0.3	1.07	-	-	-	0.28	1.92	1.97	1.13	1.69	0.06	0.63	-	-	-	-	2.56	-	0.18	-	0.27	-	0.67	0.42	0.13	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.07
H5407_009_0	2006											1900											D	D	D		T		Coin	V	V	V	V	V	P				V	V		V		P				P	V																																																									-	1262.36	44.58	400		50		1.38	500	210	150	225	5	50				375	2050		105		70				150	240															125/day 1st 5 days	150/day 1st 5 days	50 day for days 16+		100 per trip		20 coinsurance	50 ER/30 Urgent	100 hosp/50 ASC	100 hosp/50 ASC	100 hosp/50 ASC	100	100				25 group/35 ind	15/visit		Various copays		Various copays				10 /lenses	10 hearing/fitting															76.14	80.76	22.2		100		0.2	46.08	75.43	60	60.27	100	100				33	15		34.29		22.29				10	10															1900	56.94	64.61	14.7		86.4		0.2	42.48	57.71	60	52.27	100	79.2				33	15		34.29		22.29				10	10															0	5.99	0.24	0.49	-	0.36	-	0.28	1.77	1.01	0.75	0.98	0.04	0.33	-	-	-	1.03	2.56	-	0.3	-	0.13	-	-	-	0.13	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.59	5.99	0.24	0.49	-	0.36	-	0.28	1.77	1.01	0.75	0.98	0.04	0.33	-	-	-	1.03	2.56	-	0.3	-	0.13	-	-	-	0.13	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.59
H5407_010_0	2006											1900											D	D	D		T	Coin	Coin	V	V	V	V	V	P	V			V	V	V	V		P		P		P	P																																																									-	1262.36	44.58	400		50	11.07	1.44	500	210	150	225	5	50			3500	375	2050	1600	4355		195		800		150	240															150 per day	150 per day	50/day for days 6+		50 per trip	20 coinsurance	20 coinsurance	50 ER/30 Urgent	250 hosp/150 ASC	250 hosp/50 ASC	250 hosp/50 ASC	250/visit	250 per session			25 per visit	35 group/50 ind	25 per visit	0 PCP/25 SCP	Various Copays		Various copays		10 per procedure		10 per frames/lenses	10 eval/fitting															150	150	33.3		50	0.2	0.2	46.08	200	70.4	90.13	250	250			25	47.04	25	16.2	13.75		24.62		10		10	10															1900	132.8	134.6	28.8		36	0.2	0.2	42.48	183.43	70.4	82.13	250	228			24.48	47.04	25	16.2	13.75		24.62		10		10	10															0	13.97	0.5	0.96	-	0.15	2.21	0.29	1.77	3.21	0.88	1.54	0.1	0.95	-	-	7.14	1.47	4.27	2.16	4.99	-	0.4	-	0.67	-	0.13	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.96	13.97	0.5	0.96	-	0.15	2.21	0.29	1.77	3.21	0.88	1.54	0.1	0.95	-	-	7.14	1.47	4.27	2.16	4.99	-	0.4	-	0.67	-	0.13	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.96
H5407_011_0	2006											1900											D	D	D		T		Coin	V	V			V	P				V			V		P		P		P	V																																																									-	1723.12	57.95	520		65		1.79	520	325			6.5	65				357.5			71.5		253.5		65		195	312															75/day 1st 5 days	75/day 1st 5 days	50 day for days 21+		100		20 coinsurance	50 ER	125 hosp/20 ASC			125 per episode	125 per session				35 ind/25 group			25 diag hearing exam		25/exam		35 exam/40 x-ray		30 /lenses	25 hearing/30 fitting															45.68	39.35	16.62		100		0.2	50	72.37			125	125				33.23			25		25		36.92		30	25.38															1900	37.68	31.06	13.15		92.31		0.2	47.08	62.03			125	114.46				33.23			25		25		36.92		30	25.38															0	5.41	0.15	0.57	-	0.5	-	0.36	2.04	1.68	-	-	0.07	0.62	-	-	-	0.99	-	-	0.15	-	0.53	-	0.2	-	0.49	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.41	5.41	0.15	0.57	-	0.5	-	0.36	2.04	1.68	-	-	0.07	0.62	-	-	-	0.99	-	-	0.15	-	0.53	-	0.2	-	0.49	0.66	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.41
H5410_001_0	2006																						Coin	D	D	P	T	O	O	V	V	V	V	V	V	V	V	Coin	P	P	P	P	S	O	T	P	V	P	V	P	O	O	O											0																																										-	0.01															0.01					435.13			3.94		1.26																30 Gastr Bypass															30 Gastr Bypass					0 Gen; 10 Brand			Various Copays		150 Copay																0.3															0.3					5.39			94.5		150																	0.3															0.3					5.39			94.5		150																0	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	0.2	-	-	0.03	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.25	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0	-	-	-	-	0.2	-	-	0.03	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.25
H5411_001_0	2006																							D	D					V	V								V	V		V																																																																-		54.09	757.29					649.11	135.23								324.55	2542.33		757.29																							25 for days 1-5	50 for days 8-100					50 ER	50 Hosp								20  MH	10 per visit		10 chiro/pod non MC																							17.75	31.06					50	50								20	10		10																								17.75	31.06					50	50								20	10		10																							-	0.08	1.96	-	-	-	-	2.7	0.56	-	-	-	-	-	-	-	0.54	2.12	-	0.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.6	-	0.08	1.96	-	-	-	-	2.7	0.56	-	-	-	-	-	-	-	0.54	2.12	-	0.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.6
H5414_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1523.03	15.38	1290.2	839.09	172.78	15.31	1.14	152.24	31.86	279.55	221.43	0.34	231.28	18.59	3333.42	7239.81	3.39	856.87	454.96		252.41	744.98																				200/d 7	200/d 7	0/d 1-10 75 11-100																																							143.69	143.69	47.6	0	100	0.2	0.2	48	100	35	40.13	35	35	35	25	35	35	35	35		45	35								0													143.69	143.69	47.6	0	100	0.2	0.2	48	100	35	40.13	35	35	35	25	35	35	35	35		45	35								0													18.24	0.18	5.12	-	1.44	3.06	0.23	0.61	0.27	0.82	0.74	0	0.67	0.05	6.94	21.12	0.01	2.5	1.33	-	0.95	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.45	18.24	0.18	5.12	-	1.44	3.06	0.23	0.61	0.27	0.82	0.74	0	0.67	0.05	6.94	21.12	0.01	2.5	1.33	-	0.95	2.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.45
H5414_002_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P																																																						-	1626.41	16.43	1377.77	896.05	184.51	16.35	1.22	162.57	34.02	298.53	236.46	0.36	246.97	19.85	3559.68	7731.21	3.62	915.03	485.84		269.55	795.54																				100/d 7	100/d 7	0/d 1-8 75/d 9-15 125/d 16-100																																							71.85	71.85	77.39	0	100	0.2	0.2	48	100	35	40.13	35	35	35	25	35	35	35	35		45	35								0													71.85	71.85	77.39	0	100	0.2	0.2	48	100	35	40.13	35	35	35	25	35	35	35	35		45	35								0													9.74	0.1	8.89	-	1.54	3.27	0.24	0.65	0.28	0.87	0.79	0	0.72	0.06	7.42	22.55	0.01	2.67	1.42	-	1.01	2.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.54	9.74	0.1	8.89	-	1.54	3.27	0.24	0.65	0.28	0.87	0.79	0	0.72	0.06	7.42	22.55	0.01	2.67	1.42	-	1.01	2.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.54
H5414_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1692.43	17.1	1301.94	1271.16	228.68	2.11	0.02	238.73	48.43	892.7	274.45		65.89	41.64	2634.45	9993.92	0.4	679.92	606.72		291.93	724.15																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													20.27	0.2	10.85	3.71	2.86	0.63	0.01	0.99	0.61	0.6	2.25	-	0.19	0.12	7.68	29.15	0	1.98	1.77	-	1.64	2.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.63	20.27	0.2	10.85	3.71	2.86	0.63	0.01	0.99	0.61	0.6	2.25	-	0.19	0.12	7.68	29.15	0	1.98	1.77	-	1.64	2.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.63
H5414_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1692.43	17.1	1301.94	1271.16	228.68	2.11	0.02	238.73	48.43	892.7	274.45		65.89	41.64	2634.45	9993.92	0.4	679.92	606.72		291.93	724.15																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													20.27	0.2	10.85	3.71	2.86	0.63	0.01	0.99	0.61	0.6	2.25	-	0.19	0.12	7.68	29.15	0	1.98	1.77	-	1.64	2.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.63	20.27	0.2	10.85	3.71	2.86	0.63	0.01	0.99	0.61	0.6	2.25	-	0.19	0.12	7.68	29.15	0	1.98	1.77	-	1.64	2.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.63
H5414_804_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1692.43	17.1	1301.94	1271.16	228.68	2.11	0.02	238.73	48.43	892.7	274.45		65.89	41.64	2634.45	9993.92	0.4	679.92	606.72		291.93	724.15																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													20.27	0.2	10.85	3.71	2.86	0.63	0.01	0.99	0.61	0.6	2.25	-	0.19	0.12	7.68	29.15	0	1.98	1.77	-	1.64	2.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.63	20.27	0.2	10.85	3.71	2.86	0.63	0.01	0.99	0.61	0.6	2.25	-	0.19	0.12	7.68	29.15	0	1.98	1.77	-	1.64	2.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	87.63
H5415_006_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	Coin	T	Coin	Coin	V	Coin				P	Coin	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1026.32	21.74	1074.44	9.78	140.39	17.19	1.29	395.6	38.37				17.09	72.78	6196.32	10806.12					4.45			1.28	0		0					54.02	1.14	0	313.44	1931.43	0	0				125 per day (1-10)	125 per day (1-10)	0 per day (1-6) 100 per day (7-100)	10	100	10	10	25-50	10				0	10	30-Oct	25-30					0			0 - 0								125 per day (1-10)	125 per day (1-10)	0	30	0-30	0	0				107.91	107.91	29.09	0.1	100	0.1	0.1	40.5	0.03				0	0.05	10.39	25.1					0			0	0		0					107.91	107.91	0	20.1	11	0	0					107.91	107.91	29.09	0.1	100	0.1	0.1	40.5	0.03				0	0.05	10.39	25.1					0			0	0		0					107.91	107.91	0	20.1	11	0	0				0	9.23	0.2	2.6	0.98	1.17	1.72	0.13	1.34	1.27	-	-	-	-	3.71	5.37	22.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.49	0.01	-	0.53	1.77	-	-	-	-	-	53.1	9.23	0.2	2.6	0.98	1.17	1.72	0.13	1.34	1.27	-	-	-	-	3.71	5.37	22.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.49	0.01	-	0.53	1.77	-	-	-	-	-	53.1
H5415_011_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	Coin				P	Coin	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	856.07	10.04	1176.02	1253.15	153.41	4.84	0.36	476.23	56.27				178.65	113.8	5627.39	4264.32					4.45			1.28	0		0					45.06	0.53	0	723.2	2870.72	0	0				100 per day (1-10)	100 per day (1-10)	0 per day (1-6) 75 per day (7-100)	10	100	10	10	25-50	10				0	10	30-Oct	25-30					0.1			0 - 0								100 per day (1-10)	100 per day (1-10)	0	30	0-30	0	0				86.33	86.33	21.82	10	100	0.1	0.1	40.5	0.03				0	0.01	10.39	25.1					0.1			0	0		0					86.33	86.33	0	20.1	20.65	0	0					86.33	86.33	21.82	10	100	0.1	0.1	40.5	0.03				0	0.01	10.39	25.1					0.1			0	0		0					86.33	86.33	0	20.1	20.65	0	0				0	6.16	0.07	2.14	1.04	1.28	0.48	0.04	1.61	1.86	-	-	-	-	0.69	4.87	8.92	-	-	-	-	0.45	-	-	-	-	-	-	-	-	-	-	0.32	0	-	1.21	4.94	-	-	-	-	-	36.09	6.16	0.07	2.14	1.04	1.28	0.48	0.04	1.61	1.86	-	-	-	-	0.69	4.87	8.92	-	-	-	-	0.45	-	-	-	-	-	-	-	-	-	-	0.32	0	-	1.21	4.94	-	-	-	-	-	36.09
H5415_021_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	Coin				P	Coin	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	931.24	19.73	974.9	454.41	127.38	17.06	1.28	358.95	30.46				15.51	57.78	5622.26	9804.99					4.45			1.28	0		0					49.01	1.04	0	284.4	1752.49	0	0				100 per day (1-10)	100 per day (1-10)	0 per day (1-6) 75 per day (7-100)	10	100	10	10	25-50	10				0	10	30-Oct	25-30					0.2			0 - 0								100 per day (1-10)	100 per day (1-10)	0	30	0-30	0	0				86.33	86.33	21.82	10	100	0.1	0.1	40.5	0.03				0	0.04	10.39	25.1					0.2			0	0		0					86.33	86.33	0	20.1	10.4	0	0					86.33	86.33	21.82	10	100	0.1	0.1	40.5	0.03				0	0.04	10.39	25.1					0.2			0	0		0					86.33	86.33	0	20.1	10.4	0	0				0	6.7	0.14	1.77	0.38	1.06	1.71	0.13	1.21	1.01	-	-	-	-	2.06	4.87	20.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.35	0.01	-	0.48	1.52	-	-	-	-	-	44.78	6.7	0.14	1.77	0.38	1.06	1.71	0.13	1.21	1.01	-	-	-	-	2.06	4.87	20.51	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.35	0.01	-	0.48	1.52	-	-	-	-	-	44.78
H5415_039_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional				2750	Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	Coin	T	Coin	Coin	V	Coin				P	Coin	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	921.24	19.52	964.43	9.3	126.02	16.34	1.23	355.1	29.18				15.34	55.35	5561.87	9699.67					4.45			3.44	0		0					48.49	1.03	0	281.34	1733.67	0	0				100 per day (1-10)	100 per day (1-10)	0 per day (1-6) 75 per day (7-100)	10	100	10	10	25-50	10				0	10	30-Oct	25-30					0.2			0 - 50								100 per day (1-10)	100 per day (1-10)	0	30	0-30	0	0				86.33	86.33	21.82	0.1	100	0.1	0.1	40.5	0.03				0	0.03	10.39	25.1					0.2			0.1	0		0					86.33	86.33	0	20.1	10.4	0	0					61.97	86.33	15.66	0.07	71.78	0.07	0.07	29.07	0.02				0	0.03	7.46	18.02					0.2			0.1	0		0					61.97	86.33	0	14.43	7.47	0	0				0	4.76	0.14	1.26	0.67	0.75	1.17	0.09	0.86	0.69	-	-	-	-	1.39	3.46	14.56	-	-	-	-	0.89	-	-	0.35	-	-	-	-	-	-	-	0.25	0.01	-	0.34	1.08	-	-	-	-	-	32.71	4.76	0.14	1.26	0.67	0.75	1.17	0.09	0.86	0.69	-	-	-	-	1.39	3.46	14.56	-	-	-	-	0.89	-	-	0.35	-	-	-	-	-	-	-	0.25	0.01	-	0.34	1.08	-	-	-	-	-	32.71
H5415_048_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	Coin				P	Coin	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	916.73	19.42	959.7	447.33	125.4	17.5	1.32	353.36	28.12				15.26	53.35	5534.63	9652.17					4.45			1.28	0		0					48.25	1.02	0	279.97	1725.18	0	0				100 per day (1-10)	100 per day (1-10)	0 per day (1-6) 75 per day (7-100)	10	100	10	10	25-50	10				0	10	30-Oct	25-30					0.1			0 - 0								100 per day (1-10)	100 per day (1-10)	0	30	0-30	0	0				86.33	86.33	21.82	10	100	0.1	0.1	40.5	0.03				0	0	10.39	25.1					0.1			0	0		0					86.33	86.33	0	20.1	20.65	0	0					86.33	86.33	21.82	10	100	0.1	0.1	40.5	0.03				0	0	10.39	25.1					0.1			0	0		0					86.33	86.33	0	20.1	20.65	0	0				0	6.6	0.14	1.74	0.37	1.04	1.75	0.13	1.19	0.93	-	-	-	-	0.09	4.79	20.19	-	-	-	-	0.45	-	-	-	-	-	-	-	-	-	-	0.35	0.01	-	0.47	2.97	-	-	-	-	-	43.21	6.6	0.14	1.74	0.37	1.04	1.75	0.13	1.19	0.93	-	-	-	-	0.09	4.79	20.19	-	-	-	-	0.45	-	-	-	-	-	-	-	-	-	-	0.35	0.01	-	0.47	2.97	-	-	-	-	-	43.21
H5415_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	254.5	5.78	1085.63	506.03	141.85	22.83	1.72	399.73	316.7				17.27	1951.56	6260.88	10918.72					4.45			0	0		0					13.39	0.3	0	0	0	0	0				600 per admit	600 per admit	100 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	35	35-50					20											600 per admit	600 per admit	0	0	0	0	0				408.12	408.12	8.81	10	100	0.25	0.25	45.2	200				0	34.53	35	35.29					20			0	0		0					408.12	408.12	0	0	0	0	0					408.12	408.12	8.81	10	100	0.25	0.25	45.2	200				0	34.53	35	35.29					20			0	0		0					408.12	408.12	0	0	0	0	0				0	8.66	0.2	0.8	0.42	1.18	5.71	0.43	1.51	5.28	-	-	-	-	5.62	18.26	32.11	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	-	-	-	-	-	81.52	8.66	0.2	0.8	0.42	1.18	5.71	0.43	1.51	5.28	-	-	-	-	5.62	18.26	32.11	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	-	-	-	-	-	81.52
H5415_803_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	254.49	5.78	1085.6	506.01	141.85	22.83	1.72	399.71	316.69				17.27	1951.49	6260.67	10918.34					4.45			0	0		0					13.39	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.53	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.53	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.72	0.29	0.8	0.42	1.18	5.71	0.43	1.51	5.28	-	-	-	-	5.61	13.15	31.85	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	80.52	12.72	0.29	0.8	0.42	1.18	5.71	0.43	1.51	5.28	-	-	-	-	5.61	13.15	31.85	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	80.52
H5415_804_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	254.5	5.78	1085.63	506.03	141.85	22.83	1.72	399.73	316.7				17.27	1951.56	6260.88	10918.72					4.45			0	0		0					13.39	0.3	0	0	0	0	0				600 per admit	600 per admit	100 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	35	35-50					20											600 per admit	600 per admit	0	0	0	0	0				408.12	408.12	8.81	10	100	0.25	0.25	45.2	200				0	34.53	35	35.29					20			0	0		0					408.12	408.12	0	0	0	0	0					408.12	408.12	8.81	10	100	0.25	0.25	45.2	200				0	34.53	35	35.29					20			0	0		0					408.12	408.12	0	0	0	0	0				0	8.66	0.2	0.8	0.42	1.18	5.71	0.43	1.51	5.28	-	-	-	-	5.62	18.26	32.11	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	-	-	-	-	-	81.52	8.66	0.2	0.8	0.42	1.18	5.71	0.43	1.51	5.28	-	-	-	-	5.62	18.26	32.11	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.46	0.01	-	-	-	-	-	-	-	-	81.52
H5415_805_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				A	A	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				A	A	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	254.49	5.78	1085.6	506.01	141.85	22.83	1.72	399.71	316.69				17.27	1951.49	6260.67	10918.34					4.45			0	0		0					13.39	0.3	0	0	0	0	0				600 per admit	600 per admit	0 per day (1-20) 100 per day (21-100)	10	100	25	25	25-50	200				0	25-100	25-35	35					20											600 per admit	600 per admit	0	0	0	0	0				600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.53	25.2	35					20			0	0		0					600	600	0	0	0	0	0					600	600	8.81	10	100	0.25	0.25	45.2	200				0	34.53	25.2	35					20			0	0		0					600	600	0	0	0	0	0				0	12.72	0.29	0.8	0.42	1.18	5.71	0.43	1.51	5.28	-	-	-	-	5.61	13.15	31.85	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	80.52	12.72	0.29	0.8	0.42	1.18	5.71	0.43	1.51	5.28	-	-	-	-	5.61	13.15	31.85	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	0.67	0.02	-	-	-	-	-	-	-	-	80.52
H5416_001_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1107.94	103.41	899.66	0	139.33	6.54	6.61	285.59	40.62	0	17.63	5.95	0.15	18.52	4046.71	4452.54	325.03	1280.57	15.2	0.59	18.23	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50 days 1-5	50 days 1-5	25 days 10-100	0	100	20	20	50	15 NTE 100 ASC; 15 NTE 200 OPH	0	10 Ther: 20	15	15	15	5	20	35 SA: 20	10 Chiro: 15	0 OF/OP: 15	0 Chemo: 20	20				25	150 Allowance																30.98	61.96	12.87	0	100	0.2	0.2	50	0.12	0	0.14	0.15	0.2	0.11	5	20	31.25	12.5	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		30.98	61.96	12.87	0	100	0.2	0.2	50	0.12	0	0.14	0.15	0.2	0.11	5	20	31.25	12.5	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		2.86	0.53	0.97	-	1.16	1.31	1.32	1.19	4.79	-	2.46	0.89	0.03	2.13	1.69	7.42	0.85	1.33	2.28	0.12	3.65	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.23	2.86	0.53	0.97	-	1.16	1.31	1.32	1.19	4.79	-	2.46	0.89	0.03	2.13	1.69	7.42	0.85	1.33	2.28	0.12	3.65	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.23
H5416_002_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1107.94	103.41	899.66	0	139.33	6.54	6.61	285.59	40.62	0	17.63	5.95	0.15	18.52	4046.71	4452.54	325.03	1280.57	15.2	0.59	18.23	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125 days 1-5	125 days 1-5	25 days 10-100	0	100	20	20	50	15 NTE 150 ASC; 15 NTE 300 OPH	0	15 Ther: 20	15	15	15	10	25	50 SA: 20	20 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																77.45	92.94	12.87	0	100	0.2	0.2	50	0.14	0	0.17	0.15	0.2	0.12	10	25	36.63	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		77.45	92.94	12.87	0	100	0.2	0.2	50	0.14	0	0.17	0.15	0.2	0.12	10	25	36.63	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		7.15	0.8	0.97	-	1.16	1.31	1.32	1.19	5.58	-	2.99	0.89	0.03	2.31	3.37	9.28	0.99	2.13	2.28	0.12	3.65	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.78	7.15	0.8	0.97	-	1.16	1.31	1.32	1.19	5.58	-	2.99	0.89	0.03	2.31	3.37	9.28	0.99	2.13	2.28	0.12	3.65	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	47.78
H5416_003_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1026.3	73.62	925.47	0	120.11	5.58	5.91	238.17	39.1	0	16.91	5.68	0.13	16.81	3837.8	4245.48	220.77	1235.7	14.5	0.57	17.28	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150 days 1-5	150 days 1-5	25 days 10-100	0	100	20	20	50	15 NTE 200 ASC; 15 NTE 400 OPH	0	15 Ther: 20	15	15	15	15	30	50 SA: 20	20 Chiro: 25	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																92.94	92.94	12.87	0	100	0.2	0.2	50	0.15	0	0.17	0.15	0.2	0.12	15	30	38.69	22.51	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		92.94	92.94	12.87	0	100	0.2	0.2	50	0.15	0	0.17	0.15	0.2	0.12	15	30	38.69	22.51	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		7.95	0.57	0.99	-	1	1.12	1.18	0.99	5.8	-	2.88	0.85	0.03	2.09	4.8	10.61	0.71	2.32	2.18	0.11	3.46	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.9	7.95	0.57	0.99	-	1	1.12	1.18	0.99	5.8	-	2.88	0.85	0.03	2.09	4.8	10.61	0.71	2.32	2.18	0.11	3.46	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.9
H5416_004_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1090.11	101.75	885.19	1589.58	137.09	6.33	6.4	281	39.32	0	17.06	5.76	0.15	17.93	3982.77	4380.89	2.21	1259.97	14.72	0.57	17.64	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125 days 1-5	125 days 1-5	30 days 10-100	10	100	25	25	50	15 NTE 150 ASC; 15 NTE 300 OPH	0	15 Ther: 20	15	15	15	20	30	50 SA: 50	20 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																77.45	92.94	15.45	10	100	0.25	0.21	50	0.14	0	0.17	0.15	0.2	0.12	20	30	0.6	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		77.45	92.94	15.45	10	100	0.25	0.21	50	0.14	0	0.17	0.15	0.2	0.12	20	30	0.6	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		7.04	0.79	1.14	1.32	1.14	1.58	1.34	1.17	5.42	-	2.9	0.86	0.03	2.19	6.64	10.95	1.33	2.1	2.21	0.11	3.53	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.05	7.04	0.79	1.14	1.32	1.14	1.58	1.34	1.17	5.42	-	2.9	0.86	0.03	2.19	6.64	10.95	1.33	2.1	2.21	0.11	3.53	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.05
H5416_005_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1090.11	101.75	885.19	0	137.09	6.33	6.4	281	39.32	0	17.06	5.76	0.15	17.93	3982.77	4380.89	2.21	1259.97	14.72	0.57	17.64	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100 days 1-5	100 days 1-5	25 days 10-100	0	100	20	20	50	15 NTE 125 ASC; 15 NTE 250 OPH	0	15 Ther: 20	15	15	15	10	25	35 SA: 35	10 Chiro: 25	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																61.96	61.96	12.87	0	100	0.2	0.2	50	0.13	0	0.17	0.15	0.2	0.12	10.09	25	0.42	17.51	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		61.96	61.96	12.87	0	100	0.2	0.2	50	0.13	0	0.17	0.15	0.2	0.12	10.09	25	0.42	17.51	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		5.63	0.53	0.95	-	1.14	1.27	1.28	1.17	5.03	-	2.9	0.86	0.03	2.06	3.35	9.13	0.93	1.84	2.21	0.11	3.53	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.2	5.63	0.53	0.95	-	1.14	1.27	1.28	1.17	5.03	-	2.9	0.86	0.03	2.06	3.35	9.13	0.93	1.84	2.21	0.11	3.53	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.2
H5416_006_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1009.77	72.43	910.57	1489.14	118.17	5.4	5.73	234.34	37.85	0	16.37	5.5	0.13	16.27	3777.14	4177.07	1.6	1215.79	14.04	0.55	16.73	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150 days 1-5	150 days 1-5	35 days 10-100	10	100	30	30	50	15 NTE 200 ASC; 15 NTE 400 OPH	0	15 Ther: 20	15	15	15	20	35	50 SA: 50	20 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																92.94	123.92	18.02	10	100	0.3	0.22	50	0.15	0	0.17	0.15	0.2	0.13	20	35	0.5	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		92.94	123.92	18.02	10	100	0.3	0.22	50	0.15	0	0.17	0.15	0.2	0.13	20	35	0.5	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		7.82	0.75	1.37	1.24	0.98	1.62	1.24	0.98	5.66	-	2.79	0.82	0.03	2.04	6.3	12.18	0.8	2.03	2.11	0.11	3.35	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.46	7.82	0.75	1.37	1.24	0.98	1.62	1.24	0.98	5.66	-	2.79	0.82	0.03	2.04	6.3	12.18	0.8	2.03	2.11	0.11	3.35	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.46
H5417_001_0	2006											500											D	D	D	P	P	P	P	V	V	P	P	V	P	V	P	P	P	P		P	S	V	P		P	P	P																																																									-					682.71			144.05																																						75 per Trip			50																																						25			50																																							22.77			45.53																																			-	-	-	-	1.3	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.84	-	-	-	-	1.3	-	-	0.55	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.84
H5418_001_0	2006																							D	D		Coin	Coin	Coin	V									V			Coin	Coin	Coin		V																																																												-		0.83	413.67		5.36	8.72	6	410.25									297.41			33.38	11.95	5.39		11.66																																																																																																						150	114		0.2	0.1	0.2	31.78									21.79			0.04	0	0.15		10																			-	0.01	3.93	-	1.07	0.87	1.2	1.09	-	-	-	-	-	-	-	-	0.54	-	-	1.33	-	0.81	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.86	-	0.01	3.93	-	1.07	0.87	1.2	1.09	-	-	-	-	-	-	-	-	0.54	-	-	1.33	-	0.81	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.86
H5419_001_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1170.24	24.93	922.49	17.09	140.66	15.83	1.1	313.89	310.62	9.34	25.38			24.59	12273.85	5978.6	1.47	876.35	3777.57	23656.55		776.19			395.54		169.52			42.38												200 per day 1000 annual max	300 per admit	75 each day for days 21-100		100 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	10 per visit	10 per visit		10 per visit	25 per visit	10 per visit		10 per visit			10 per visit		10 per visit			10 per visit												84	36.31	38.27	0.15	100	0.3	0.3	50	109.18	0.02	0.02			0.02	7.67	5.22	0.5	10	1.46	3.25		10			60.62		10			10												none	84	36.31	38.27	0.15	100	0.3	0.3	50	109.18	0.02	0.02			0.02	7.67	5.22	0.5	10	1.46	3.25		10			60.62		10			10													8.19	0.08	2.94	2.56	1.17	4.75	0.33	1.31	2.83	0.2	0.54	-	-	0.53	7.85	2.6	0.74	0.73	0.46	6.41	-	0.65	-	-	2	-	0.14	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	47.04	8.19	0.08	2.94	2.56	1.17	4.75	0.33	1.31	2.83	0.2	0.54	-	-	0.53	7.85	2.6	0.74	0.73	0.46	6.41	-	0.65	-	-	2	-	0.14	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	47.04
H5419_002_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1188.96	25.33	948.96	15.58	162.26	19.84	1.38	248.82	246.23	6.92	18.81			18.23	12854.16	7690.91	2.01	1221.74	5092.85	33323.33		859.09			437.78		187.62			46.91												200 per day 1000 annual max	300 per admit	75 each day for days 21-100		100 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	10 per visit	10 per visit		10 per visit	25 per visit	10 per visit		10 per visit			10 per visit		10 per visit			10 per visit												84	36.31	38.27	0.15	100	0.3	0.3	50	107.94	0.02	0.02			0.02	8.06	5.38	0.5	10	1.66	3.22		10			57.97		10			10												none	84	36.31	38.27	0.15	100	0.3	0.3	50	107.94	0.02	0.02			0.02	8.06	5.38	0.5	10	1.66	3.22		10			57.97		10			10													8.32	0.08	3.03	2.34	1.35	5.95	0.42	1.04	2.21	0.15	0.4	-	-	0.39	8.63	3.45	1.01	1.02	0.71	8.95	-	0.72	-	-	2.11	-	0.16	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	52.45	8.32	0.08	3.03	2.34	1.35	5.95	0.42	1.04	2.21	0.15	0.4	-	-	0.39	8.63	3.45	1.01	1.02	0.71	8.95	-	0.72	-	-	2.11	-	0.16	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	52.45
H5419_003_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1318.18	28.09	683.02	12.45	177.22	18.91	1.32	331.09	327.64	9.02	24.51			23.75	13292.84	6216.9	1.54	925.84	4108.7	25147.59		870.03			443.36		190.01			47.5												200 per day 1000 annual max	300 per admit	75 each day for days 21-100		100 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	10 per visit	10 per visit		10 per visit	25 per visit	10 per visit		10 per visit			10 per visit		10 per visit			10 per visit												84	36.31	38.27	0.15	100	0.3	0.3	50	107.56	0.02	0.02			0.02	7.89	5.45	0.5	10	1.36	3.25		10			58.1		10			10												none	84	36.31	38.27	0.15	100	0.3	0.3	50	107.56	0.02	0.02			0.02	7.89	5.45	0.5	10	1.36	3.25		10			58.1		10			10													9.23	0.08	2.18	1.87	1.48	5.67	0.4	1.38	2.94	0.19	0.53	-	-	0.51	8.74	2.82	0.77	0.77	0.47	6.81	-	0.73	-	-	2.15	-	0.16	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	49.9	9.23	0.08	2.18	1.87	1.48	5.67	0.4	1.38	2.94	0.19	0.53	-	-	0.51	8.74	2.82	0.77	0.77	0.47	6.81	-	0.73	-	-	2.15	-	0.16	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	49.9
H5419_004_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1168.31	24.71	905.6	17.19	141.09	15.93	1.11	314.84	311.56	9.4	25.53			24.74	12130.82	5947.35	1.48	851.54	3710.9	23358.63		754.21			384.34		164.72			42.51												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			13.75 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	109.24	0.02	0.02			0.02	10.95	10.66	0.5	25	1.46	5.11		25			60.81		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	109.24	0.02	0.02			0.02	10.95	10.66	0.5	25	1.46	5.11		25			60.81		25			10													10.22	0.22	3.85	2.58	1.76	4.78	0.33	1.31	2.84	0.2	0.55	-	-	0.53	11.07	5.28	0.74	1.77	0.45	9.95	-	1.57	-	-	1.95	-	0.34	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	62.35	10.22	0.22	3.85	2.58	1.76	4.78	0.33	1.31	2.84	0.2	0.55	-	-	0.53	11.07	5.28	0.74	1.77	0.45	9.95	-	1.57	-	-	1.95	-	0.34	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	62.35
H5419_005_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1195.24	25.03	947.35	15.58	162.26	19.84	1.38	248.82	253.84	6.92	18.81			18.23	12687.81	7737.06	2.01	1183.56	5092.85	33087.1		832.24			424.1		181.76			46.91												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			13.75 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	107.94	0.02	0.02			0.02	11.54	11.16	0.5	25	1.66	5.02		25			57.97		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	107.94	0.02	0.02			0.02	11.54	11.16	0.5	25	1.66	5.02		25			57.97		25			10													10.46	0.23	4.03	2.34	2.03	5.95	0.42	1.04	2.28	0.15	0.4	-	-	0.39	12.2	7.19	1.01	2.47	0.71	13.85	-	1.73	-	-	2.05	-	0.38	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	71.33	10.46	0.23	4.03	2.34	2.03	5.95	0.42	1.04	2.28	0.15	0.4	-	-	0.39	12.2	7.19	1.01	2.47	0.71	13.85	-	1.73	-	-	2.05	-	0.38	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	71.33
H5419_006_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1317.04	27.85	671.05	12.55	177.9	19.05	1.33	332.35	328.89	9.09	24.69			23.93	13143.58	6188.73	1.55	900.34	4039.35	24849.6		846.06			431.14		184.78			47.68												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			13.75 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	107.63	0.02	0.02			0.02	11.33	10.99	0.5	25	1.36	5.1		25			58.32		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	107.63	0.02	0.02			0.02	11.33	10.99	0.5	25	1.36	5.1		25			58.32		25			10													11.52	0.25	2.85	1.88	2.22	5.72	0.4	1.38	2.95	0.19	0.53	-	-	0.51	12.41	5.67	0.77	1.88	0.46	10.57	-	1.76	-	-	2.1	-	0.38	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	66.46	11.52	0.25	2.85	1.88	2.22	5.72	0.4	1.38	2.95	0.19	0.53	-	-	0.51	12.41	5.67	0.77	1.88	0.46	10.57	-	1.76	-	-	2.1	-	0.38	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	66.46
H5419_801_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1187.02	25.1	878.48	16.33	148.97	16.89	1.18	305.21	302.03	8.92	24.24			23.48	12321.74	6248.95	1.58	912.08	3960.39	25095.22		777.33			396.12		169.76			43.81												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			21.25 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	108.84	0.02	0.02			0.02	16.05	10.82	0.5	25	1.49	6.91		25			59.78		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	108.84	0.02	0.02			0.02	16.05	10.82	0.5	25	1.49	6.91		25			59.78		25			10													10.39	0.23	3.74	2.45	1.86	5.07	0.35	1.27	2.74	0.19	0.52	-	-	0.5	16.48	5.64	0.79	1.9	0.49	14.46	-	1.62	-	-	1.97	-	0.35	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	73.04	10.39	0.23	3.74	2.45	1.86	5.07	0.35	1.27	2.74	0.19	0.52	-	-	0.5	16.48	5.64	0.79	1.9	0.49	14.46	-	1.62	-	-	1.97	-	0.35	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	73.04
H5419_802_0	2006											none											D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin			Coin	V	V	Coin	V	V	V		V			V		V			V												none																																										-	1187.02	25.1	878.48	16.33	148.97	16.89	1.18	305.21	302.03	8.92	24.24			23.48	12321.74	6248.95	1.58	912.08	3960.39	25095.22		777.33			396.12		169.76			43.81												250 per day 1250 annual max	900 per admit	100 each day for days 21-100		150 per trip			50 per admit	100 per admit	See comment 1	See comment 1			See comment 1 2	25 per visit	25 per visit		25 per visit	25 per visit	25 per visit		25 per visit			21.25 per visit		25 per visit			10 per visit												105.01	108.94	51.03	0.15	150	0.3	0.3	50	108.84	0.02	0.02			0.02	16.05	10.82	0.5	25	1.49	6.91		25			59.78		25			10												none	105.01	108.94	51.03	0.15	150	0.3	0.3	50	108.84	0.02	0.02			0.02	16.05	10.82	0.5	25	1.49	6.91		25			59.78		25			10													10.39	0.23	3.74	2.45	1.86	5.07	0.35	1.27	2.74	0.19	0.52	-	-	0.5	16.48	5.64	0.79	1.9	0.49	14.46	-	1.62	-	-	1.97	-	0.35	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	73.04	10.39	0.23	3.74	2.45	1.86	5.07	0.35	1.27	2.74	0.19	0.52	-	-	0.5	16.48	5.64	0.79	1.9	0.49	14.46	-	1.62	-	-	1.97	-	0.35	-	-	0.04	-	-	-	-	-	-	-	-	-	-	-	73.04
H5419_805_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H5419_806_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H5420_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	O	Coin	Coin	V	V	V	V	V	V	V	P	P	V	V	V	V	Coin	0	T	V	V	0	V	0	0	0	0	V	V	V	V	V						none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1998.77	44.44	684.44	2551.48	218.13	3.04	0.51	280.78	195.05	56.4	23.5	4.7	4.7	4.7	3376.98	3376.98	562.83	21.07	562.83	0	5.61	0	0	515.76	642.04	275.16	530.38	0	0	0	0	227.16	130.04	225.13	337.7	1688.49						0 1 to 90 days	0 1 to 190 days lifetime	0 1 to 100 days	0	100	0	0	60x50+40x25	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25 if non-pref	25	0	0	0						0	0	0	0	100	0	0	40	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5	25	0	0	0						none	0	0	0	0	95	0	0	38	23.75	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.38	23.75	0	0	0						0	-	-	-	-	1.73	-	-	0.89	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.04	0.26	-	-	-	-	-	-	-	-	3.3	-	-	-	-	1.73	-	-	0.89	0.39	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.04	0.26	-	-	-	-	-	-	-	-	3.3
H5420_003_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						none	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	O	Coin	Coin	V	V	V	V	V	Coin	V	P	P	V	V	V	V	Coin	0	T	V	V	0	V	0	0	0	0	V	V	V	V	V						none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							2126.35	47.28	728.13	5907.57	218.13	2.86	0.48	226.78	146.29	42.3	17.62	3.52	0.27	3.52	3376.98	3376.98	562.83	1125.66	562.83	0	5.28	0	0	429.8	370.59	158.82	368.32	0	0	0	0	227.16	97.53	225.13	337.7	1688.49						175 1-7 days then 0	175 1-7 days then 0	0 1-6; 75 7-100	0	100	"20 for ""high cost"""	20	60x50+40x25	75	0	0	50	20	0	0	20	20	20	25 MRI/A MST PET	0	0.2	0	0	0	0	0	0	0	0	0	0	25 if non-pref	75	20	20	25 Nuclear Med						148.95	148.95	43.4	0	100	0.02	0.2	40	75	0	0.04	50	0.2	0	0	20	20	20	2.29	0	0	0	0	0	0	0	0	0	0	0	0	2.5	75	20	20	0.5						none	148.95	148.95	43.4	0	100	0.02	0.2	40	75	0	0.04	50	0.2	0	0	20	20	20	2.29	0	0	0	0	0	0	0	0	0	0	0	0	2.5	75	20	20	0.5						0	26.39	0.59	2.63	-	1.82	0.06	0.1	0.76	0.91	-	0	0.01	0.05	-	-	5.63	0.94	1.88	0.11	-	-	-	-	-	-	-	-	-	-	-	-	0.05	0.61	0.38	0.56	0.07	-	-	-	-	-	43.54	26.39	0.59	2.63	-	1.82	0.06	0.1	0.76	0.91	-	0	0.01	0.05	-	-	5.63	0.94	1.88	0.11	-	-	-	-	-	-	-	-	-	-	-	-	0.05	0.61	0.38	0.56	0.07	-	-	-	-	-	43.54
H5421_032_0	2006											2960											A	D	D	Coin	P	Coin	Coin	V	V	V	Coin	V	V	V	P	P	Coin	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	291.6	78.97	762.12	17.61	96.19	10.16	11.61	296.5	287.01	0	20.96	0	1.46	204.75	3876.74	4102.89	1.92	669.94	18.73	342.47	19.36	0	0	0	124	0	222	0	0	0	0											300	150 days 1-5	0 days 1-20 100 days 21-100	0	100	0	0	50	50 - ASC 75 OP Facility	0	0.1		50		10	25 - Spec. 30 - Chiro Podiatrist	1	25	10		0.2				25 - 1 Routine Exam		25 - 1 Routine Exam															300	107.55	27.6	0.15	100	0.2	0.2	50	68.24	0	0.09	0	50	33.96	10	25.18	0.5	27.35	0.09	24.93	0.2	0	0	0	25	0	25	0	0	0	0												300	107.55	27.6	0.15	100	0.2	0.2	50	68.24	0	0.09	0	50	33.96	10	25.18	0.5	27.35	0.09	24.93	0.2	0	0	0	25	0	25	0	0	0	0												7.29	0.71	1.75	2.64	0.8	2.03	2.32	1.24	1.63	-	1.89	-	0.01	0.58	3.23	8.61	0.95	1.53	1.69	0.71	3.87	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.2	7.29	0.71	1.75	2.64	0.8	2.03	2.32	1.24	1.63	-	1.89	-	0.01	0.58	3.23	8.61	0.95	1.53	1.69	0.71	3.87	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.2
H5421_034_0	2006											2960											A	D	D	Coin	P	Coin	Coin	V	V	V	Coin	V	V	V	P	P	Coin	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	291.6	78.97	762.12	17.61	96.19	10.16	11.61	296.5	287.01	0	20.96	0	1.46	204.75	3876.74	4102.89	1.92	669.94	18.73	342.47	19.36	0	0	0	124	0	222	0	0	0	0											150	75 days 1-5	0 days 1-20 100 days 21-100	0	50	0	0	35	25 - ASC 50 OP Facility	0	0.1		50		5	15 - Spec. 20 - Chiro Podiatrist	1	15	10		0.2				15 - 1 Routine Exam		15 - 1 Routine Exam															150	53.78	27.6	0.15	50	0.2	0.2	35	43.24	0	0.09	0	50	24.47	5	15.18	0.5	17.51	0.09	14.96	0.2	0	0	0	15	0	15	0	0	0	0												150	53.78	27.6	0.15	50	0.2	0.2	35	43.24	0	0.09	0	50	24.47	5	15.18	0.5	17.51	0.09	14.96	0.2	0	0	0	15	0	15	0	0	0	0												3.65	0.35	1.75	2.64	0.4	2.03	2.32	0.86	1.03	-	1.89	-	0.01	0.42	1.62	5.19	0.95	0.98	1.69	0.43	3.87	-	-	-	0.16	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.51	3.65	0.35	1.75	2.64	0.4	2.03	2.32	0.86	1.03	-	1.89	-	0.01	0.42	1.62	5.19	0.95	0.98	1.69	0.43	3.87	-	-	-	0.16	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.51
H5421_035_0	2006											2960											A	D	D	Coin	P	Coin	Coin	V	V	V	Coin	V	V	V	P	P	Coin	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	263.58	58.82	557.77	15.53	104.39	7.46	10.99	279.54	334.29	0	16.93	0	0.4	205.57	3470.89	3657.01	1.47	1146.47	21.48	311.84	14.84	0	0	0	124	0	222	0	0	0	0											300	150 days 1-5	0 days 1-20 100 days 21-100	0	100	0	0	50	50 - ASC 75 OP Facility	0	0.1		50		10	25 - Spec. 30 - Chiro Podiatrist	1	25	10		0.2				25 - 1 Routine Exam		25 - 1 Routine Exam															300	107.55	27.6	0.15	100	0.2	0.2	50	64.18	0	0.09	0	50	33.87	10	25.25	0.49	27.06	0.09	24.97	0.2	0	0	0	25	0	25	0	0	0	0												300	107.55	27.6	0.15	100	0.2	0.2	50	64.18	0	0.09	0	50	33.87	10	25.25	0.49	27.06	0.09	24.97	0.2	0	0	0	25	0	25	0	0	0	0												6.59	0.53	1.28	2.33	0.87	1.49	2.2	1.16	1.79	-	1.52	-	0	0.58	2.89	7.69	0.72	2.59	1.93	0.65	2.97	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.51	6.59	0.53	1.28	2.33	0.87	1.49	2.2	1.16	1.79	-	1.52	-	0	0.58	2.89	7.69	0.72	2.59	1.93	0.65	2.97	-	-	-	0.26	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.51
H5421_037_0	2006											2960											A	D	D	Coin	P	Coin	Coin	V	V	V	Coin	V	V	V	P	P	Coin	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	263.58	58.82	557.77	15.53	104.39	7.46	10.99	279.54	334.29	0	16.93	0	0.4	205.57	3470.89	3657.01	1.47	1146.47	21.48	311.84	14.84	0	0	0	124	0	222	0	0	0	0											150	75 days 1-5	0 days 1-20 100 days 21-100	0	50	0	0	35	25 - ASC 50 OP Facility	0	0.1		50		5	15 - Spec. 20 - Chiro Podiatrist	1	15	10		0.2				15 - 1 Routine Exam		15 - 1 Routine Exam															150	53.78	27.6	0.15	50	0.2	0.2	35	39.18	0	0.09	0	50	24.25	5	15.25	0.49	17.32	0.09	14.98	0.2	0	0	0	15	0	15	0	0	0	0												150	53.78	27.6	0.15	50	0.2	0.2	35	39.18	0	0.09	0	50	24.25	5	15.25	0.49	17.32	0.09	14.98	0.2	0	0	0	15	0	15	0	0	0	0												3.29	0.26	1.28	2.33	0.43	1.49	2.2	0.82	1.09	-	1.52	-	0	0.42	1.45	4.65	0.72	1.65	1.93	0.39	2.97	-	-	-	0.16	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.34	3.29	0.26	1.28	2.33	0.43	1.49	2.2	0.82	1.09	-	1.52	-	0	0.42	1.45	4.65	0.72	1.65	1.93	0.39	2.97	-	-	-	0.16	-	0.28	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.34
H5421_801_0	2006											2960											A	D	D	Coin	P	Coin	Coin	V	V	V	Coin	V	V	V	P	P	Coin	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	321.32	83.27	750.93	0	129.35	10.67	11.99	293.6	350.05	9783.08	21.33	43.63	1.19	973.6	3826.75	5228.96	2.39	850.14	24.69	13518.08	21.05	64.65	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				761.1	54.07	67.96	0	108.17	0.23	0.23	100.5	282.36	5.91	0.23	156.25	569.13	53.8	14.81	17.26	0.23	19.78	0.23	19.44	0.23	13.75	0	0	0	0	0	0	0	0	0												761.1	54.07	67.96	0	108.17	0.23	0.23	100.5	282.36	5.91	0.23	156.25	569.13	53.8	14.81	17.26	0.23	19.78	0.23	19.44	0.23	13.75	0	0	0	0	0	0	0	0	0												20.38	0.38	4.25	-	1.17	2.49	2.79	2.46	8.24	4.82	4.97	0.57	0.06	4.37	4.72	7.52	0.56	1.4	5.75	21.89	4.9	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.76	20.38	0.38	4.25	-	1.17	2.49	2.79	2.46	8.24	4.82	4.97	0.57	0.06	4.37	4.72	7.52	0.56	1.4	5.75	21.89	4.9	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.76
H5422_001_0	2006																						A	A	D	V	T	Coin	Coin	P	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	O	V	V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	352	5.3	945.4	0	339.5	37.21	2.45	283.1	288.8	0	282.43	0	0.26	535.1	0	0	178.7	200.97	0	9484.51	6.5	367.5	0	2932.71	207.2	0	171.5	0	0	0	1200											400 / admit	400 / admit	150 / day days 1-20	0 copay	100 copay	20 coinsurance	20 coinsurance	50 copay	200 copay		25 copay		20 coinsurance	15 PT/OT/ST copay 2500 Cardiovascular coinsurance			25 copay	15 copay		15 PCP copay / 15 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	15 Vision Exams copay		25 copay	15 copay		15 copay															400	400	114.25	0	100	0.2	0.2	50	200	0	25	0	0.2	36.02	0	0	25	15	0	14.79	0.2	15	0	17.6	15	0	15	0	0	0	0												400	400	114.25	0	100	0.2	0.2	50	200	0	25	0	0.2	36.02	0	0	25	15	0	14.79	0.2	15	0	17.6	15	0	15	0	0	0	0											0	11.73	0.18	9	-	2.83	7.44	0.49	1.18	4.81	-	0.59	-	0.05	1.61	-	-	0.37	0.25	-	11.69	1.3	0.46	-	4.3	0.26	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.76	11.73	0.18	9	-	2.83	7.44	0.49	1.18	4.81	-	0.59	-	0.05	1.61	-	-	0.37	0.25	-	11.69	1.3	0.46	-	4.3	0.26	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.76
H5422_002_0	2006																						A	A	D	V	T	Coin	Coin	P	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	O	V	V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	304.4	4.3	832.6	0	247.4	19.24	1.42	302.3	308.4	0	300.73	0	0.3	574.1	0	0	221.2	247.5	0	9434.65	7.04	350.5	0	2932.71	188.7	0	158.8	0	0	0	1200											400 / admit	400 / admit	150 / day days 1-20	0 copay	100 copay	20 coinsurance	20 coinsurance	50 copay	200 copay		25 copay		20 coinsurance	15 PT/OT/ST copay 2500 Cardiovascular coinsurance			25 copay	15 copay		15 PCP copay / 15 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	15 Vision Exams copay		25 copay	15 copay		15 copay															400	400	114.25	0	100	0.2	0.2	50	200	0	25	0	0.2	36.23	0	0	25	15	0	14.79	0.2	15	0	17.6	15	0	15	0	0	0	0												400	400	114.25	0	100	0.2	0.2	50	200	0	25	0	0.2	36.23	0	0	25	15	0	14.79	0.2	15	0	17.6	15	0	15	0	0	0	0											0	10.15	0.14	7.93	-	2.06	3.85	0.28	1.26	5.14	-	0.63	-	0.06	1.73	-	-	0.46	0.31	-	11.63	1.41	0.44	-	4.3	0.24	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.22	10.15	0.14	7.93	-	2.06	3.85	0.28	1.26	5.14	-	0.63	-	0.06	1.73	-	-	0.46	0.31	-	11.63	1.41	0.44	-	4.3	0.24	-	0.2	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.22
H5422_003_0	2006																						A	A	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin												0	0	0	0	0.24	0.65	0.05	0.14	0.68	0.26	0.72	0	0.01	0.69	0	0	0.04	0.05	0.65	5.15	0.2	0.12	0	0	0	0	0	0	0	0	0											9.64	479.3	7	1410.1	40.51	11.37	30.6	2.14	6.42	32.02	12.52	34.02	0	0.4	32.67	0	0	2.02	2.34	30.97	244.14	9.7	5.91	0	0	0	3.66	0	0	0	0	17											Medicare Part A Deductible	Medicare Part A Deductible	Medicare Part A Deductible	0 copay	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance			Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance	Medicare Part B Deductible and 20 coinsurance																				761.79	761.79	28.48	0	0.21	0.21	0.21	0.21	0.3	0.3	0.3	0	0.21	0.23	0	0	0.21	0.07	0.22	0.19	0.21	0.21	0	0	0	0	0	0	0	0	0												761.79	761.79	28.48	0	0.21	0.21	0.21	0.21	0.3	0.3	0.3	0	0.21	0.23	0	0	0.21	0.07	0.22	0.19	0.21	0.21	0	0	0	0	0	0	0	0	0											123	30.43	0.44	3.35	-	2.35	6.33	0.44	1.33	9.55	3.73	10.14	-	0.08	7.62	-	-	0.42	0.16	6.77	46.24	2.01	1.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.61	30.43	0.44	3.35	-	2.59	6.98	0.49	1.46	10.22	4	10.86	-	0.09	8.31	-	-	0.46	0.21	7.42	51.39	2.21	1.35	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	142.25
H5422_801_0	2006																						A	A	D	V	T	Coin	Coin	P	P	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	O	V	V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	317.9	4.6	865.7	0	265.2	20.88	1.52	310.4	316.7	0	309.73	0	0.3	586.9	0	0	222.6	242.2	0	9396.43	7.16	353.7	0	0	0	0	0	0	0	0	0											400 / admit	400 / admit	150 / day days 1-20	0 copay	100 copay	20 coinsurance	20 coinsurance	50 copay	200 copay		25 copay		20 coinsurance	20 PT/OT/ST copay 2500 Cardiovascular coinsurance			25 copay	20 copay		20 PCP copay / 20 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	20 Vision Exams copay			20 copay		20 copay															400	400	114.25	0	100	0.2	0.2	50	200	0	25	0	0.2	38.68	0	0	25	20	0	19.71	0.2	20	0	0	0	0	0	0	0	0	0												400	400	114.25	0	100	0.2	0.2	50	200	0	25	0	0.2	38.68	0	0	25	20	0	19.71	0.2	20	0	0	0	0	0	0	0	0	0											0	10.6	0.15	8.24	-	2.21	4.18	0.3	1.29	5.28	-	0.65	-	0.06	1.89	-	-	0.46	0.4	-	15.43	1.43	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.17	10.6	0.15	8.24	-	2.21	4.18	0.3	1.29	5.28	-	0.65	-	0.06	1.89	-	-	0.46	0.4	-	15.43	1.43	0.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.17
H5422_802_0	2006																						A	A	D	V	T	Coin	Coin	P	P	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	O	V	V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	323.8	4.6	867.8	0	262.6	21.11	1.51	311	317.3	0	25.06	0	0.3	588	0	0	217.3	239.83	0	9307.92	7.15	317.4	0	0	0	0	0	0	0	0	0											400 / admit	400 / admit	150 / day days 1-20	0 copay	100 copay	20 coinsurance	20 coinsurance	50 copay	200 copay		20 coinsurance		20 coinsurance	20 PT/OT/ST copay 20 Cardiovascular coinsurance			25 copay	20 copay		20 PCP copay / 20 SCP copay	20 coinsurance Generic 20 coinsurance Brand 0 Deductible	20 Vision Exams copay			20 copay		20 copay															400	400	114.25	0	100	0.2	0.2	50	200	0	0.15	0	0.2	38.58	0	0	25	20	0	19.71	0.2	20	0	0	0	0	0	0	0	0	0												400	400	114.25	0	100	0.2	0.2	50	200	0	0.15	0	0.2	38.58	0	0	25	20	0	19.71	0.2	20	0	0	0	0	0	0	0	0	0												10.79	0.15	8.26	-	2.19	4.22	0.3	1.3	5.29	-	3.76	-	0.06	1.89	-	-	0.45	0.4	-	15.29	1.43	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.32	10.79	0.15	8.26	-	2.19	4.22	0.3	1.3	5.29	-	3.76	-	0.06	1.89	-	-	0.45	0.4	-	15.29	1.43	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	56.32
H5424_001_0	2006											2800											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1408.13	36.42	466.36	0	46.13	5.38	5.42	224.63	29.5	0	30.5	0.21	0.14	16.18	4975.15	5188.26	180.98	7.2	14.72	374	8.58	0			117.8		210.9															275	275	125	0	150	30	30	50	30	0	0/30	30	30	30/40/30	May-00	20	40/30	30	0/30	0/20	30	0			20		20															275	275	125	0	150	0.3	0.3	50	0.3	0	0.24	0.3	0.3	0.3	5	19.03	37.5	0.3	0.16	0.32	0.3	0			20		20																160.74	160.74	73.06	0	87.67	0.18	0.18	29.22	0.18	0	0.14	0.18	0.18	0.18	5	19.03	37.5	0.18	0.09	0.32	0.18	0			20		20																18.86	0.49	2.84	-	0.34	0.94	0.95	0.55	5.17	-	4.23	0.04	0.02	2.84	2.07	8.23	0.57	1.26	1.38	0.01	1.5	-			0.2		0.35															52.84	18.86	0.49	2.84	-	0.34	0.94	0.95	0.55	5.17	-	4.23	0.04	0.02	2.84	2.07	8.23	0.57	1.26	1.38	0.01	1.5	-			0.2		0.35															52.84
H5424_003_0	2006											2400											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1408.13	36.42	466.36		46.13	5.38	5.42	224.63	29.5		30.5	0.21	0.14	16.18	4975.15	5188.26	180.98	7.2	14.72	374	8.58				117.8		210.9															225	225	75		150	20	20	50	20		0/20	20	20	20/40/30	May-00	10	40/30	20	0/20	0/10	20				10		10															225	225	75		150	0.2	0.2	50	0.2		0.16	0.2	0.2	0.2	5	9.51	37.5	0.2	0.11	0.32	0.2				10		10																139.71	139.71	46.57		93.14	0.12	0.12	31.05	0.12		0.1	0.12	0.12	0.12	5	9.51	37.5	0.12	0.07	0.32	0.12				10		10																16.39	0.42	1.81	-	0.36	0.67	0.67	0.58	3.66	-	2.99	0.03	0.02	2.01	2.07	4.11	0.57	0.89	0.98	0.01	1.07	-	-	-	0.1	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.6	16.39	0.42	1.81	-	0.36	0.67	0.67	0.58	3.66	-	2.99	0.03	0.02	2.01	2.07	4.11	0.57	0.89	0.98	0.01	1.07	-	-	-	0.1	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.6
H5424_004_0	2006											3400											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1406.58	36.38	465.84	0	46.08	5.37	5.41	224.38	29.44	0	30.43	0.21	0.14	16.15	4969.75	5182.62	180.78	7.18	14.68	373.59	8.56	0			117.8		210.9															295	295	150	0	150	30	30	50	30	0	0/30	30	30	30/40/30	Oct-00	28	40/30	30	0/30	0/28	30	0			28		28															295	295	150	0	150	0.3	0.3	50	0.3	0	0.24	0.3	0.3	0.3	10	26.64	37.5	0.3	0.16	0.32	0.3	0			28		28																183.34	183.34	93.23	0	93.23	0.19	0.19	31.08	0.19	0	0.15	0.19	0.19	0.19	10	26.64	37.5	0.19	0.1	0.32	0.19	0			28		28																21.49	0.56	3.62	-	0.36	1	1.01	0.58	5.49	-	4.48	0.04	0.03	3.01	4.14	11.5	0.56	1.34	1.47	0.01	1.6	-			0.27		0.49															63.05	21.49	0.56	3.62	-	0.36	1	1.01	0.58	5.49	-	4.48	0.04	0.03	3.01	4.14	11.5	0.56	1.34	1.47	0.01	1.6	-			0.27		0.49															63.05
H5424_005_0	2006											600											D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	P	T		V	V	V	V																																																								-	1628.38	43.98	489.65	0	53.46	6.24	6.28	381.48	452.13	0	945.76	2.32	0.24	1871.68	7476.71	5748.61	221.78	612.37	3235.99	412.48	9.46	0	0		117.8	0	310.13	0														25	25	15	0	100	20	20	40	15	0	0/10	15	20	15/10/8/4	Feb-00	4	04-Aug	10	0/10	0/4	20	0	0		05-Apr	0	4	0														25	25	15	0	100	0.2	0.2	40	15	0	9.25	15	0.2	14.56	1.86	3.81	7	10	5.36	0.29	0.2	0	0		4.95	0	4	0															18.51	18.51	11.11	0	74.05	0.15	0.15	29.62	11.11	0	6.85	11.11	0.15	10.79	1.86	3.81	7	7.4	3.97	0.29	0.15	0	0		4.95	0	4	0															2.51	0.07	0.45	-	0.33	0.92	0.93	0.94	0.42	-	0.54	0	0.04	1.68	1.16	1.82	0.13	0.38	1.07	0.01	1.4	-	-		0.05	-	0.1	-														14.96	2.51	0.07	0.45	-	0.33	0.92	0.93	0.94	0.42	-	0.54	0	0.04	1.68	1.16	1.82	0.13	0.38	1.07	0.01	1.4	-	-		0.05	-	0.1	-														14.96
H5424_801_0	2006											2800											D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	V	Coin	P			V		V																																																									-	1472.39	28.84	491.57	0	48.54	5.5	5.78	235.54	31.8	0	36.04	0.23	0	17.45	5304.16	5610.95	166.72	7.87	15.88	408.05	9.23	0			126.64		226.72															225	275	125	0	150	30	30	50	30	0	0/30	30	30	30/40/30	Oct-00	20	40/30	30	0/30	0/20	30	0			20		20															225	275	125	0	150	0.3	0.3	50	0.3	0	0.23	0.3	0	0.3	10	19.03	37.5	0.3	0.29	0.29	0.3	0			20		20																131.12	160.26	72.84	0	87.41	0.17	0.17	29.14	0.17	0	0.14	0.17	0	0.17	10	19.03	37.5	0.17	0.17	0.29	0.17	0			20		20																16.09	0.39	2.98	-	0.35	0.96	1.01	0.57	5.56	-	4.9	0.04	-	3.05	4.42	8.9	0.52	1.38	2.67	0.01	1.61	-			0.21		0.38															56	16.09	0.39	2.98	-	0.35	0.96	1.01	0.57	5.56	-	4.9	0.04	-	3.05	4.42	8.9	0.52	1.38	2.67	0.01	1.61	-			0.21		0.38															56
H5425_001_0	2006																						D	D			T	Coin	Coin	V	V		Coin			V	V	V	V			V	Coin	V			V	P	V				V																																																					-	540.15	9.75	346.86	0	193	10	6.67	467	231	0	22.38	0	0	218	4804	4227	229	882	0	1428	6.69	712	0	0	425	292	182	0	0	0	3833											days 1-4	days 1-4	days 21-100			0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 10 urgent care			20 rad therapy & specialized							10 PT & OT 20 CORF		10 hearing podiatry & chiro																																																																100	100	20	0	100	0.05	0.04	32.08	100	0	0.09	0	0	10	10	10	10	11	0	10	0.2	10	0	0	10	25	5	0	0	0	10												4.5	0.08	0.58	-	1.61	0.5	0.3	1.25	1.93	-	1.97	-	-	0.18	4	3.52	0.19	0.81	-	1.19	1.34	0.59	-	-	0.35	0.61	0.08	-	-	-	3.19	-	-	-	-	-	-	-	-	-	-	28.78	4.5	0.08	0.58	-	1.61	0.5	0.3	1.25	1.93	-	1.97	-	-	0.18	4	3.52	0.19	0.81	-	1.19	1.34	0.59	-	-	0.35	0.61	0.08	-	-	-	3.19	-	-	-	-	-	-	-	-	-	-	28.78
H5425_003_0	2006																						D	D			T	Coin	Coin	V	V		Coin			V	V	V	V			V	Coin	V			V	P	V				V																																																					-	569.89	10.24	427.23	0	209	12.65	8.38	400	187	0	17.16	0	0	177	4378	3844	227	874	0	1409	5.29	649	0	0	388	286	166	0	0	0	3948											days 1-4	days 1-4	days 21-100			0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 10 urgent care			20 rad therapy & specialized							10 PT & OT 20 CORF		10 hearing podiatry & chiro																																																																100	100	20	0	100	0.05	0.05	30.87	100	0	0.09	0	0	10	10	10	10	11	0	10	0.2	10	0	0	10	25	5	0	0	0	10												4.75	0.09	0.71	-	1.74	0.63	0.39	1.03	1.56	-	1.51	-	-	0.15	3.65	3.2	0.19	0.8	-	1.17	1.06	0.54	-	-	0.32	0.6	0.07	-	-	-	3.29	-	-	-	-	-	-	-	-	-	-	27.45	4.75	0.09	0.71	-	1.74	0.63	0.39	1.03	1.56	-	1.51	-	-	0.15	3.65	3.2	0.19	0.8	-	1.17	1.06	0.54	-	-	0.32	0.6	0.07	-	-	-	3.29	-	-	-	-	-	-	-	-	-	-	27.45
H5425_801_0	2006																						D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V	V		V	Coin	V			V	P	V				V																																																					-	547.46	9.75	366.6	0	197	10.65	7.08	451	220	0	21.11	0	0	208	4700	4133	229	880	0	1424	6.36	697	0	0	416	290	178	0	0	0	2024.92											days 1-4	days 1-4	days 21-100			0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 10 urgent care			20 rad therapy & specialized							10 PT & OT 20 CORF		10 hearing podiatry & chiro							0 preferred 10 non-preferred																																																									100	100	20	0	100	0.05	0.05	31.8	100	0	0.09	0	0	10	10	10	10	11	0	10	0.2	10	0	0	10	25	5	0	0	0	5												4.56	0.08	0.61	-	1.64	0.53	0.33	1.2	1.83	-	1.86	-	-	0.17	3.92	3.44	0.19	0.81	-	1.19	1.27	0.58	-	-	0.35	0.6	0.07	-	-	-	0.84	-	-	-	-	-	-	-	-	-	-	26.08	4.56	0.08	0.61	-	1.64	0.53	0.33	1.2	1.83	-	1.86	-	-	0.17	3.92	3.44	0.19	0.81	-	1.19	1.27	0.58	-	-	0.35	0.6	0.07	-	-	-	0.84	-	-	-	-	-	-	-	-	-	-	26.08
H5425_802_0	2006																						D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V	V		V	Coin	V			V	P	V				V																																																					-	547.46	9.75	366.6	0	197	10.65	7.08	451	220	0	21.11	0	0	208	4700	4133	229	880	0	1424	6.36	697	0	0	416	290	178	0	0	0	2024.92											days 1-4	days 1-4	days 21-100			0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 10 urgent care			20 rad therapy & specialized							10 PT & OT 20 CORF		10 hearing podiatry & chiro							0 preferred 10 non-preferred																																																									100	100	20	0	100	0.05	0.05	31.8	100	0	0.09	0	0	10	10	10	10	11	0	10	0.2	10	0	0	10	25	5	0	0	0	5												4.56	0.08	0.61	-	1.64	0.53	0.33	1.2	1.83	-	1.86	-	-	0.17	3.92	3.44	0.19	0.81	-	1.19	1.27	0.58	-	-	0.35	0.6	0.07	-	-	-	0.84	-	-	-	-	-	-	-	-	-	-	26.08	4.56	0.08	0.61	-	1.64	0.53	0.33	1.2	1.83	-	1.86	-	-	0.17	3.92	3.44	0.19	0.81	-	1.19	1.27	0.58	-	-	0.35	0.6	0.07	-	-	-	0.84	-	-	-	-	-	-	-	-	-	-	26.08
H5426_001_0	2006											3000											D	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V		V	V	P	V	P		V	V											0																																										-	1881.14	56.71	895.62	2116.77	303.51	9.05	1.87	353.97	341.42	720.2	745.9	26.73	41.55	552.86	10895.58	18515.13	389.21	236.95	3951.61	520.31	543.41	146.56	0	0	175.62	266.71	230.1	41.84	0	111.06	76.11											100 Days 1-7; 0 Days 8-90	400 per Admit	75 days 1-7; 50 Days 8-100	No Cost Sharing	75 per Trip	20 Coinsurance	20 Prosth/supp; 15 diab test strips	50 per visit waived if admitted for ER; 15 Urgent Care	200 per hosp Surg; 0 non-hosp incl ASC	25 per visit	Various Copays	No Cost Sharing	200 per visit	Various Copays	10 Radiology; 25 Hep B Vaccines	Various Copays	20 Psych; 10 MH Non-Phys	15 per OV;  0 per hosp visit	15 per OV;  0 per hosp visit	No Cost Sharing	5 Gen; 40 Brand	10 Chiro Visits; No CS for MC Eyewear		No Cost Sharing	10 per Visit	No Cost Sharing	10 per Visit	No Cost Sharing		No Cost Sharing	10; Routine Podiatry											89.24	62.02	50.12	0	75	0.2	0.21	43.5	139.86	25	40.36	0	200	0.52	0.23	4.91	16.35	11.5	9.48	0	25.96	1.57	0	0	10	0	10	0	0	0	10												89.24	62.02	50.12	0	75	0.2	0.21	43.5	139.86	25	40.36	0	200	0.52	0.23	4.91	16.35	11.5	9.48	0	25.96	1.57	0	0	10	0	10	0	0	0	10											0	13.99	0.29	3.74	-	1.9	1.81	0.4	1.28	3.98	1.5	2.51	-	0.69	0.02	0.21	7.57	0.53	0.23	3.12	-	1.18	0.02	-	-	0.15	-	0.19	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	45.37	13.99	0.29	3.74	-	1.9	1.81	0.4	1.28	3.98	1.5	2.51	-	0.69	0.02	0.21	7.57	0.53	0.23	3.12	-	1.18	0.02	-	-	0.15	-	0.19	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	45.37
H5426_002_0	2006											3000											D	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V		V	V	P	V	P		V	V											0																																										-	1604.67	48.36	824.57	1942.96	276.17	8.47	1.83	330.19	302.82	638.78	661.58	23.71	36.85	490.36	10098.19	16884.53	234.34	151.19	3620.89	476.66	500.3	100.12		0	112.57	252.39	209.37	38.07		101.06	69.25											100 Days 1-7; 0 Days 8-90	400 per Admit	75 days 1-7; 50 Days 8-100	No Cost Sharing	75 per Trip	20 Coinsurance	20 Prosth/supp; 15 diab test strips	50 per visit waived if admitted for ER; 15 Urgent Care	200 per hosp Surg; 0 non-hosp incl ASC	25 per visit	Various Copays	No Cost Sharing	200 per visit	Various Copays	10 Radiology; 25 Hep B Vaccines	Various Copays	20 Psych; 10 MH Non-Phys	15 per OV;  0 per hosp visit	15 per OV;  0 per hosp visit	No Cost Sharing	5 Gen; 40 Brand	10 Chiro Visits; No CS for MC Eyewear		No Cost Sharing	10 per Visit	No Cost Sharing	10 per Visit	No Cost Sharing		No Cost Sharing	10; Routine Podiatry											89.24	61.29	50.12	0	75	0.2	0.21	43.5	139.86	25	40.36	0	200	0.55	0.23	4.56	16.35	11.5	9.48	0	25.96	2.09		0	10	0	10	0		0	10												89.24	61.29	50.12	0	75	0.2	0.21	43.5	139.86	25	40.36	0	200	0.55	0.23	4.56	16.35	11.5	9.48	0	25.96	2.09		0	10	0	10	0		0	10											0	11.93	0.25	3.44	-	1.73	1.69	0.38	1.2	3.53	1.33	2.23	-	0.61	0.02	0.19	6.42	0.32	0.14	2.86	-	1.08	0.02	-	-	0.09	-	0.17	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	39.71	11.93	0.25	3.44	-	1.73	1.69	0.38	1.2	3.53	1.33	2.23	-	0.61	0.02	0.19	6.42	0.32	0.14	2.86	-	1.08	0.02	-	-	0.09	-	0.17	-	-	-	0.06	-	-	-	-	-	-	-	-	-	-	39.71
H5427_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						none	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	Ded	Coin	Coin	V	V	V	V	V	V	V	P	P	V	V	V	V	Coin	O	T	V	V	P	V	P	V	O	O	V	V	V	V	V						none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1128	72	770.28	3931.63	189.56	4.74	1.83	289.82	227.41	334.43	139.35	27.87	27.87	27.87	3052.37	2950.63	508.73	1017.46	508.73	10174.57	4.63	0	0	1136.8	1046.64	448.56	621.32	0	0	12603.81	0	201.92	151.61	203.49	305.24	1424.44						150 1 to 6 days	200 1 to 6 days	0 1-7; 50 8-20; 100 21-100	0	100 deductible	20	20	60x50+40x20	100	0	150	100	100	0	5	20	20	25	28.18	0	0	0	0	60 x .15	10	10	10	10	0	0	0	0	25	20	20	0						111.12	138.89	35.51	0	100	0.2	0.2	38	100	0	150	100	100	0	5	20	20	25	28.18	0	0	0	0	9	10	10	10	10	0	0	0	0	25	20	20	0						none	111.12	138.89	35.51	0	100	0.2	0.2	38	100	0	150	100	100	0	5	20	20	25	28.18	0	0	0	0	9	10	10	10	10	0	0	0	0	25	20	20	0						0	10.44	0.83	2.28	-	1.58	0.95	0.37	0.92	1.9	-	1.74	0.23	0.23	-	1.27	4.92	0.85	2.12	1.19	-	-	-	-	0.85	0.87	0.37	0.52	-	-	-	-	-	0.32	0.34	0.51	-	-	-	-	-	-	35.6	10.44	0.83	2.28	-	1.58	0.95	0.37	0.92	1.9	-	1.74	0.23	0.23	-	1.27	4.92	0.85	2.12	1.19	-	-	-	-	0.85	0.87	0.37	0.52	-	-	-	-	-	0.32	0.34	0.51	-	-	-	-	-	-	35.6
H5427_002_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional	0	0	0	0	0	none	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	V	V	V	V	Coin	O	T	V	V	P	V	P	V	O	O	V	V	V	V	V	Coin	Coin	Coin	Coin	Coin	none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	1479.56	94.44	856.11	4369.73	239.41	4.74	1.83	366.04	287.22	422.38	175.99	35.2	35.2	35.2	3855.11	3726.6	642.52	23.38	642.52	12850.36	5.85	0	0	859.6	588	252	883.96	0	0	15918.46	0	201.92	191.48	257.01	385.51	1799.05	0	0	0	0	0	0	0	0 1-7; 25 8-20; 0 21-100	0	5000	20	20	60x25+40x20	5000	0x93+25*7	25	50	50	50	0	0	0	0	2500	0	0	0	0	60 x 15	10	10	10	10	0	0	0	0	0	0	0	0x93+25*7	0	0	0	0	0	0	0	8.52	0	50	0.2	0.2	23	50	1.75	25	50	50	50	0	0	0	0	25	0	0	0	0	9	10	10	10	10	0	0	0	0	0	0	0	1.75	0	0	0	0	0	none	0	0	8.52	0	50	0.2	0.2	23	50	1.75	25	50	50	50	0	0	0	0	25	0	0	0	0	9	10	10	10	10	0	0	0	0	0	0	0	1.75	0	0	0	0	0	0	-	-	0.61	-	1	0.95	0.37	0.7	1.2	0.06	0.37	0.15	0.15	0.15	-	-	-	-	1.34	-	-	-	-	0.64	0.49	0.21	0.74	-	-	-	-	-	-	-	-	0.26	-	-	-	-	-	9.37	-	-	0.61	-	1	0.95	0.37	0.7	1.2	0.06	0.37	0.15	0.15	0.15	-	-	-	-	1.34	-	-	-	-	0.64	0.49	0.21	0.74	-	-	-	-	-	-	-	-	0.26	-	-	-	-	-	9.37
H5428_001_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5429_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	Coin	V	V	V	V	O	O	O	Coin	P	V	V	V						3200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1343.11	85.73	12.16	4674.8	2.31	0.66	0.11	415.29	19.58	2648.4	1103.5	220.7	220.7	220.7	1573.66	1573.66	262.28	10.3	262.28	0	4.76	0	0	0	1042.15	446.64	0	0	0	0	0	0.33	146.46	104.91	157.37	786.83						300 for 1st 10 days	300 for 1st 10 days	150 for 1st 10 days	40	10000	0	20	50	20	0	12	0	0	0	0	20	20	2000	0	0	0.2	0.2	0	0.5	10	10	10	0	0	0	0	20	1000	20	20	0						270.77	270.77	59.55	40	100	0	0.2	50	0.2	0	11.54	0	0	0	0	20	20	20	0	0	0.2	0.2	0	0.5	10	10	10	0	0	0	0	0.2	10	20	20	0						3200	267.99	267.99	58.93	39.59	98.97	0	0.2	49.49	0.2	0	11.42	0	0	0	0	19.79	19.79	19.79	0	0	0.2	0.2	0	0.49	9.9	9.9	9.9	0	0	0	0	0.2	9.9	19.79	19.79	0						0	29.99	1.91	0.06	15.42	0.02	-	0.02	1.71	3.87	-	1.05	-	-	-	-	2.6	0.43	0.02	-	-	0.94	-	-	-	0.86	0.37	-	-	-	-	-	0.07	0.12	0.17	0.26	-	-	-	-	-	-	59.9	29.99	1.91	0.06	15.42	0.02	-	0.02	1.71	3.87	-	1.05	-	-	-	-	2.6	0.43	0.02	-	-	0.94	-	-	-	0.86	0.37	-	-	-	-	-	0.07	0.12	0.17	0.26	-	-	-	-	-	-	59.9
H5429_002_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	Coin	V	V	V	V	O	O	O	Coin	P	V	V	V						3200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1577.61	100.7	14.29	5490.98	2.72	0.78	0.13	487.8	22.99	3110.78	1296.16	259.23	259.23	259.23	1848.4	1848.4	308.07	12.1	308.07	0	5.59	0	0	4.23	1224.1	524.61	304.31	130.42	0	0	0	0.39	15.33	123.23	184.84	924.2						250 for 1st 7 days	250 for 1st 7 days	150 for 1st 10 days	10	10000	0	20	50	5000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	0.5	0	0	0	0	0	0	0	20	0	10	10	0						194.6	194.6	59.55	10	100	0	0.2	50	50	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	0.5	0	0	0	0	0	0	0	0.2	0	10	10	0						3200	192.6	192.6	58.93	9.9	98.97	0	0.2	49.49	49.49	0	11.42	0	0	0	0	9.9	9.9	19.79	0	0	0.2	0.2	0	0.49	0	0	0	0	0	0	0	0.2	0	9.9	9.9	0						0	25.32	1.62	0.07	4.53	0.02	-	0.03	2.01	0.09	-	1.23	-	-	-	-	1.52	0.25	0.02	-	-	1.11	-	-	2.09	-	-	-	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	40.25	25.32	1.62	0.07	4.53	0.02	-	0.03	2.01	0.09	-	1.23	-	-	-	-	1.52	0.25	0.02	-	-	1.11	-	-	2.09	-	-	-	-	-	-	-	0.08	-	0.1	0.15	-	-	-	-	-	-	40.25
H5429_005_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	Coin	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						3500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1425.86	91.01	11.9	4962.81	2.26	0.65	0.11	440.88	19.14	2811.56	1171.48	234.3	234.3	234.3	1670.61	1670.61	278.43	10.08	278.43	0	4.65	0	0	0	1106.36	474.15	0	0	0	0	0	0.33	155.49	111.37	167.06	835.3						300 for 1st 10 days	300 for 1st 10 days	150 for 1st 5 days	40	10000	0	20	50	20	0	12	0	0	0	0	20	25	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	25	25	0						264.69	264.69	95.78	40	100	0	0.2	50	0.2	0	11.54	0	0	0	0	20	25	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	25	25	0						3500	263.81	263.81	95.46	39.87	99.67	0	0.2	49.83	0.2	0	11.5	0	0	0	0	19.93	24.92	19.93	0	0	0.2	0.2	0	2.22	9.97	9.97	9.97	0	0	0	0	0.2	9.97	24.92	24.92	0						0	31.35	2	0.09	16.49	0.02	-	0.02	1.83	3.82	-	1.12	-	-	-	-	2.78	0.58	0.02	-	-	0.93	-	-	-	0.92	0.39	-	-	-	-	-	0.06	0.13	0.23	0.35	-	-	-	-	-	-	63.12	31.35	2	0.09	16.49	0.02	-	0.02	1.83	3.82	-	1.12	-	-	-	-	2.78	0.58	0.02	-	-	0.93	-	-	-	0.92	0.39	-	-	-	-	-	0.06	0.13	0.23	0.35	-	-	-	-	-	-	63.12
H5429_006_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3500	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						3500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1657.73	105.81	13.83	5769.87	2.63	0.76	0.13	512.58	22.26	3268.78	1361.99	272.4	272.4	272.4	1942.29	1942.29	323.71	11.72	323.71	0	5.41	0	0	2497.5	1286.27	551.26	319.77	137.04	0	0	0	0.38	14.84	129.49	194.23	971.14						250 for 1st 7 days	250 for 1st 7 days	150 for 1st 10 days	40	10000	0	20	50	5000	0	12	0	0	0	0	10	20	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						194.32	194.32	59.55	40	100	0	0.2	50	50	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						3500	193.67	193.67	59.35	39.87	99.67	0	0.2	49.83	49.83	0	11.5	0	0	0	0	9.97	19.93	19.93	0	0	0.2	0.2	0	2.22	0	0	0	0	0	0	0	0.2	0	9.97	9.97	0						0	26.75	1.71	0.07	19.17	0.02	-	0.03	2.13	0.09	-	1.31	-	-	-	-	1.61	0.54	0.02	-	-	1.08	-	-	0.46	-	-	-	-	-	-	-	0.08	-	0.11	0.16	-	-	-	-	-	-	55.33	26.75	1.71	0.07	19.17	0.02	-	0.03	2.13	0.09	-	1.31	-	-	-	-	1.61	0.54	0.02	-	-	1.08	-	-	0.46	-	-	-	-	-	-	-	0.08	-	0.11	0.16	-	-	-	-	-	-	55.33
H5429_007_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						3200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1489.02	95.04	14.76	5182.65	2.8	0.81	0.13	460.41	23.75	2936.11	1223.38	244.68	244.68	244.68	1744.61	1744.61	290.77	12.5	290.77	0	5.77	0	0	0	1155.37	495.16	0	0	0	0	0	0.4	15.83	116.31	174.46	872.31						250 for 1st 5 days	250 for 1st 5 days	150 for 1st 6 days	50	10000	0	20	50	10000	0	12	0	0	0	0	10	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	20	20	0						180.35	180.35	86.8	50	100	0	0.2	50	100	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	20	20	0						3200	177.95	177.95	85.65	49.33	98.67	0	0.2	49.33	98.67	0	11.39	0	0	0	0	9.87	19.73	19.73	0	0	0.2	0.2	0	2.2	9.87	9.87	9.87	0	0	0	0	0.2	9.87	19.73	19.73	0						0	22.08	1.41	0.11	21.31	0.02	-	0.03	1.89	0.2	-	1.16	-	-	-	-	1.43	0.48	0.02	-	-	1.14	-	-	-	0.95	0.41	-	-	-	-	-	0.08	0.01	0.19	0.29	-	-	-	-	-	-	53.2	22.08	1.41	0.11	21.31	0.02	-	0.03	1.89	0.2	-	1.16	-	-	-	-	1.43	0.48	0.02	-	-	1.14	-	-	-	0.95	0.41	-	-	-	-	-	0.08	0.01	0.19	0.29	-	-	-	-	-	-	53.2
H5429_008_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						3200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1668.3	106.49	16.53	5806.64	3.14	0.9	0.15	515.84	26.6	3289.62	1370.67	274.13	274.13	274.13	1954.66	1954.66	325.78	14	325.78	0	6.47	0	0	2513.41	1294.47	554.77	321.81	137.92	0	0	0	0.45	17.74	130.31	195.47	977.33						150 for 1st 5 days	150 for 1st 5 days	100 for 1st 6 days	8	10000	0	20	50	10000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2.23	0	0	10	0	0	0	0	20	0	10	10	0						104.71	104.71	57.87	8	100	0	0.2	50	100	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2.23	0	0	10	0	0	0	0	0.2	0	10	10	0						3200	103.32	103.32	57.1	7.89	98.67	0	0.2	49.33	98.67	0	11.39	0	0	0	0	9.87	9.87	19.73	0	0	0.2	0.2	0	2.2	0	0	9.87	0	0	0	0	0.2	0	9.87	9.87	0						0	14.36	0.92	0.08	3.82	0.03	-	0.03	2.12	0.22	-	1.3	-	-	-	-	1.61	0.27	0.02	-	-	1.28	-	-	0.46	-	-	0.26	-	-	-	-	0.09	-	0.11	0.16	-	-	-	-	-	-	27.13	14.36	0.92	0.08	3.82	0.03	-	0.03	2.12	0.22	-	1.3	-	-	-	-	1.61	0.27	0.02	-	-	1.28	-	-	0.46	-	-	0.26	-	-	-	-	0.09	-	0.11	0.16	-	-	-	-	-	-	27.13
H5429_011_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						0	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1476.34	94.23	17.94	5138.51	3.41	0.98	0.16	456.49	28.87	2911.1	1212.96	242.59	242.59	242.59	1729.75	1729.75	288.29	15.2	288.29	0	7.02	0	0	0	1145.52	490.94	0	0	0	0	0	0.49	19.25	115.32	172.98	864.88						250 for 1st 7 days	250 for 1st 7 days	150 for 1st 6 days	48	10000	0	20	50	10000	0	12	0	0	0	0	5	10	1000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						193.81	193.81	86.8	47.5	100	0	0.2	50	100	0	11.54	0	0	0	0	5	10	10	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						0	193.81	193.81	86.8	47.5	100	0	0.2	50	100	0	11.54	0	0	0	0	5	10	10	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						0	23.84	1.52	0.13	20.34	0.03	-	0.03	1.9	0.24	-	1.17	-	-	-	-	0.72	0.24	0.01	-	-	1.4	-	-	-	-	-	-	-	-	-	-	0.1	-	0.1	0.14	-	-	-	-	-	-	51.92	23.84	1.52	0.13	20.34	0.03	-	0.03	1.9	0.24	-	1.17	-	-	-	-	0.72	0.24	0.01	-	-	1.4	-	-	-	-	-	-	-	-	-	-	0.1	-	0.1	0.14	-	-	-	-	-	-	51.92
H5429_012_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						0	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1542.85	98.48	20.83	5370	3.96	1.14	0.19	477.05	33.53	3042.25	1267.6	253.52	253.52	253.52	1807.68	1807.68	301.28	17.65	301.28	0	8.15	0	0	2324.41	1197.13	513.06	297.61	127.55	0	0	0	0.57	22.35	120.51	180.77	903.84						100 for 1st 5 days	100 for 1st 5 days	100 for 1st 6 days	10	10000	0	20	50	5000	0	12	0	0	0	0	0	10	0	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						67.26	67.26	57.87	10	100	0	0.2	50	50	0	11.54	0	0	0	0	0	10	0	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						0	67.26	67.26	57.87	10	100	0	0.2	50	50	0	11.54	0	0	0	0	0	10	0	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						0	8.65	0.55	0.1	4.48	0.03	-	0.04	1.99	0.14	-	1.22	-	-	-	-	-	0.25	-	-	-	1.63	-	-	0.43	-	-	-	-	-	-	-	0.11	-	0.1	0.15	-	-	-	-	-	-	19.87	8.65	0.55	0.1	4.48	0.03	-	0.04	1.99	0.14	-	1.22	-	-	-	-	-	0.25	-	-	-	1.63	-	-	0.43	-	-	-	-	-	-	-	0.11	-	0.1	0.15	-	-	-	-	-	-	19.87
H5429_015_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						3200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1476.04	94.22	13.58	5137.46	2.58	0.74	0.12	456.39	21.85	2910.5	1212.71	242.54	242.54	242.54	1729.4	1729.4	288.23	11.5	288.23	0	5.31	0	0	0	1145.29	490.84	0	0	0	0	0	0.37	14.57	115.29	172.94	864.7						250 for 1st 9 days	250 for 1st 9 days	150 for 1st 5 days	45	10000	0	20	50	20000	0	12	0	0	0	0	15	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	2500	20	20	0						214.15	214.15	95.78	45	100	0	0.2	50	200	0	11.54	0	0	0	0	15	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	25	20	20	0						3200	211.3	211.3	94.5	44.4	98.67	0	0.2	49.33	197.33	0	11.39	0	0	0	0	14.8	19.73	19.73	0	0	0.2	0.2	0	2.2	9.87	9.87	9.87	0	0	0	0	0.2	24.67	19.73	19.73	0						0	25.99	1.66	0.11	19.01	0.02	-	0.02	1.88	0.36	-	1.15	-	-	-	-	2.13	0.47	0.02	-	-	1.05	-	-	-	0.94	0.4	-	-	-	-	-	0.07	0.03	0.19	0.28	-	-	-	-	-	-	55.79	25.99	1.66	0.11	19.01	0.02	-	0.02	1.88	0.36	-	1.15	-	-	-	-	2.13	0.47	0.02	-	-	1.05	-	-	-	0.94	0.4	-	-	-	-	-	0.07	0.03	0.19	0.28	-	-	-	-	-	-	55.79
H5429_016_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						3200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1684.96	107.55	15.5	5864.62	2.95	0.85	0.14	520.99	24.95	3322.46	1384.36	276.87	276.87	276.87	1974.18	1974.18	329.03	13.13	329.03	0	6.06	0	0	2538.51	1307.4	560.31	325.02	139.29	0	0	0	0.42	16.63	131.61	197.42	987.09						200 for 1st 5 days	200 for 1st 5 days	100 for 1st 5 days	5	10000	0	20	50	10000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						138.2	138.2	63.85	5	100	0	0.2	50	100	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						3200	136.36	136.36	63	4.93	98.67	0	0.2	49.33	98.67	0	11.39	0	0	0	0	9.87	9.87	19.73	0	0	0.2	0.2	0	2.2	0	0	0	0	0	0	0	0.2	0	9.87	9.87	0						0	19.15	1.22	0.08	2.41	0.02	-	0.03	2.14	0.21	-	1.31	-	-	-	-	1.62	0.27	0.02	-	-	1.2	-	-	0.47	-	-	-	-	-	-	-	0.08	-	0.11	0.16	-	-	-	-	-	-	30.5	19.15	1.22	0.08	2.41	0.02	-	0.03	2.14	0.21	-	1.31	-	-	-	-	1.62	0.27	0.02	-	-	1.2	-	-	0.47	-	-	-	-	-	-	-	0.08	-	0.11	0.16	-	-	-	-	-	-	30.5
H5429_020_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						3200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1479.41	94.43	11.14	5149.19	2.12	0.61	0.1	457.44	17.93	2917.15	1215.48	243.1	243.1	243.1	1733.35	1733.35	288.89	9.44	288.89	0	4.36	0	0	0	1147.91	491.96	0	0	0	0	0	0.3	11.95	115.56	173.34	866.68						250 for 1st 12 days	250 for 1st 12 days	150 for 1st 10 days	40	10000	0	20	50	20000	0	12	0	0	0	0	10	20	2000	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	20	1000	20	20	0						226.75	226.75	59.55	40	100	0	0.2	50	200	0	11.54	0	0	0	0	10	20	20	0	0	0.2	0.2	0	2.23	10	10	10	0	0	0	0	0.2	10	20	20	0						3200	223.73	223.73	58.75	39.47	98.67	0	0.2	49.33	197.33	0	11.39	0	0	0	0	9.87	19.73	19.73	0	0	0.2	0.2	0	2.2	9.87	9.87	9.87	0	0	0	0	0.2	9.87	19.73	19.73	0						0	27.58	1.76	0.05	16.94	0.02	-	0.02	1.88	0.29	-	1.15	-	-	-	-	1.43	0.48	0.02	-	-	0.86	-	-	-	0.94	0.4	-	-	-	-	-	0.06	0.01	0.19	0.29	-	-	-	-	-	-	54.37	27.58	1.76	0.05	16.94	0.02	-	0.02	1.88	0.29	-	1.15	-	-	-	-	1.43	0.48	0.02	-	-	0.86	-	-	-	0.94	0.4	-	-	-	-	-	0.06	0.01	0.19	0.29	-	-	-	-	-	-	54.37
H5429_021_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						3200	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	P	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	O	O	O	Coin	P	V	V	V						3200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1720.73	109.83	12.96	5989.12	2.46	0.71	0.12	532.05	20.85	3392.99	1413.75	282.75	282.75	282.75	2016.09	2016.09	336.02	10.98	336.02	0	5.07	0	0	2592.4	1335.15	572.21	331.92	142.25	0	0	0	0.35	13.9	134.41	201.61	1008.05						250 for 1st 5 days	250 for 1st 5 days	150 for 1st 10 days	15	10000	0	20	50	10000	0	12	0	0	0	0	10	10	2000	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	20	0	10	10	0						172.9	172.9	59.55	15	100	0	0.2	50	100	0	11.54	0	0	0	0	10	10	20	0	0	0.2	0.2	0	2.23	0	0	0	0	0	0	0	0.2	0	10	10	0						3200	170.59	170.59	58.75	14.8	98.67	0	0.2	49.33	98.67	0	11.39	0	0	0	0	9.87	9.87	19.73	0	0	0.2	0.2	0	2.2	0	0	0	0	0	0	0	0.2	0	9.87	9.87	0						0	24.46	1.56	0.06	7.39	0.02	-	0.02	2.19	0.17	-	1.34	-	-	-	-	1.66	0.28	0.02	-	-	1	-	-	0.48	-	-	-	-	-	-	-	0.07	-	0.11	0.17	-	-	-	-	-	-	40.99	24.46	1.56	0.06	7.39	0.02	-	0.02	2.19	0.17	-	1.34	-	-	-	-	1.66	0.28	0.02	-	-	1	-	-	0.48	-	-	-	-	-	-	-	0.07	-	0.11	0.17	-	-	-	-	-	-	40.99
H5430_001_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5431_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional	0	0	0	0	0	none	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab	0	0	0	0	0	D	D	D	V	Ded	Coin	Coin	V	V	V	V	V	V	V	P	P	V	V	V	V	Coin	O	T	V	V	P	V	P	V	O	Ded	V	V	V	V	V	Coin	Coin	Coin	Coin	Coin	none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	1316	84	991.46	5060.59	243.99	6.23	7.17	373.04	292.71	430.46	179.36	35.87	35.87	35.87	3523.53	3523.53	587.26	21.37	587.26	0	5.96	0	24.75	574	865.34	370.86	246.45	0	0	7245	141.12	600.6	195.14	234.9	352.35	1761.77	0	0	0	0	0	630 non-pref only	150 days 1-5	250 days 15-30	0	0	13	13	60x50+40x0	100	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.48	103.05	45.06	0	0	0.13	0.13	30	100	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	none	151.48	103.05	45.06	0	0	0.13	0.13	30	100	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.61	0.72	3.72	-	-	0.81	0.93	0.93	2.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.17	16.61	0.72	3.72	-	-	0.81	0.93	0.93	2.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.17
H5433_001_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	370.14	92.41	114.19	35.49	29.73	58.15	4.23	313	32.61	12.28	33.83	0	0	34.26	117.24	190.08	8.42	2.76	43.02	0	0	10.7	0	0	0.96	0.92	0	0	0	0	5.56											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											0	22.5	5.62	17.89	-	6.93	13.55	0.99	1.3	7.6	2.86	7.88	-	-	7.98	27.32	44.29	1.96	0.64	10.02	-	-	2.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	181.84	22.5	5.62	17.89	-	6.93	13.55	0.99	1.3	7.6	2.86	7.88	-	-	7.98	27.32	44.29	1.96	0.64	10.02	-	-	2.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	181.84
H5434_001_0	2006	OP Facility - Emergency	OP Facility - Other	Other Non-Covered	OP Facility - Surgery	OP Facility - Other	Other Non-Covered					2500	Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab	Physicals					A	A	D		T	O		V	V					V	V	V	V	V		V	S											V	V	O	V	V	V					25000																																										-	280.11	4	96.49		204.34	73.01		195.88	154.09					867.38	3321.98	3399.87	354.86	15.49		875.55	232.96											1.64	164.13	206.39	112.23	1.82	23.05					500 for Tier 1 750 for Tier 2 1250 for Tier 3	500 for Tier 1 750 for Tier 2 1250 for Tier 3	100 for days 21-100						100 for Tier 1 250 for Tier 2 350 for Tier 3					100 for Tier 1 250 for Tier 2 350 for Tier 3							10 Generic 30 Preferrred Brand 50 Non-preferred Brand 500 bi-annual max																					530	530	0		100	20		50	118					118	10	30	30	30		30	11.01											30	30	5	75	30	10					27500	513.01	513.01	0		100	20		50	117.11					117.11	9.68	29.52	29.52	29.52		29.52	11.01											29.52	29.52	5	75	29.52	9.68						11.97	0.17	-	-	1.7	0.12	-	0.82	1.5	-	-	-	-	8.46	2.68	8.36	0.87	0.04	-	2.15	0.21	-	-	-	-	-	-	-	-	-	-	0	0.4	0.09	0.7	0	0.02	-	-	-	-	40.3	11.97	0.17	-	-	1.7	0.12	-	0.82	1.5	-	-	-	-	8.46	2.68	8.36	0.87	0.04	-	2.15	0.21	-	-	-	-	-	-	-	-	-	-	0	0.4	0.09	0.7	0	0.02	-	-	-	-	40.3
H5434_002_0	2006	OP Facility - Emergency	OP Facility - Other	Other Non-Covered	OP Facility - Surgery	OP Facility - Other	Other Non-Covered					2500	Urgent Care	Substance Abuse	Allergy Shots	Ambulatory Surgical Center	Cardiac Rehab	Physicals					A	A	D		T	O		V	V					V	V	V	V	V		V	S											V	V	O	V	V	V					25000																																										-	280.11	4	106.14		204.34	73.01		219.38	117.8					844.04	3090.45	3162.9	330.13	14.41		814.52	232.96											1.64	128.93	206.39	148.52	1.82	23.05					500 for Tier 1 750 for Tier 2 1250 for Tier 3	500 for Tier 1 750 for Tier 2 1250 for Tier 3	100 for days 21-100						100 for Tier 1 250 for Tier 2 350 for Tier 3					100 for Tier 1 250 for Tier 2 350 for Tier 3							10 Generic 30 Preferrred Brand 50 Non-preferred Brand 500 bi-annual max																Routine PCP Physicals					530	530	0		100	20		50	118					118	10	30	30	30		30	11.01											30	30	5	75	30	10					27500	513.01	513.01	0		100	20		50	117.11					117.11	9.68	29.52	29.52	29.52		29.52	11.01											29.52	29.52	5	75	29.52	9.68						11.97	0.17	-	-	1.7	0.12	-	0.91	1.15	-	-	-	-	8.24	2.49	7.78	0.81	0.04	-	2	0.21	-	-	-	-	-	-	-	-	-	-	0	0.32	0.09	0.93	0	0.02	-	-	-	-	38.97	11.97	0.17	-	-	1.7	0.12	-	0.91	1.15	-	-	-	-	8.24	2.49	7.78	0.81	0.04	-	2	0.21	-	-	-	-	-	-	-	-	-	-	0	0.32	0.09	0.93	0	0.02	-	-	-	-	38.97
H5435_001_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											2000																																										-	1735.5	36.63	1261.75	1993.32	240.23	17.14	1.71	312.81	347.47	0	26	0	1.72	885.98	8110.25	4728.36	203.58	763.68	3968.29	8479.19	32.05	0	0	0	0	0	0	0	0	0	0											300 per admit	Same as inpatient hopital with 190 day lifetime limit	0 [Day(s) 1-10]; 75 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	100	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20		10	Cardiac Rehabilitation: 20; Pulmonary Rehabilitation: 20; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	15	20	Occupational Therapy: 20; PT/ Speech Therapy: 20	Routine Xray: 20; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											52.26	36.08	52	0	100	0.2	0.28	49.12	50	0	0.2	0	0.1	38.67	4.94	15.57	20	20	23.03	0	0.2	0	0	0	0	0	0	0	0	0	0											2000	37.86	27.53	52	0	100	0.2	0.28	45.7	40.44	0	0.19	0	0.09	36.65	4.94	15.57	20	20	23.03	0	0.2	0	0	0	0	0	0	0	0	0	0												5.47	0.08	5.47	-	2	3.43	0.48	1.19	1.17	-	5.02	-	0.16	2.71	3.34	6.14	0.34	1.27	7.62	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.29	5.47	0.08	5.47	-	2	3.43	0.48	1.19	1.17	-	5.02	-	0.16	2.71	3.34	6.14	0.34	1.27	7.62	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.29
H5435_002_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											2000																																										-	1781.5	37.6	1295.19	2039.23	245.77	17.72	1.76	320.02	356.67	0	26.87	0	1.78	906.39	7666.5	4583.36	201.3	755.11	3756.33	8172.94	32.05	0	0	0	0	0	0	0	0	0	0											400 per admit	Same as inpatient hopital with 190 day lifetime limit	0 [Day(s) 1-10]; 75 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	125	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 75; Outpatient Hospital: 75	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20		10	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 75; Non-Surgical Cases - ASC: 75	10	20	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	48.11	52	0	125	0.2	0.28	49.12	75	0	0.2	0	0.1	56.11	9.87	20.58	25	25	27.37	0	0.2	0	0	0	0	0	0	0	0	0	0											2000	40.32	30.69	52	0	125	0.2	0.28	42.13	55.53	0	0.19	0	0.08	51.99	9.87	20.58	25	25	27.37	0	0.2	0	0	0	0	0	0	0	0	0	0												5.99	0.1	5.61	-	2.56	3.54	0.5	1.12	1.65	-	4.99	-	0.15	3.93	6.31	7.86	0.42	1.57	8.57	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.27	5.99	0.1	5.61	-	2.56	3.54	0.5	1.12	1.65	-	4.99	-	0.15	3.93	6.31	7.86	0.42	1.57	8.57	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.27
H5435_003_0	2006											3000											D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											3000																																										-	1798.56	37.96	1307.6	2065.61	248.95	17.78	1.77	323.46	360.09	0	26.95	0	1.79	918.11	7765.68	4642.66	203.9	764.88	3805.14	8278.68	32.05	0	0	0	0	0	0	0	0	0	0											600 per admit	Same as inpatient hopital with 190 day lifetime limit	0 [Day(s) 1-10]; 115 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	150	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :40	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20		10	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	20	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											104.53	72.17	80	0	150	0.2	0.28	49.58	100	0	0.2	0	0.1	71.67	9.87	20.58	25	25	27.28	0	0.2	0	0	0	0	0	0	0	0	0	0											3000	76.2	55.36	80	0	150	0.2	0.28	42.85	81.21	0	0.19	0	0.08	67.7	9.87	20.58	25	25	27.28	0	0.2	0	0	0	0	0	0	0	0	0	0												11.42	0.18	8.72	-	3.11	3.56	0.5	1.16	2.44	-	5.02	-	0.15	5.18	6.39	7.96	0.42	1.59	8.65	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.85	11.42	0.18	8.72	-	3.11	3.56	0.5	1.16	2.44	-	5.02	-	0.15	5.18	6.39	7.96	0.42	1.59	8.65	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.85
H5435_004_0	2006											3000											D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											3000																																										-	1883.65	39.76	1369.45	2160.7	260.41	19.69	1.96	338.35	377.12	0	29.86	0	1.98	960.38	8123.16	4856.37	213.29	800.09	3978.26	8659.77	32.05	0	0	0	0	0	0	0	0	0	0											200 day days 1 to 4	Same as inpatient hopital with 190 day lifetime limit	0 [Day(s) 1-10]; 115 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	150	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :40	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20		10	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	20	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											104.94	199.78	80	0	150	0.2	0.28	49.58	100	0	0.2	0	0.1	71.67	9.87	20.58	25	25	27.82	0	0.2	0	0	0	0	0	0	0	0	0	0											3000	71.79	180.11	80	0	150	0.2	0.28	41.69	78.01	0	0.18	0	0.08	67.02	9.87	20.58	25	25	27.82	0	0.2	0	0	0	0	0	0	0	0	0	0												11.27	0.6	9.13	-	3.26	3.94	0.55	1.18	2.45	-	5.51	-	0.16	5.36	6.68	8.33	0.44	1.67	9.22	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.17	11.27	0.6	9.13	-	3.26	3.94	0.55	1.18	2.45	-	5.51	-	0.16	5.36	6.68	8.33	0.44	1.67	9.22	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.17
H5435_005_0	2006											3000											D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											3000																																										-	2034.12	42.94	1478.85	2355.81	283.92	23.08	2.3	368.9	407.25	0	34.99	0	2.32	1047.1	8856.67	5294.89	232.55	872.33	4334.22	9441.73	32.05	0	0	0	0	0	0	0	0	0	0											200 day days 1 to 4	Same as inpatient hopital with 190 day lifetime limit	0 [Day(s) 1-10]; 115 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	150	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :40	Ambulatory Surgical Center: 100; Outpatient Hospital: 100	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20		10	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 100; Non-Surgical Cases - ASC: 100	10	20	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											104.94	199.78	80	0	150	0.2	0.28	49.58	100	0	0.2	0	0.1	71.67	9.87	20.58	25	25	28.55	0	0.2	0	0	0	0	0	0	0	0	0	0											3000	64.98	176.07	80	0	150	0.2	0.28	40.17	73.5	0	0.18	0	0.08	66.12	9.87	20.58	25	25	28.55	0	0.2	0	0	0	0	0	0	0	0	0	0												11.01	0.63	9.86	-	3.55	4.62	0.65	1.23	2.49	-	6.4	-	0.19	5.77	7.28	9.08	0.48	1.82	10.31	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.8	11.01	0.63	9.86	-	3.55	4.62	0.65	1.23	2.49	-	6.4	-	0.19	5.77	7.28	9.08	0.48	1.82	10.31	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	81.8
H5435_006_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											2000																																										-	1676.81	35.39	1219.08	1917.48	231.09	15.8	1.57	300.91	335.71	0	23.96	0	1.59	852.27	7801.69	4548.47	195.84	734.63	3818.86	8156.6	32.05	0	0	0	0	0	0	0	0	0	0											300 per admit	Same as inpatient hopital with 190 day lifetime limit	0 [Day(s) 1-10]; 75 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	100	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 50; Outpatient Hospital: 50	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20		10	Cardiac Rehabilitation: 20; Pulmonary Rehabilitation: 20; Non-Surgical Cases - Outpatient: 50; Non-Surgical Cases - ASC: 50	5	15	20	Occupational Therapy: 20; PT/ Speech Therapy: 20	Routine Xray: 20; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											52.26	36.08	52	0	100	0.2	0.28	49.12	50	0	0.2	0	0.1	38.67	4.94	15.57	20	20	22.68	0	0.2	0	0	0	0	0	0	0	0	0	0											2000	39.58	28.56	52	0	100	0.2	0.28	46.1	41.59	0	0.19	0	0.09	36.88	4.94	15.57	20	20	22.68	0	0.2	0	0	0	0	0	0	0	0	0	0												5.53	0.08	5.28	-	1.93	3.16	0.44	1.16	1.16	-	4.64	-	0.15	2.62	3.21	5.9	0.33	1.22	7.22	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.44	5.53	0.08	5.28	-	1.93	3.16	0.44	1.16	1.16	-	4.64	-	0.15	2.62	3.21	5.9	0.33	1.22	7.22	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.44
H5435_008_0	2006											1000											D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											1000																																										-	1895.07	40	1377.76	2180.62	262.81	21.8	2.17	345.06	379.41	0	33.05	0	2.19	969.23	9533.12	6256.24	235.66	884.01	4986.05	10563.9	32.05	0	0	0	0	0	0	0	0	0	0											0 per admit	Same as inpatient hopital with 190 day lifetime limit	0 [Day(s) 1-10]; 115 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	150	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20		10	Cardiac Rehabilitation: 15; Pulmonary Rehabilitation: 15; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	15	Occupational Therapy: 15; PT/ Speech Therapy: 15	Routine Xray: 15; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	80	0	150	0.2	0.28	47.4	0	0	0.2	0	0.1	5.67	0	1.5	15	15	19.49	0	0.2	0	0	0	0	0	0	0	0	0	0											1000	0	0	80	0	150	0.2	0.28	46.32	0	0	0.2	0	0.1	5.44	0	1.5	15	15	19.49	0	0.2	0	0	0	0	0	0	0	0	0	0												-	-	9.19	-	3.29	4.36	0.61	1.33	-	-	6.54	-	0.21	0.44	-	0.78	0.29	1.11	8.1	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.66	-	-	9.19	-	3.29	4.36	0.61	1.33	-	-	6.54	-	0.21	0.44	-	0.78	0.29	1.11	8.1	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.66
H5435_009_0	2006											500											D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	V	V	V	V	P	V	Coin	O	T	P	P	P	P	P	O	O	O											500																																										-	1763.6	37.23	1282.18	2020.54	243.51	19.03	1.89	316.4	353.09	0	28.85	0	1.91	898.08	8833.28	5929.71	268.37	1006.7	5017.9	9788.39	32.05	0	0	0	0	0	0	0	0	0	0											0 per admit	Same as inpatient hopital with 190 day lifetime limit	0 [Day(s) 1-10]; 115 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	150	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :40	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20		10	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	0	0	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	0	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	80	0	150	0.2	0.28	49.58	0	0	0.2	0	0.1	0	0	0	0	0	7.28	0	0.2	0	0	0	0	0	0	0	0	0	0											500	0	0	80	0	150	0.2	0.28	46.88	0	0	0.19	0	0.09	0	0	0	0	0	7.28	0	0.2	0	0	0	0	0	0	0	0	0	0												-	-	8.55	-	3.04	3.81	0.53	1.24	-	-	5.62	-	0.18	-	-	-	-	-	3.04	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.43	-	-	8.55	-	3.04	3.81	0.53	1.24	-	-	5.62	-	0.18	-	-	-	-	-	3.04	-	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	32.43
H5435_801_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	Coin	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	208.37	22060.1	22289.62	356.1	319.7	0	1059.33	0	104.75	768.48	7473.97	5074	3.18	861.43	4458.07	8375.83	0	0	0	0	0	0	0	0	0	0	0											No copay [Day(s) 1-90];60 additional days each benefit period plus additional 425 lifetime reserve days.	No copay [Day(s) 1-90];190 day lifetime limit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	50 Coinsurance	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.59
H5435_802_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	Coin	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	208.37	22060.1	22289.62	356.1	319.7	0	1059.33	0	104.75	768.48	7473.97	5074	3.18	861.43	4458.07	8375.83	0	0	0	0	0	0	0	0	0	0	0											No copay [Day(s) 1-90];60 additional days each benefit period plus additional 425 lifetime reserve days.	No copay [Day(s) 1-90];190 day lifetime limit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	50 Coinsurance	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.59	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.59
H5435_803_0	2006											500											D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	13.69	17.75	1.59	270.15	38.44	0	25.42	0	1.9	20.69	7473.97	5042.89	3.05	1.78	22.95	11.78	30.17	2.05	0	0	0	0	0	0	0	0	0											100 [Day(s) 1-5];90 days per benefit period plus additional 425 lifetime reserve days.	100 [Day(s) 1-5];90 days per benefit period and 190 day lifetime limit	50 [Day(s) 1-7]; 0 [Day(s) 8-100]; Day 101 - Mbr Responsibility	Covered in Full	10 Coinsurance	15 Coinsurance	Prosthetics: 15 Coinsurance; Supplies: 15 Coinsurance	ER: 50; Urgent Care :50	Ambulatory Surgical Center: 10 Coinsurance; Outpatient Hospital: 10 Coinsurance	0	Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 10 Coinsurance; Pulmonary Rehabilitation: 10 Coinsurance; Non-Surgical Cases - Outpatient: 10 Coinsurance; Non-Surgical Cases - ASC: 10 Coinsurance	0	Specialist: 0 Chiropractic (Medicare-covered): 10 Coinsurance	50 Coinsurance	Occupational Therapy: 10 Coinsurance; PT/ Speech Therapy: 10 Coinsurance	Routine Xray: 10 Coinsurance; Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance	Routine Lab: 10 Coinsurance; Renal Dialysis: 0.1	Inhalation Solutions: 15 Coinsurance; Oral Chemo: 15 Coinsurance; Anti-Emetics / Antigens: 15 Coinsurance; Self Injectibles: 15 Coinsurance; Office Based Injectibles: 15 Coinsurance; Immunosuppressives: 15 Coinsurance	10 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											59.54	99.89	25	0	0.1	0.15	0.15	50	0.1	0	0.1	0	0.1	0.1	0	0.43	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0											500	11.43	71.34	13.99	0	0.1	0.15	0.15	37.85	0.08	0	0.08	0	0.08	0.08	0	0.43	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0												1.52	0.2	1.35	-	1.37	2.66	0.24	0.85	2.99	-	1.98	-	0.15	1.61	-	0.18	1.52	0.18	2.3	1.18	4.53	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.01	1.52	0.2	1.35	-	1.37	2.66	0.24	0.85	2.99	-	1.98	-	0.15	1.61	-	0.18	1.52	0.18	2.3	1.18	4.53	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.01
H5435_804_0	2006											500											D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	13.69	17.75	1.59	270.15	38.44	0	25.42	0	1.9	20.69	7473.97	5042.89	3.05	1.78	22.95	11.78	30.17	2.05	0	0	0	0	0	0	0	0	0											100 [Day(s) 1-5];90 days per benefit period plus additional 425 lifetime reserve days.	100 [Day(s) 1-5];90 days per benefit period and 190 day lifetime limit	50 [Day(s) 1-7]; 0 [Day(s) 8-100]; Day 101 - Mbr Responsibility	Covered in Full	10 Coinsurance	15 Coinsurance	Prosthetics: 15 Coinsurance; Supplies: 15 Coinsurance	ER: 50; Urgent Care :50	Ambulatory Surgical Center: 10 Coinsurance; Outpatient Hospital: 10 Coinsurance	0	Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 10 Coinsurance; Pulmonary Rehabilitation: 10 Coinsurance; Non-Surgical Cases - Outpatient: 10 Coinsurance; Non-Surgical Cases - ASC: 10 Coinsurance	0	Specialist: 0 Chiropractic (Medicare-covered): 10 Coinsurance	50 Coinsurance	Occupational Therapy: 10 Coinsurance; PT/ Speech Therapy: 10 Coinsurance	Routine Xray: 10 Coinsurance; Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance	Routine Lab: 10 Coinsurance; Renal Dialysis: 0.1	Inhalation Solutions: 15 Coinsurance; Oral Chemo: 15 Coinsurance; Anti-Emetics / Antigens: 15 Coinsurance; Self Injectibles: 15 Coinsurance; Office Based Injectibles: 15 Coinsurance; Immunosuppressives: 15 Coinsurance	10 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											59.54	99.89	25	0	0.1	0.15	0.15	50	0.1	0	0.1	0	0.1	0.1	0	0.43	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0											500	11.43	71.34	13.99	0	0.1	0.15	0.15	37.85	0.08	0	0.08	0	0.08	0.08	0	0.43	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0												1.52	0.2	1.35	-	1.37	2.66	0.24	0.85	2.99	-	1.98	-	0.15	1.61	-	0.18	1.52	0.18	2.3	1.18	4.53	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.01	1.52	0.2	1.35	-	1.37	2.66	0.24	0.85	2.99	-	1.98	-	0.15	1.61	-	0.18	1.52	0.18	2.3	1.18	4.53	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.01
H5435_805_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	208.37	22060.1	22289.62	272.8	319.7	0	909.29	0	104.75	768.48	6415.43	4300.85	197.12	739.42	3826.67	7189.55	0	0	0	0	0	0	0	0	0	0	0											0 per Admit	0 190 day lifetime limit	0 [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :10	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		10	Cardiac Rehabilitation: 10; Pulmonary Rehabilitation: 10; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	Specialist: 10 Chiropractic (Medicare-covered): 20	10	Occupational Therapy: 10; PT/ Speech Therapy: 10	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 10	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	10 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	1.09	-	-	-	-	0.09	0.24	5.35	3.97	0.16	0.62	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.6	-	-	-	-	-	-	-	1.09	-	-	-	-	0.09	0.24	5.35	3.97	0.16	0.62	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.6
H5435_806_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	208.37	22060.1	22289.62	272.8	319.7	0	909.29	0	104.75	768.48	6415.43	4300.85	197.12	739.42	3826.67	7189.55	0	0	0	0	0	0	0	0	0	0	0											0 per Admit	0 190 day lifetime limit	0 [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :10	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		10	Cardiac Rehabilitation: 10; Pulmonary Rehabilitation: 10; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	Specialist: 10 Chiropractic (Medicare-covered): 20	10	Occupational Therapy: 10; PT/ Speech Therapy: 10	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 10	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	10 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	1.09	-	-	-	-	0.09	0.24	5.35	3.97	0.16	0.62	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.6	-	-	-	-	-	-	-	1.09	-	-	-	-	0.09	0.24	5.35	3.97	0.16	0.62	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.6
H5435_807_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	208.37	22060.1	22289.62	272.41	319.7	0	861.93	0	104.75	768.48	6081.29	4101.27	186.85	700.91	3557.09	6815.1	0	0	0	0	0	0	0	0	0	0	0											250 per Admit	250 per Admit 190 day lifetime limit	0 [Day(s) 1-20];50 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	50	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :15	Ambulatory Surgical Center: 125; Outpatient Hospital: 125	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15		15	Cardiac Rehabilitation: 15; Pulmonary Rehabilitation: 15; Non-Surgical Cases - Outpatient: 125; Non-Surgical Cases - ASC: 125	15	Specialist: 15 Chiropractic (Medicare-covered): 20	15	Occupational Therapy: 15; PT/ Speech Therapy: 15	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15	Routine Lab: 0; Renal Dialysis: 15	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	15 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0											0	43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0												5.8	0.08	2.32	-	0.87	-	-	1.1	3.33	-	0.75	-	0.13	5.34	7.6	5.32	0.23	0.88	0.76	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.63	5.8	0.08	2.32	-	0.87	-	-	1.1	3.33	-	0.75	-	0.13	5.34	7.6	5.32	0.23	0.88	0.76	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.63
H5435_808_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	208.37	22060.1	22289.62	272.41	319.7	0	861.93	0	104.75	768.48	6081.29	4101.27	186.85	700.91	3557.09	6815.1	0	0	0	0	0	0	0	0	0	0	0											250 per Admit	250 per Admit 190 day lifetime limit	0 [Day(s) 1-20];50 [Day(s) 21-100];Day 101 - Mbr Responsibility	Covered in Full	50	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :15	Ambulatory Surgical Center: 125; Outpatient Hospital: 125	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15		15	Cardiac Rehabilitation: 15; Pulmonary Rehabilitation: 15; Non-Surgical Cases - Outpatient: 125; Non-Surgical Cases - ASC: 125	15	Specialist: 15 Chiropractic (Medicare-covered): 20	15	Occupational Therapy: 15; PT/ Speech Therapy: 15	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15	Routine Lab: 0; Renal Dialysis: 15	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	15 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0											0	43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0												5.8	0.08	2.32	-	0.87	-	-	1.1	3.33	-	0.75	-	0.13	5.34	7.6	5.32	0.23	0.88	0.76	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.63	5.8	0.08	2.32	-	0.87	-	-	1.1	3.33	-	0.75	-	0.13	5.34	7.6	5.32	0.23	0.88	0.76	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.63
H5435_809_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	O	T	P	P	P	P	P	O	O	O											2000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	208.37	17.03	1.7	271.33	319.7	0	856.16	0	1.71	768.48	6415.43	3771.02	170.67	640.22	3186.99	6762.08	32.05	0	0	0	0	0	0	0	0	0	0											400 per Admit	400 per Admit 190 day lifetime limit	0 [Day(s) 1-10];75 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	125	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 75; Outpatient Hospital: 75	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 75; Non-Surgical Cases - ASC: 75	10	Specialist: 25 Chiropractic (Medicare-covered): 25	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 25	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	25 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	48.11	52	0	125	0.2	0.28	49.12	75	0	50.47	0	0.1	56.11	10	25	25	25	21.21	0.31	0.2	25	0	0	0	0	0	0	0	0	0											2000	57.52	40.89	49.22	0	125	0.2	0.28	46.06	66.93	0	49.08	0	0.09	54.3	10	25	25	25	21.21	0.31	0.2	25	0	0	0	0	0	0	0	0	0												7.65	0.11	4.76	-	2.17	3.41	0.48	1.04	1.78	-	3.5	-	0.16	3.48	5.35	7.86	0.36	1.33	5.63	0.18	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.66	7.65	0.11	4.76	-	2.17	3.41	0.48	1.04	1.78	-	3.5	-	0.16	3.48	5.35	7.86	0.36	1.33	5.63	0.18	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.66
H5435_810_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	O	T	P	P	P	P	P	O	O	O											2000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	208.37	17.03	1.7	271.33	319.7	0	856.16	0	1.71	768.48	6415.43	3771.02	170.67	640.22	3186.99	6762.08	32.05	0	0	0	0	0	0	0	0	0	0											400 per Admit	400 per Admit 190 day lifetime limit	0 [Day(s) 1-10];75 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	125	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 75; Outpatient Hospital: 75	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 75; Non-Surgical Cases - ASC: 75	10	Specialist: 25 Chiropractic (Medicare-covered): 25	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 25	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	25 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	48.11	52	0	125	0.2	0.28	49.12	75	0	50.47	0	0.1	56.11	10	25	25	25	21.21	0.31	0.2	25	0	0	0	0	0	0	0	0	0											2000	57.52	40.89	49.22	0	125	0.2	0.28	46.06	66.93	0	49.08	0	0.09	54.3	10	25	25	25	21.21	0.31	0.2	25	0	0	0	0	0	0	0	0	0												7.65	0.11	4.76	-	2.17	3.41	0.48	1.04	1.78	-	3.5	-	0.16	3.48	5.35	7.86	0.36	1.33	5.63	0.18	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.66	7.65	0.11	4.76	-	2.17	3.41	0.48	1.04	1.78	-	3.5	-	0.16	3.48	5.35	7.86	0.36	1.33	5.63	0.18	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.66
H5435_811_0	2006											3000											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											3000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	13.22	22060.1	1.45	11.94	37.11	0	24.54	0	1.83	19.98	55.14	106.07	1.63	1.72	22.16	11.37	32.05	2.04	0	0	0	0	0	0	0	0	0											20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150)	20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150) 190 lifetime limit	20 Coinsurance [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	20 Coinsurance	Not Covered	Prosthetics: 20 Coinsurance; Supplies: 20 Coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 Coinsurance	Specialist: 20 Coinsurance Chiropractic (Medicare-covered): 20 Coinsurance	20 Coinsurance limit of 50 visits/yr	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 Coinsurance; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 20 Coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	75	0	0.2	0	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											3000	86.5	97.74	70.24	0	0.2	0	0.2	0.19	0.19	0	0.19	0	0.19	0.19	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0												11.51	0.27	6.8	-	2.64	-	0.29	2.27	7.05	-	4.67	-	0.35	3.8	11.03	21.21	0.33	0.34	4.43	2.27	6.41	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.09	11.51	0.27	6.8	-	2.64	-	0.29	2.27	7.05	-	4.67	-	0.35	3.8	11.03	21.21	0.33	0.34	4.43	2.27	6.41	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.09
H5435_812_0	2006											3000											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											3000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1596.83	33.71	1160.93	1728.95	13.22	22060.1	1.45	11.94	37.11	0	24.54	0	1.83	19.98	55.14	106.07	1.63	1.72	22.16	11.37	32.05	2.04	0	0	0	0	0	0	0	0	0											20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150)	20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150) 190 lifetime limit	20 Coinsurance [Day(s) 1-100];Day 101 - Mbr Responsibility	Covered in Full	20 Coinsurance	Not Covered	Prosthetics: 20 Coinsurance; Supplies: 20 Coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 Coinsurance	Specialist: 20 Coinsurance Chiropractic (Medicare-covered): 20 Coinsurance	20 Coinsurance limit of 50 visits/yr	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 Coinsurance; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 20 Coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	75	0	0.2	0	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											3000	86.5	97.74	70.24	0	0.2	0	0.2	0.19	0.19	0	0.19	0	0.19	0.19	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0												11.51	0.27	6.8	-	2.64	-	0.29	2.27	7.05	-	4.67	-	0.35	3.8	11.03	21.21	0.33	0.34	4.43	2.27	6.41	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.09	11.51	0.27	6.8	-	2.64	-	0.29	2.27	7.05	-	4.67	-	0.35	3.8	11.03	21.21	0.33	0.34	4.43	2.27	6.41	0.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	86.09
H5435_813_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	Coin	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	233.8	24751.91	25009.43	399.56	358.71	0	1188.59	0	117.53	862.25	8385.96	5693.13	3.39	966.54	5002.05	9397.86	0	0	0	0	0	0	0	0	0	0	0											No copay [Day(s) 1-90]; 60 additional days each benefit period plus additional 425 lifetime reserve days.	No copay [Day(s) 1-90];190 day lifetime limit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	50 Coinsurance	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.69
H5435_814_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	Coin	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	233.8	24751.91	25009.43	399.56	358.71	0	1188.59	0	117.53	862.25	8385.96	5693.13	3.39	966.54	5002.05	9397.86	0	0	0	0	0	0	0	0	0	0	0											No copay [Day(s) 1-90]; 60 additional days each benefit period plus additional 425 lifetime reserve days.	No copay [Day(s) 1-90];190 day lifetime limit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	50 Coinsurance	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.69
H5435_815_0	2006											500											D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	14.59	18.91	1.69	303.11	40.96	0	27.09	0	2.02	22.05	8385.96	5659.99	3.25	1.9	24.46	12.55	30.17	2.18	0	0	0	0	0	0	0	0	0											100 [Day(s) 1-5];90 days per benefit period plus additional 425 lifetime reserve days.	100 [Day(s) 1-5];90 days per benefit period and 190 day lifetime limit	50 [Day(s) 1-7]; 0 [Day(s) 8-100]; Day 101 - Mbr Responsibility	Covered in Full	10 Coinsurance	15 Coinsurance	Prosthetics: 15 Coinsurance; Supplies: 15 Coinsurance	ER: 50; Urgent Care :50	Ambulatory Surgical Center: 10 Coinsurance; Outpatient Hospital: 10 Coinsurance	0	Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 10 Coinsurance; Pulmonary Rehabilitation: 10 Coinsurance; Non-Surgical Cases - Outpatient: 10 Coinsurance; Non-Surgical Cases - ASC: 10 Coinsurance	0	Specialist: 0 Chiropractic (Medicare-covered): 10 Coinsurance	50 Coinsurance	Occupational Therapy: 10 Coinsurance; PT/ Speech Therapy: 10 Coinsurance	Routine Xray: 10 Coinsurance; Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance	Routine Lab: 10 Coinsurance; Renal Dialysis: 0.1	Inhalation Solutions: 15 Coinsurance; Oral Chemo: 15 Coinsurance; Anti-Emetics / Antigens: 15 Coinsurance; Self Injectibles: 15 Coinsurance; Office Based Injectibles: 15 Coinsurance; Immunosuppressives: 15 Coinsurance	10 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											59.54	99.89	25	0	0.1	0.15	0.15	50	0.1	0	0.1	0	0.1	0.1	0	0.4	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0											500	9.52	70.21	13.55	0	0.1	0.15	0.15	37.37	0.08	0	0.08	0	0.08	0.08	0	0.4	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0												1.42	0.22	1.47	-	1.46	2.84	0.25	0.94	3.1	-	2.05	-	0.15	1.67	-	0.19	1.62	0.19	2.45	1.26	4.53	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.03	1.42	0.22	1.47	-	1.46	2.84	0.25	0.94	3.1	-	2.05	-	0.15	1.67	-	0.19	1.62	0.19	2.45	1.26	4.53	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.03
H5435_816_0	2006											500											D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	14.59	18.91	1.69	303.11	40.96	0	27.09	0	2.02	22.05	8385.96	5659.99	3.25	1.9	24.46	12.55	30.17	2.18	0	0	0	0	0	0	0	0	0											100 [Day(s) 1-5];90 days per benefit period plus additional 425 lifetime reserve days.	100 [Day(s) 1-5];90 days per benefit period and 190 day lifetime limit	50 [Day(s) 1-7]; 0 [Day(s) 8-100]; Day 101 - Mbr Responsibility	Covered in Full	10 Coinsurance	15 Coinsurance	Prosthetics: 15 Coinsurance; Supplies: 15 Coinsurance	ER: 50; Urgent Care :50	Ambulatory Surgical Center: 10 Coinsurance; Outpatient Hospital: 10 Coinsurance	0	Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 10 Coinsurance; Pulmonary Rehabilitation: 10 Coinsurance; Non-Surgical Cases - Outpatient: 10 Coinsurance; Non-Surgical Cases - ASC: 10 Coinsurance	0	Specialist: 0 Chiropractic (Medicare-covered): 10 Coinsurance	50 Coinsurance	Occupational Therapy: 10 Coinsurance; PT/ Speech Therapy: 10 Coinsurance	Routine Xray: 10 Coinsurance; Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance	Routine Lab: 10 Coinsurance; Renal Dialysis: 0.1	Inhalation Solutions: 15 Coinsurance; Oral Chemo: 15 Coinsurance; Anti-Emetics / Antigens: 15 Coinsurance; Self Injectibles: 15 Coinsurance; Office Based Injectibles: 15 Coinsurance; Immunosuppressives: 15 Coinsurance	10 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											59.54	99.89	25	0	0.1	0.15	0.15	50	0.1	0	0.1	0	0.1	0.1	0	0.4	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0											500	9.52	70.21	13.55	0	0.1	0.15	0.15	37.37	0.08	0	0.08	0	0.08	0.08	0	0.4	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0												1.42	0.22	1.47	-	1.46	2.84	0.25	0.94	3.1	-	2.05	-	0.15	1.67	-	0.19	1.62	0.19	2.45	1.26	4.53	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.03	1.42	0.22	1.47	-	1.46	2.84	0.25	0.94	3.1	-	2.05	-	0.15	1.67	-	0.19	1.62	0.19	2.45	1.26	4.53	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.03
H5435_817_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	233.8	24751.91	25009.43	306.09	358.71	0	1020.25	0	117.53	862.25	7198.25	4825.65	221.17	829.65	4293.61	8066.84	0	0	0	0	0	0	0	0	0	0	0											0 per Admit	0 190 day lifetime limit	0 [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :10	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		10	Cardiac Rehabilitation: 10; Pulmonary Rehabilitation: 10; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	Specialist: 10 Chiropractic (Medicare-covered): 20	10	Occupational Therapy: 10; PT/ Speech Therapy: 10	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 10	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	10 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	1.23	-	-	-	-	0.1	0.27	6	4.46	0.18	0.69	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.02	-	-	-	-	-	-	-	1.23	-	-	-	-	0.1	0.27	6	4.46	0.18	0.69	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.02
H5435_818_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	233.8	24751.91	25009.43	306.09	358.71	0	1020.25	0	117.53	862.25	7198.25	4825.65	221.17	829.65	4293.61	8066.84	0	0	0	0	0	0	0	0	0	0	0											0 per Admit	0 190 day lifetime limit	0 [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :10	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		10	Cardiac Rehabilitation: 10; Pulmonary Rehabilitation: 10; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	Specialist: 10 Chiropractic (Medicare-covered): 20	10	Occupational Therapy: 10; PT/ Speech Therapy: 10	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 10	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	10 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	1.23	-	-	-	-	0.1	0.27	6	4.46	0.18	0.69	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.02	-	-	-	-	-	-	-	1.23	-	-	-	-	0.1	0.27	6	4.46	0.18	0.69	-	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.02
H5435_819_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	233.8	24751.91	25009.43	305.65	358.71	0	967.11	0	117.53	862.25	6823.34	4601.71	209.65	786.44	3991.13	7646.69	0	0	0	0	0	0	0	0	0	0	0											250 per Admit	250 per Admit 190 day lifetime limit	0 [Day(s) 1-20]; 50 [Day(s) 21-100]; Day 101 - Mbr Responsibility	Covered in Full	50	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :15	Ambulatory Surgical Center: 125; Outpatient Hospital: 125	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15		15	Cardiac Rehabilitation: 15; Pulmonary Rehabilitation: 15; Non-Surgical Cases - Outpatient: 125; Non-Surgical Cases - ASC: 125	15	Specialist: 15 Chiropractic (Medicare-covered): 20	15	Occupational Therapy: 15; PT/ Speech Therapy: 15	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15	Routine Lab: 0; Renal Dialysis: 15	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	15 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0											0	43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0												6.5	0.09	2.61	-	0.97	-	-	1.23	3.74	-	0.84	-	0.15	6	8.53	5.97	0.26	0.98	0.85	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.86	6.5	0.09	2.61	-	0.97	-	-	1.23	3.74	-	0.84	-	0.15	6	8.53	5.97	0.26	0.98	0.85	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.86
H5435_820_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	233.8	24751.91	25009.43	305.65	358.71	0	967.11	0	117.53	862.25	6823.34	4601.71	209.65	786.44	3991.13	7646.69	0	0	0	0	0	0	0	0	0	0	0											250 per Admit	250 per Admit 190 day lifetime limit	0 [Day(s) 1-20]; 50 [Day(s) 21-100]; Day 101 - Mbr Responsibility	Covered in Full	50	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :15	Ambulatory Surgical Center: 125; Outpatient Hospital: 125	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15		15	Cardiac Rehabilitation: 15; Pulmonary Rehabilitation: 15; Non-Surgical Cases - Outpatient: 125; Non-Surgical Cases - ASC: 125	15	Specialist: 15 Chiropractic (Medicare-covered): 20	15	Occupational Therapy: 15; PT/ Speech Therapy: 15	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15	Routine Lab: 0; Renal Dialysis: 15	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	15 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0											0	43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0												6.5	0.09	2.61	-	0.97	-	-	1.23	3.74	-	0.84	-	0.15	6	8.53	5.97	0.26	0.98	0.85	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.86	6.5	0.09	2.61	-	0.97	-	-	1.23	3.74	-	0.84	-	0.15	6	8.53	5.97	0.26	0.98	0.85	0.13	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.86
H5435_821_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	O	T	P	P	P	P	P	O	O	O											2000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	233.8	18.22	1.81	304.43	358.71	0	960.63	0	1.83	862.25	7198.25	4231.16	191.5	718.34	3581.87	7587.2	32.05	0	0	0	0	0	0	0	0	0	0											400 per Admit	400 per Admit 190 day lifetime limit	0 [Day(s) 1-10];75 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	125	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 75; Outpatient Hospital: 75	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 75; Non-Surgical Cases - ASC: 75	10	Specialist: 25 Chiropractic (Medicare-covered): 25	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 25	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	25 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	48.11	52	0	125	0.2	0.28	49.12	75	0	48.11	0	0.1	56.11	10	25	25	25	21.02	0.31	0.2	25	0	0	0	0	0	0	0	0	0											2000	54.92	39.35	48.62	0	125	0.2	0.28	45.4	65.21	0	46.43	0	0.09	53.92	10	25	25	25	21.02	0.31	0.2	25	0	0	0	0	0	0	0	0	0												8.2	0.12	5.28	-	2.44	3.64	0.51	1.15	1.95	-	3.72	-	0.17	3.87	6	8.81	0.4	1.5	6.27	0.2	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.64	8.2	0.12	5.28	-	2.44	3.64	0.51	1.15	1.95	-	3.72	-	0.17	3.87	6	8.81	0.4	1.5	6.27	0.2	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.64
H5435_822_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	O	T	P	P	P	P	P	O	O	O											2000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	233.8	18.22	1.81	304.43	358.71	0	960.63	0	1.83	862.25	7198.25	4231.16	191.5	718.34	3581.87	7587.2	32.05	0	0	0	0	0	0	0	0	0	0											400 per Admit	400 per Admit 190 day lifetime limit	0 [Day(s) 1-10];75 [Day(s) 11-100];Day 101 - Mbr Responsibility	Covered in Full	125	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 75; Outpatient Hospital: 75	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 75; Non-Surgical Cases - ASC: 75	10	Specialist: 25 Chiropractic (Medicare-covered): 25	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 25	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	25 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	48.11	52	0	125	0.2	0.28	49.12	75	0	48.11	0	0.1	56.11	10	25	25	25	21.02	0.31	0.2	25	0	0	0	0	0	0	0	0	0											2000	54.92	39.35	48.62	0	125	0.2	0.28	45.4	65.21	0	46.43	0	0.09	53.92	10	25	25	25	21.02	0.31	0.2	25	0	0	0	0	0	0	0	0	0												8.2	0.12	5.28	-	2.44	3.64	0.51	1.15	1.95	-	3.72	-	0.17	3.87	6	8.81	0.4	1.5	6.27	0.2	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.64	8.2	0.12	5.28	-	2.44	3.64	0.51	1.15	1.95	-	3.72	-	0.17	3.87	6	8.81	0.4	1.5	6.27	0.2	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	60.64
H5435_823_0	2006											3000											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											3000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	14.12	24751.91	1.55	12.76	39.66	0	26.23	0	1.96	21.35	58.93	113.35	1.75	1.84	23.68	12.15	32.05	2.17	0	0	0	0	0	0	0	0	0											20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150)	20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150) 190 lifetime limit	20 Coinsurance [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	20 Coinsurance	Not Covered	Prosthetics: 20 Coinsurance; Supplies: 20 Coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 Coinsurance	Specialist: 20 Coinsurance Chiropractic (Medicare-covered): 20 Coinsurance	20 Coinsurance limit of 50 visits/yr	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 Coinsurance; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 20 Coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	75	0	0.2	0	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											3000	83.91	96.2	69.65	0	0.2	0	0.2	0.19	0.19	0	0.19	0	0.19	0.19	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0												12.53	0.3	7.56	-	2.82	-	0.31	2.4	7.47	-	4.94	-	0.37	4.02	11.79	22.67	0.35	0.37	4.74	2.43	6.41	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.91	12.53	0.3	7.56	-	2.82	-	0.31	2.4	7.47	-	4.94	-	0.37	4.02	11.79	22.67	0.35	0.37	4.74	2.43	6.41	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.91
H5435_824_0	2006											3000											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											3000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1791.68	37.82	1302.59	1939.92	14.12	24751.91	1.55	12.76	39.66	0	26.23	0	1.96	21.35	58.93	113.35	1.75	1.84	23.68	12.15	32.05	2.17	0	0	0	0	0	0	0	0	0											20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150)	20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150) 190 lifetime limit	20 Coinsurance [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	20 Coinsurance	Not Covered	Prosthetics: 20 Coinsurance; Supplies: 20 Coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 Coinsurance	Specialist: 20 Coinsurance Chiropractic (Medicare-covered): 20 Coinsurance	20 Coinsurance limit of 50 visits/yr	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 Coinsurance; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 20 Coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	75	0	0.2	0	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											3000	83.91	96.2	69.65	0	0.2	0	0.2	0.19	0.19	0	0.19	0	0.19	0.19	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0												12.53	0.3	7.56	-	2.82	-	0.31	2.4	7.47	-	4.94	-	0.37	4.02	11.79	22.67	0.35	0.37	4.74	2.43	6.41	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.91	12.53	0.3	7.56	-	2.82	-	0.31	2.4	7.47	-	4.94	-	0.37	4.02	11.79	22.67	0.35	0.37	4.74	2.43	6.41	0.43	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	91.91
H5435_825_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	Coin	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	245.8	26022.39	26293.14	420.07	377.12	0	1249.6	0	123.56	906.51	8816.4	5985.36	3.75	1016.15	5258.8	9880.25	0	0	0	0	0	0	0	0	0	0	0											No copay [Day(s) 1-90]; 60 additional days each benefit period plus additional 425 lifetime reserve days.	No copay [Day(s) 1-90]; 190 day lifetime limit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	50 Coinsurance	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.87
H5435_826_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	Coin	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	245.8	26022.39	26293.14	420.07	377.12	0	1249.6	0	123.56	906.51	8816.4	5985.36	3.75	1016.15	5258.8	9880.25	0	0	0	0	0	0	0	0	0	0	0											No copay [Day(s) 1-90]; 60 additional days each benefit period plus additional 425 lifetime reserve days.	No copay [Day(s) 1-90]; 190 day lifetime limit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	50 Coinsurance	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.87	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.87
H5435_827_0	2006											500											D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	16.19	20.99	1.88	318.67	45.46	0	30.07	0	2.24	24.48	8816.4	5948.57	3.6	2.1	27.15	13.93	30.17	2.42	0	0	0	0	0	0	0	0	0											100 [Day(s) 1-5]; 90 days per benefit period plus additional 425 lifetime reserve days.	100 [Day(s) 1-5]; 90 days per benefit period and 190 day lifetime limit	50 [Day(s) 1-7]; 0 [Day(s) 8-100]; Day 101 - Mbr Responsibility	Covered in Full	10 Coinsurance	15 Coinsurance	Prosthetics: 15 Coinsurance; Supplies: 15 Coinsurance	ER: 50; Urgent Care :50	Ambulatory Surgical Center: 10 Coinsurance; Outpatient Hospital: 10 Coinsurance	0	Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 10 Coinsurance; Pulmonary Rehabilitation: 10 Coinsurance; Non-Surgical Cases - Outpatient: 10 Coinsurance; Non-Surgical Cases - ASC: 10 Coinsurance	0	Specialist: 0 Chiropractic (Medicare-covered): 10 Coinsurance	50 Coinsurance	Occupational Therapy: 10 Coinsurance; PT/ Speech Therapy: 10 Coinsurance	Routine Xray: 10 Coinsurance; Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance	Routine Lab: 10 Coinsurance; Renal Dialysis: 0.1	Inhalation Solutions: 15 Coinsurance; Oral Chemo: 15 Coinsurance; Anti-Emetics / Antigens: 15 Coinsurance; Self Injectibles: 15 Coinsurance; Office Based Injectibles: 15 Coinsurance; Immunosuppressives: 15 Coinsurance	10 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											59.54	99.89	25	0	0.1	0.15	0.15	50	0.1	0	0.1	0	0.1	0.1	0	0.43	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0											500	5.66	67.92	12.66	0	0.1	0.15	0.15	36.39	0.08	0	0.08	0	0.08	0.08	0	0.43	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0												0.89	0.23	1.45	-	1.62	3.15	0.28	0.97	3.42	-	2.26	-	0.17	1.84	-	0.21	1.8	0.21	2.71	1.39	4.53	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.37	0.89	0.23	1.45	-	1.62	3.15	0.28	0.97	3.42	-	2.26	-	0.17	1.84	-	0.21	1.8	0.21	2.71	1.39	4.53	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.37
H5435_828_0	2006											500											D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	16.19	20.99	1.88	318.67	45.46	0	30.07	0	2.24	24.48	8816.4	5948.57	3.6	2.1	27.15	13.93	30.17	2.42	0	0	0	0	0	0	0	0	0											100 [Day(s) 1-5]; 90 days per benefit period plus additional 425 lifetime reserve days.	100 [Day(s) 1-5]; 90 days per benefit period and 190 day lifetime limit	50 [Day(s) 1-7]; 0 [Day(s) 8-100]; Day 101 - Mbr Responsibility	Covered in Full	10 Coinsurance	15 Coinsurance	Prosthetics: 15 Coinsurance; Supplies: 15 Coinsurance	ER: 50; Urgent Care :50	Ambulatory Surgical Center: 10 Coinsurance; Outpatient Hospital: 10 Coinsurance	0	Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 10 Coinsurance; Pulmonary Rehabilitation: 10 Coinsurance; Non-Surgical Cases - Outpatient: 10 Coinsurance; Non-Surgical Cases - ASC: 10 Coinsurance	0	Specialist: 0 Chiropractic (Medicare-covered): 10 Coinsurance	50 Coinsurance	Occupational Therapy: 10 Coinsurance; PT/ Speech Therapy: 10 Coinsurance	Routine Xray: 10 Coinsurance; Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance	Routine Lab: 10 Coinsurance; Renal Dialysis: 0.1	Inhalation Solutions: 15 Coinsurance; Oral Chemo: 15 Coinsurance; Anti-Emetics / Antigens: 15 Coinsurance; Self Injectibles: 15 Coinsurance; Office Based Injectibles: 15 Coinsurance; Immunosuppressives: 15 Coinsurance	10 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											59.54	99.89	25	0	0.1	0.15	0.15	50	0.1	0	0.1	0	0.1	0.1	0	0.43	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0											500	5.66	67.92	12.66	0	0.1	0.15	0.15	36.39	0.08	0	0.08	0	0.08	0.08	0	0.43	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0												0.89	0.23	1.45	-	1.62	3.15	0.28	0.97	3.42	-	2.26	-	0.17	1.84	-	0.21	1.8	0.21	2.71	1.39	4.53	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.37	0.89	0.23	1.45	-	1.62	3.15	0.28	0.97	3.42	-	2.26	-	0.17	1.84	-	0.21	1.8	0.21	2.71	1.39	4.53	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	27.37
H5435_829_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	245.8	26022.39	26293.14	321.8	377.12	0	1072.62	0	123.56	906.51	7567.73	5073.35	232.52	872.23	4513.99	8480.9	0	0	0	0	0	0	0	0	0	0	0											0 per Admit	0 190 day lifetime limit	0 [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :10	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		10	Cardiac Rehabilitation: 10; Pulmonary Rehabilitation: 10; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	Specialist: 10 Chiropractic (Medicare-covered): 20	10	Occupational Therapy: 10; PT/ Speech Therapy: 10	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 10	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	10 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	1.29	-	-	-	-	0.1	0.29	6.31	4.69	0.19	0.73	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.69	-	-	-	-	-	-	-	1.29	-	-	-	-	0.1	0.29	6.31	4.69	0.19	0.73	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.69
H5435_830_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	245.8	26022.39	26293.14	321.8	377.12	0	1072.62	0	123.56	906.51	7567.73	5073.35	232.52	872.23	4513.99	8480.9	0	0	0	0	0	0	0	0	0	0	0											0 per Admit	0 190 day lifetime limit	0 [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :10	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		10	Cardiac Rehabilitation: 10; Pulmonary Rehabilitation: 10; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	Specialist: 10 Chiropractic (Medicare-covered): 20	10	Occupational Therapy: 10; PT/ Speech Therapy: 10	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 10	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	10 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	1.29	-	-	-	-	0.1	0.29	6.31	4.69	0.19	0.73	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.69	-	-	-	-	-	-	-	1.29	-	-	-	-	0.1	0.29	6.31	4.69	0.19	0.73	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	13.69
H5435_831_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	245.8	26022.39	26293.14	321.34	377.12	0	1016.75	0	123.56	906.51	7173.57	4837.91	220.41	826.8	4195.99	8039.18	0	0	0	0	0	0	0	0	0	0	0											250 per Admit	250 per Admit 190 day lifetime limit	0 [Day(s) 1-20]; 50 [Day(s) 21-100]; Day 101 - Mbr Responsibility	Covered in Full	50	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :15	Ambulatory Surgical Center: 125; Outpatient Hospital: 125	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15		15	Cardiac Rehabilitation: 15; Pulmonary Rehabilitation: 15; Non-Surgical Cases - Outpatient: 125; Non-Surgical Cases - ASC: 125	15	Specialist: 15 Chiropractic (Medicare-covered): 20	15	Occupational Therapy: 15; PT/ Speech Therapy: 15	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15	Routine Lab: 0; Renal Dialysis: 15	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	15 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0											0	43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0												6.84	0.1	2.74	-	1.02	-	-	1.29	3.93	-	0.89	-	0.15	6.3	8.97	6.28	0.28	1.03	0.89	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85	6.84	0.1	2.74	-	1.02	-	-	1.29	3.93	-	0.89	-	0.15	6.3	8.97	6.28	0.28	1.03	0.89	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85
H5435_832_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	245.8	26022.39	26293.14	321.34	377.12	0	1016.75	0	123.56	906.51	7173.57	4837.91	220.41	826.8	4195.99	8039.18	0	0	0	0	0	0	0	0	0	0	0											250 per Admit	250 per Admit 190 day lifetime limit	0 [Day(s) 1-20]; 50 [Day(s) 21-100]; Day 101 - Mbr Responsibility	Covered in Full	50	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :15	Ambulatory Surgical Center: 125; Outpatient Hospital: 125	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15		15	Cardiac Rehabilitation: 15; Pulmonary Rehabilitation: 15; Non-Surgical Cases - Outpatient: 125; Non-Surgical Cases - ASC: 125	15	Specialist: 15 Chiropractic (Medicare-covered): 20	15	Occupational Therapy: 15; PT/ Speech Therapy: 15	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15	Routine Lab: 0; Renal Dialysis: 15	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	15 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0											0	43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0												6.84	0.1	2.74	-	1.02	-	-	1.29	3.93	-	0.89	-	0.15	6.3	8.97	6.28	0.28	1.03	0.89	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85	6.84	0.1	2.74	-	1.02	-	-	1.29	3.93	-	0.89	-	0.15	6.3	8.97	6.28	0.28	1.03	0.89	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.85
H5435_833_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	O	T	P	P	P	P	P	O	O	O											2000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	245.8	20.34	2.02	320.06	377.12	0	1009.94	0	2.04	906.51	7567.73	4448.34	201.32	755.21	3759.34	7976.64	32.05	0	0	0	0	0	0	0	0	0	0											400 per Admit	400 per Admit 190 day lifetime limit	0 [Day(s) 1-10]; 75 [Day(s) 11-100]; Day 101 - Mbr Responsibility	Covered in Full	125	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 75; Outpatient Hospital: 75	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 75; Non-Surgical Cases - ASC: 75	10	Specialist: 25 Chiropractic (Medicare-covered): 25	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 25	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	25 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	48.11	52	0	125	0.2	0.28	49.12	75	0	51.09	0	0.1	56.11	10	25	25	25	21.25	0.31	0.2	25	0	0	0	0	0	0	0	0	0											2000	52.91	38.16	48.16	0	125	0.2	0.28	44.9	63.87	0	49.18	0	0.09	53.62	10	25	25	25	21.25	0.31	0.2	25	0	0	0	0	0	0	0	0	0												8.3	0.13	5.5	-	2.56	4.07	0.57	1.2	2.01	-	4.14	-	0.19	4.05	6.31	9.27	0.42	1.57	6.66	0.21	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.55	8.3	0.13	5.5	-	2.56	4.07	0.57	1.2	2.01	-	4.14	-	0.19	4.05	6.31	9.27	0.42	1.57	6.66	0.21	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.55
H5435_834_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	O	T	P	P	P	P	P	O	O	O											2000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	245.8	20.34	2.02	320.06	377.12	0	1009.94	0	2.04	906.51	7567.73	4448.34	201.32	755.21	3759.34	7976.64	32.05	0	0	0	0	0	0	0	0	0	0											400 per Admit	400 per Admit 190 day lifetime limit	0 [Day(s) 1-10]; 75 [Day(s) 11-100]; Day 101 - Mbr Responsibility	Covered in Full	125	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 75; Outpatient Hospital: 75	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 75; Non-Surgical Cases - ASC: 75	10	Specialist: 25 Chiropractic (Medicare-covered): 25	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 25	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	25 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	48.11	52	0	125	0.2	0.28	49.12	75	0	51.09	0	0.1	56.11	10	25	25	25	21.25	0.31	0.2	25	0	0	0	0	0	0	0	0	0											2000	52.91	38.16	48.16	0	125	0.2	0.28	44.9	63.87	0	49.18	0	0.09	53.62	10	25	25	25	21.25	0.31	0.2	25	0	0	0	0	0	0	0	0	0												8.3	0.13	5.5	-	2.56	4.07	0.57	1.2	2.01	-	4.14	-	0.19	4.05	6.31	9.27	0.42	1.57	6.66	0.21	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.55	8.3	0.13	5.5	-	2.56	4.07	0.57	1.2	2.01	-	4.14	-	0.19	4.05	6.31	9.27	0.42	1.57	6.66	0.21	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.55
H5435_835_0	2006											3000											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											3000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	15.75	26022.39	1.72	14.23	44.22	0	29.25	0	2.18	23.81	65.71	126.4	1.95	2.05	26.41	13.55	32.05	2.41	0	0	0	0	0	0	0	0	0											20 Coinsurance   not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150)	20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150) 190 lifetime limit	20 Coinsurance [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	20 Coinsurance	Not Covered	Prosthetics: 20 Coinsurance; Supplies: 20 Coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 Coinsurance	Specialist: 20 Coinsurance Chiropractic (Medicare-covered): 20 Coinsurance	20 Coinsurance limit of 50 visits/yr	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 Coinsurance; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 20 Coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	75	0	0.2	0	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											3000	79.42	93.54	68.62	0	0.2	0	0.2	0.19	0.19	0	0.19	0	0.19	0.19	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0												12.47	0.31	7.83	-	3.15	-	0.34	2.66	8.26	-	5.46	-	0.41	4.45	13.14	25.28	0.39	0.41	5.28	2.71	6.41	0.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.45	12.47	0.31	7.83	-	3.15	-	0.34	2.66	8.26	-	5.46	-	0.41	4.45	13.14	25.28	0.39	0.41	5.28	2.71	6.41	0.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.45
H5435_836_0	2006											3000											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											3000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1883.65	39.76	1369.45	2039.5	15.75	26022.39	1.72	14.23	44.22	0	29.25	0	2.18	23.81	65.71	126.4	1.95	2.05	26.41	13.55	32.05	2.41	0	0	0	0	0	0	0	0	0											20 Coinsurance   not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150)	20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150) 190 lifetime limit	20 Coinsurance [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	20 Coinsurance	Not Covered	Prosthetics: 20 Coinsurance; Supplies: 20 Coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 Coinsurance	Specialist: 20 Coinsurance Chiropractic (Medicare-covered): 20 Coinsurance	20 Coinsurance limit of 50 visits/yr	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 Coinsurance; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 20 Coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	75	0	0.2	0	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											3000	79.42	93.54	68.62	0	0.2	0	0.2	0.19	0.19	0	0.19	0	0.19	0.19	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0												12.47	0.31	7.83	-	3.15	-	0.34	2.66	8.26	-	5.46	-	0.41	4.45	13.14	25.28	0.39	0.41	5.28	2.71	6.41	0.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.45	12.47	0.31	7.83	-	3.15	-	0.34	2.66	8.26	-	5.46	-	0.41	4.45	13.14	25.28	0.39	0.41	5.28	2.71	6.41	0.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	99.45
H5435_837_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	Coin	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	258.24	27339.32	27623.77	441.32	396.21	0	1312.84	0	129.82	952.38	9262.58	6288.26	4.13	1067.57	5524.93	10380.26	0	0	0	0	0	0	0	0	0	0	0											No copay [Day(s) 1-90]; 60 additional days each benefit period plus additional 425 lifetime reserve days.	No copay [Day(s) 1-90]; 190 day lifetime limit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	50 Coinsurance	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.06
H5435_838_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	Coin	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	258.24	27339.32	27623.77	441.32	396.21	0	1312.84	0	129.82	952.38	9262.58	6288.26	4.13	1067.57	5524.93	10380.26	0	0	0	0	0	0	0	0	0	0	0											No copay [Day(s) 1-90]; 60 additional days each benefit period plus additional 425 lifetime reserve days.	No copay [Day(s) 1-90]; 190 day lifetime limit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	50 Coinsurance	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.06	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.06
H5435_839_0	2006											500											D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	17.85	23.15	2.07	334.8	50.12	0	33.15	0	2.47	26.99	9262.58	6247.7	3.97	2.32	29.93	15.36	30.17	2.66	0	0	0	0	0	0	0	0	0											100 [Day(s) 1-5]; 90 days per benefit period plus additional 425 lifetime reserve days.	100 [Day(s) 1-5]; 90 days per benefit period and 190 day lifetime limit	50 [Day(s) 1-7]; 0 [Day(s) 8-100]; Day 101 - Mbr Responsibility	Covered in Full	10 Coinsurance	15 Coinsurance	Prosthetics: 15 Coinsurance; Supplies: 15 Coinsurance	ER: 50; Urgent Care :50	Ambulatory Surgical Center: 10 Coinsurance; Outpatient Hospital: 10 Coinsurance	0	Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 10 Coinsurance; Pulmonary Rehabilitation: 10 Coinsurance; Non-Surgical Cases - Outpatient: 10 Coinsurance; Non-Surgical Cases - ASC: 10 Coinsurance	0	Specialist: 0 Chiropractic (Medicare-covered): 10 Coinsurance	50 Coinsurance	Occupational Therapy: 10 Coinsurance; PT/ Speech Therapy: 10 Coinsurance	Routine Xray: 10 Coinsurance; Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance	Routine Lab: 10 Coinsurance; Renal Dialysis: 0.1	Inhalation Solutions: 15 Coinsurance; Oral Chemo: 15 Coinsurance; Anti-Emetics / Antigens: 15 Coinsurance; Self Injectibles: 15 Coinsurance; Office Based Injectibles: 15 Coinsurance; Immunosuppressives: 15 Coinsurance	10 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											59.54	99.89	25	0	0.1	0.15	0.15	50	0.1	0	0.1	0	0.1	0.1	0	0.45	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0											500	1.67	65.55	11.75	0	0.1	0.15	0.15	35.39	0.07	0	0.07	0	0.07	0.07	0	0.45	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0												0.28	0.23	1.41	-	1.79	3.47	0.31	0.99	3.75	-	2.48	-	0.18	2.02	-	0.23	1.99	0.23	2.99	1.54	4.53	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.66	0.28	0.23	1.41	-	1.79	3.47	0.31	0.99	3.75	-	2.48	-	0.18	2.02	-	0.23	1.99	0.23	2.99	1.54	4.53	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.66
H5435_840_0	2006											500											D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	17.85	23.15	2.07	334.8	50.12	0	33.15	0	2.47	26.99	9262.58	6247.7	3.97	2.32	29.93	15.36	30.17	2.66	0	0	0	0	0	0	0	0	0											100 [Day(s) 1-5]; 90 days per benefit period plus additional 425 lifetime reserve days.	100 [Day(s) 1-5]; 90 days per benefit period and 190 day lifetime limit	50 [Day(s) 1-7]; 0 [Day(s) 8-100]; Day 101 - Mbr Responsibility	Covered in Full	10 Coinsurance	15 Coinsurance	Prosthetics: 15 Coinsurance; Supplies: 15 Coinsurance	ER: 50; Urgent Care :50	Ambulatory Surgical Center: 10 Coinsurance; Outpatient Hospital: 10 Coinsurance	0	Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 10 Coinsurance; Pulmonary Rehabilitation: 10 Coinsurance; Non-Surgical Cases - Outpatient: 10 Coinsurance; Non-Surgical Cases - ASC: 10 Coinsurance	0	Specialist: 0 Chiropractic (Medicare-covered): 10 Coinsurance	50 Coinsurance	Occupational Therapy: 10 Coinsurance; PT/ Speech Therapy: 10 Coinsurance	Routine Xray: 10 Coinsurance; Therapy - Radiation: 10 Coinsurance; MRI/CT/MRA/PET/SPEC: 10 Coinsurance	Routine Lab: 10 Coinsurance; Renal Dialysis: 0.1	Inhalation Solutions: 15 Coinsurance; Oral Chemo: 15 Coinsurance; Anti-Emetics / Antigens: 15 Coinsurance; Self Injectibles: 15 Coinsurance; Office Based Injectibles: 15 Coinsurance; Immunosuppressives: 15 Coinsurance	10 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											59.54	99.89	25	0	0.1	0.15	0.15	50	0.1	0	0.1	0	0.1	0.1	0	0.45	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0											500	1.67	65.55	11.75	0	0.1	0.15	0.15	35.39	0.07	0	0.07	0	0.07	0.07	0	0.45	0.5	0.1	0.1	0.1	0.15	0.1	0	0	0	0	0	0	0	0	0												0.28	0.23	1.41	-	1.79	3.47	0.31	0.99	3.75	-	2.48	-	0.18	2.02	-	0.23	1.99	0.23	2.99	1.54	4.53	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.66	0.28	0.23	1.41	-	1.79	3.47	0.31	0.99	3.75	-	2.48	-	0.18	2.02	-	0.23	1.99	0.23	2.99	1.54	4.53	0.27	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.66
H5435_841_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	258.24	27339.32	27623.77	338.08	396.21	0	1126.9	0	129.82	952.38	7950.71	5330.1	244.29	916.37	4742.43	8910.1	0	0	0	0	0	0	0	0	0	0	0											0 per Admit	0 190 day lifetime limit	0 [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :10	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		10	Cardiac Rehabilitation: 10; Pulmonary Rehabilitation: 10; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	Specialist: 10 Chiropractic (Medicare-covered): 20	10	Occupational Therapy: 10; PT/ Speech Therapy: 10	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 10	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	10 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	1.35	-	-	-	-	0.11	0.3	6.63	4.93	0.2	0.76	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.38	-	-	-	-	-	-	-	1.35	-	-	-	-	0.11	0.3	6.63	4.93	0.2	0.76	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.38
H5435_842_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	258.24	27339.32	27623.77	338.08	396.21	0	1126.9	0	129.82	952.38	7950.71	5330.1	244.29	916.37	4742.43	8910.1	0	0	0	0	0	0	0	0	0	0	0											0 per Admit	0 190 day lifetime limit	0 [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :10	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		10	Cardiac Rehabilitation: 10; Pulmonary Rehabilitation: 10; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	10	Specialist: 10 Chiropractic (Medicare-covered): 20	10	Occupational Therapy: 10; PT/ Speech Therapy: 10	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 10	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	10 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	48.03	0	0	0	0	10	3.78	10	11.09	10	10	0	0.14	0	10	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	1.35	-	-	-	-	0.11	0.3	6.63	4.93	0.2	0.76	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.38	-	-	-	-	-	-	-	1.35	-	-	-	-	0.11	0.3	6.63	4.93	0.2	0.76	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	14.38
H5435_843_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	258.24	27339.32	27623.77	337.6	396.21	0	1068.21	0	129.82	952.38	7536.61	5082.74	231.56	868.65	4408.34	8446.03	0	0	0	0	0	0	0	0	0	0	0											250 per Admit	250 per Admit 190 day lifetime limit	0 [Day(s) 1-20]; 50 [Day(s) 21-100]; Day 101 - Mbr Responsibility	Covered in Full	50	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :15	Ambulatory Surgical Center: 125; Outpatient Hospital: 125	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15		15	Cardiac Rehabilitation: 15; Pulmonary Rehabilitation: 15; Non-Surgical Cases - Outpatient: 125; Non-Surgical Cases - ASC: 125	15	Specialist: 15 Chiropractic (Medicare-covered): 20	15	Occupational Therapy: 15; PT/ Speech Therapy: 15	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15	Routine Lab: 0; Renal Dialysis: 15	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	15 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0											0	43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0												7.18	0.1	2.88	-	1.08	-	-	1.36	4.13	-	0.93	-	0.16	6.62	9.42	6.6	0.29	1.09	0.94	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.92	7.18	0.1	2.88	-	1.08	-	-	1.36	4.13	-	0.93	-	0.16	6.62	9.42	6.6	0.29	1.09	0.94	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.92
H5435_844_0	2006											0											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											0					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	258.24	27339.32	27623.77	337.6	396.21	0	1068.21	0	129.82	952.38	7536.61	5082.74	231.56	868.65	4408.34	8446.03	0	0	0	0	0	0	0	0	0	0	0											250 per Admit	250 per Admit 190 day lifetime limit	0 [Day(s) 1-20]; 50 [Day(s) 21-100]; Day 101 - Mbr Responsibility	Covered in Full	50	0	Prosthetics: 0; Supplies: 0	ER: 50; Urgent Care :15	Ambulatory Surgical Center: 125; Outpatient Hospital: 125	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15		15	Cardiac Rehabilitation: 15; Pulmonary Rehabilitation: 15; Non-Surgical Cases - Outpatient: 125; Non-Surgical Cases - ASC: 125	15	Specialist: 15 Chiropractic (Medicare-covered): 20	15	Occupational Therapy: 15; PT/ Speech Therapy: 15	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 15	Routine Lab: 0; Renal Dialysis: 15	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	15 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0											0	43.55	30.07	24	0	50	0	0	48.32	125	0	10.46	0	15	83.44	15	15.57	15	15	2.56	0.2	0	15	0	0	0	0	0	0	0	0	0												7.18	0.1	2.88	-	1.08	-	-	1.36	4.13	-	0.93	-	0.16	6.62	9.42	6.6	0.29	1.09	0.94	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.92	7.18	0.1	2.88	-	1.08	-	-	1.36	4.13	-	0.93	-	0.16	6.62	9.42	6.6	0.29	1.09	0.94	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.92
H5435_845_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	O	T	P	P	P	P	P	O	O	O											2000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	258.24	22.54	2.24	336.26	396.21	0	1061.05	0	2.26	952.38	7950.71	4673.46	211.51	793.43	3949.22	8380.32	32.05	0	0	0	0	0	0	0	0	0	0											400 per Admit	400 per Admit 190 day lifetime limit	0 [Day(s) 1-10]; 75 [Day(s) 11-100]; Day 101 - Mbr Responsibility	Covered in Full	125	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 75; Outpatient Hospital: 75	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 75; Non-Surgical Cases - ASC: 75	10	Specialist: 25 Chiropractic (Medicare-covered): 25	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 25	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	25 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	48.11	52	0	125	0.2	0.28	49.12	75	0	53.88	0	0.1	56.11	10	25	25	25	21.43	0.31	0.2	25	0	0	0	0	0	0	0	0	0											2000	50.84	36.93	47.69	0	125	0.2	0.28	44.38	62.5	0	51.73	0	0.09	53.31	10	25	25	25	21.43	0.31	0.2	25	0	0	0	0	0	0	0	0	0												8.38	0.13	5.72	-	2.69	4.51	0.63	1.24	2.06	-	4.57	-	0.21	4.23	6.63	9.74	0.44	1.65	7.05	0.22	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.52	8.38	0.13	5.72	-	2.69	4.51	0.63	1.24	2.06	-	4.57	-	0.21	4.23	6.63	9.74	0.44	1.65	7.05	0.22	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.52
H5435_846_0	2006											2000											D	D	D	V	T	Coin	Coin	V	P	P	P	P	Coin	P	V	V	V	V	V	V	Coin	O	T	P	P	P	P	P	O	O	O											2000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	258.24	22.54	2.24	336.26	396.21	0	1061.05	0	2.26	952.38	7950.71	4673.46	211.51	793.43	3949.22	8380.32	32.05	0	0	0	0	0	0	0	0	0	0											400 per Admit	400 per Admit 190 day lifetime limit	0 [Day(s) 1-10]; 75 [Day(s) 11-100]; Day 101 - Mbr Responsibility	Covered in Full	125	20 Coinsurance	Prosthetics: 30 Coinsurance; Supplies: 20 Coinsurance	ER: 50; Urgent Care :30	Ambulatory Surgical Center: 75; Outpatient Hospital: 75	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		10 Coinsurance	Cardiac Rehabilitation: 25; Pulmonary Rehabilitation: 25; Non-Surgical Cases - Outpatient: 75; Non-Surgical Cases - ASC: 75	10	Specialist: 25 Chiropractic (Medicare-covered): 25	25	Occupational Therapy: 25; PT/ Speech Therapy: 25	Routine Xray: 25; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 0; Renal Dialysis: 25	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	25 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											69.69	48.11	52	0	125	0.2	0.28	49.12	75	0	53.88	0	0.1	56.11	10	25	25	25	21.43	0.31	0.2	25	0	0	0	0	0	0	0	0	0											2000	50.84	36.93	47.69	0	125	0.2	0.28	44.38	62.5	0	51.73	0	0.09	53.31	10	25	25	25	21.43	0.31	0.2	25	0	0	0	0	0	0	0	0	0												8.38	0.13	5.72	-	2.69	4.51	0.63	1.24	2.06	-	4.57	-	0.21	4.23	6.63	9.74	0.44	1.65	7.05	0.22	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.52	8.38	0.13	5.72	-	2.69	4.51	0.63	1.24	2.06	-	4.57	-	0.21	4.23	6.63	9.74	0.44	1.65	7.05	0.22	6.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.52
H5435_847_0	2006											3000											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											3000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	17.44	27339.32	1.91	15.76	48.97	0	32.39	0	2.41	26.37	72.77	139.99	2.16	2.27	29.25	15.01	32.05	2.65	0	0	0	0	0	0	0	0	0											20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150)	20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150) 190 lifetime limit	20 Coinsurance [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	20 Coinsurance	Not Covered	Prosthetics: 20 Coinsurance; Supplies: 20 Coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 Coinsurance	Specialist: 20 Coinsurance Chiropractic (Medicare-covered): 20 Coinsurance	20 Coinsurance limit of 50 visits/yr	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 Coinsurance; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 20 Coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	75	0	0.2	0	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											3000	74.51	90.62	67.5	0	0.2	0	0.2	0.19	0.19	0	0.19	0	0.19	0.19	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0												12.29	0.32	8.09	-	3.49	-	0.38	2.92	9.08	-	6	-	0.45	4.89	14.55	28	0.43	0.45	5.85	3	6.41	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.13	12.29	0.32	8.09	-	3.49	-	0.38	2.92	9.08	-	6	-	0.45	4.89	14.55	28	0.43	0.45	5.85	3	6.41	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.13
H5435_848_0	2006											3000											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											3000					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1978.97	41.77	1438.76	2142.71	17.44	27339.32	1.91	15.76	48.97	0	32.39	0	2.41	26.37	72.77	139.99	2.16	2.27	29.25	15.01	32.05	2.65	0	0	0	0	0	0	0	0	0											20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150)	20 Coinsurance  not to exceed 912 (Days 1-60); 228/day  (Days 61-90); 456/day  (Days 91-150) 190 lifetime limit	20 Coinsurance [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	20 Coinsurance	Not Covered	Prosthetics: 20 Coinsurance; Supplies: 20 Coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 Coinsurance	Specialist: 20 Coinsurance Chiropractic (Medicare-covered): 20 Coinsurance	20 Coinsurance limit of 50 visits/yr	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 Coinsurance; Therapy - Radiation: 20 Coinsurance; MRI/CT/MRA/PET/SPEC: 20 Coinsurance	Routine Lab: 20 Coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 Coinsurance; Oral Chemo: 20 Coinsurance; Anti-Emetics / Antigens: 20 Coinsurance; Self Injectibles: 20 Coinsurance; Office Based Injectibles: 20 Coinsurance; Immunosuppressives: 20 Coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	75	0	0.2	0	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											3000	74.51	90.62	67.5	0	0.2	0	0.2	0.19	0.19	0	0.19	0	0.19	0.19	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0												12.29	0.32	8.09	-	3.49	-	0.38	2.92	9.08	-	6	-	0.45	4.89	14.55	28	0.43	0.45	5.85	3	6.41	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.13	12.29	0.32	8.09	-	3.49	-	0.38	2.92	9.08	-	6	-	0.45	4.89	14.55	28	0.43	0.45	5.85	3	6.41	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.13
H5435_849_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.32	0.4	0.04	0.21	0.65		0.6		0.04	0.49	1.35	2.6	0.16	0.04	0.54	0.28	0.75	0.07																				8.52	1807.57	38.15	1314.15	1957.13	13.87	16.98	1.52	12.53	38.94	0	25.76	0	1.92	20.97	57.87	111.32	2.74	1.8	23.26	11.93	32.05	2.79	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	16.16	0.35	6.13	-	2.77	3.4	0.3	2.51	7.79	-	5.15	-	0.38	4.19	11.57	22.26	1.37	0.36	4.65	2.39	6.41	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.72	16.16	0.35	6.13	-	3.1	3.79	0.34	2.71	8.43	-	5.75	-	0.43	4.68	12.92	24.86	1.53	0.4	5.19	2.67	7.16	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.24
H5435_850_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.32	0.4	0.04	0.21	0.65		0.6		0.04	0.49	1.35	2.6	0.16	0.04	0.54	0.28	0.75	0.07																				8.52	1807.57	38.15	1314.15	1957.13	13.87	16.98	1.52	12.53	38.94	0	25.76	0	1.92	20.97	57.87	111.32	2.74	1.8	23.26	11.93	32.05	2.79	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	16.16	0.35	6.13	-	2.77	3.4	0.3	2.51	7.79	-	5.15	-	0.38	4.19	11.57	22.26	1.37	0.36	4.65	2.39	6.41	0.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	98.72	16.16	0.35	6.13	-	3.1	3.79	0.34	2.71	8.43	-	5.75	-	0.43	4.68	12.92	24.86	1.53	0.4	5.19	2.67	7.16	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.24
H5435_851_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.4	0.49	0.04	0.25	0.79		0.74		0.05	0.6	1.65	3.18	0.2	0.05	0.66	0.34	0.75	0.08																				10.28	1939.46	40.94	1410.03	2099.93	17	20.82	1.86	15.36	47.73	0	31.57	0	2.35	25.7	70.92	136.43	3.36	2.21	28.5	14.63	32.05	3.4	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	17.34	0.38	6.58	-	3.4	4.16	0.37	3.07	9.55	-	6.31	-	0.47	5.14	14.18	27.29	1.68	0.44	5.7	2.93	6.41	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.08	17.34	0.38	6.58	-	3.8	4.65	0.42	3.33	10.34	-	7.05	-	0.53	5.74	15.84	30.47	1.88	0.49	6.37	3.27	7.16	0.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	126.36
H5435_852_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.4	0.49	0.04	0.25	0.79		0.74		0.05	0.6	1.65	3.18	0.2	0.05	0.66	0.34	0.75	0.08																				10.28	1939.46	40.94	1410.03	2099.93	17	20.82	1.86	15.36	47.73	0	31.57	0	2.35	25.7	70.92	136.43	3.36	2.21	28.5	14.63	32.05	3.4	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	17.34	0.38	6.58	-	3.4	4.16	0.37	3.07	9.55	-	6.31	-	0.47	5.14	14.18	27.29	1.68	0.44	5.7	2.93	6.41	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.08	17.34	0.38	6.58	-	3.8	4.65	0.42	3.33	10.34	-	7.05	-	0.53	5.74	15.84	30.47	1.88	0.49	6.37	3.27	7.16	0.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	126.36
H5435_853_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.34	0.41	0.04	0.22	0.67		0.63		0.05	0.51	1.41	2.71	0.17	0.04	0.57	0.29	0.75	0.07																				8.88	1845.56	38.96	1341.76	1998.26	14.51	17.76	1.59	13.1	40.72	0	26.93	0	2.01	21.93	60.51	116.41	2.87	1.89	24.32	12.48	32.05	2.91	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	16.5	0.36	6.26	-	2.9	3.55	0.32	2.62	8.14	-	5.39	-	0.4	4.39	12.1	23.28	1.43	0.38	4.86	2.5	6.41	0.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	102.38	16.5	0.36	6.26	-	3.24	3.97	0.35	2.84	8.82	-	6.01	-	0.45	4.9	13.51	26	1.6	0.42	5.43	2.79	7.16	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.26
H5435_854_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.34	0.41	0.04	0.22	0.67		0.63		0.05	0.51	1.41	2.71	0.17	0.04	0.57	0.29	0.75	0.07																				8.88	1845.56	38.96	1341.76	1998.26	14.51	17.76	1.59	13.1	40.72	0	26.93	0	2.01	21.93	60.51	116.41	2.87	1.89	24.32	12.48	32.05	2.91	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	16.5	0.36	6.26	-	2.9	3.55	0.32	2.62	8.14	-	5.39	-	0.4	4.39	12.1	23.28	1.43	0.38	4.86	2.5	6.41	0.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	102.38	16.5	0.36	6.26	-	3.24	3.97	0.35	2.84	8.82	-	6.01	-	0.45	4.9	13.51	26	1.6	0.42	5.43	2.79	7.16	0.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.26
H5435_855_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.37	0.46	0.04	0.24	0.75		0.69		0.05	0.57	1.56	3	0.18	0.05	0.63	0.32	0.75	0.07																				9.74	1937.41	40.9	1408.54	2097.71	16.04	19.64	1.76	14.49	45.03	0	29.78	0	2.22	24.24	66.91	128.7	3.17	2.08	26.89	13.8	32.05	3.21	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	17.32	0.38	6.57	-	3.21	3.93	0.35	2.9	9.01	-	5.96	-	0.44	4.85	13.38	25.74	1.59	0.42	5.38	2.76	6.41	0.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.22	17.32	0.38	6.57	-	3.58	4.39	0.39	3.14	9.75	-	6.65	-	0.5	5.41	14.94	28.74	1.77	0.47	6.01	3.08	7.16	0.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	120.96
H5435_856_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.37	0.46	0.04	0.24	0.75		0.69		0.05	0.57	1.56	3	0.18	0.05	0.63	0.32	0.75	0.07																				9.74	1937.41	40.9	1408.54	2097.71	16.04	19.64	1.76	14.49	45.03	0	29.78	0	2.22	24.24	66.91	128.7	3.17	2.08	26.89	13.8	32.05	3.21	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	17.32	0.38	6.57	-	3.21	3.93	0.35	2.9	9.01	-	5.96	-	0.44	4.85	13.38	25.74	1.59	0.42	5.38	2.76	6.41	0.64	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.22	17.32	0.38	6.57	-	3.58	4.39	0.39	3.14	9.75	-	6.65	-	0.5	5.41	14.94	28.74	1.77	0.47	6.01	3.08	7.16	0.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	120.96
H5435_857_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.36	0.44	0.04	0.23	0.72		0.67		0.05	0.54	1.5	2.88	0.18	0.05	0.6	0.31	0.75	0.07																				9.38	1899.5	40.1	1380.98	2056.67	15.41	18.86	1.69	13.92	43.25	0	28.61	0	2.13	23.29	64.27	123.64	3.05	2	25.83	13.25	32.05	3.09	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	16.98	0.37	6.44	-	3.08	3.77	0.34	2.78	8.65	-	5.72	-	0.43	4.66	12.85	24.73	1.52	0.4	5.17	2.65	6.41	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.58	16.98	0.37	6.44	-	3.44	4.21	0.38	3.01	9.37	-	6.39	-	0.48	5.2	14.35	27.61	1.7	0.45	5.77	2.96	7.16	0.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.96
H5435_858_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.36	0.44	0.04	0.23	0.72		0.67		0.05	0.54	1.5	2.88	0.18	0.05	0.6	0.31	0.75	0.07																				9.38	1899.5	40.1	1380.98	2056.67	15.41	18.86	1.69	13.92	43.25	0	28.61	0	2.13	23.29	64.27	123.64	3.05	2	25.83	13.25	32.05	3.09	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	16.98	0.37	6.44	-	3.08	3.77	0.34	2.78	8.65	-	5.72	-	0.43	4.66	12.85	24.73	1.52	0.4	5.17	2.65	6.41	0.62	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	107.58	16.98	0.37	6.44	-	3.44	4.21	0.38	3.01	9.37	-	6.39	-	0.48	5.2	14.35	27.61	1.7	0.45	5.77	2.96	7.16	0.69	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.96
H5435_859_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.31	0.38	0.03	0.2	0.62		0.57		0.04	0.47	1.29	2.48	0.15	0.04	0.52	0.27	0.75	0.06																				8.18	1600.67	33.79	1163.72	1733.11	13.25	16.23	1.45	11.97	37.2	0	24.6	0	1.83	20.03	55.28	106.34	2.62	1.72	22.22	11.4	32.05	2.67	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.31	0.31	5.43	-	2.65	3.25	0.29	2.39	7.44	-	4.92	-	0.37	4.01	11.06	21.27	1.31	0.34	4.44	2.28	6.41	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.01	14.31	0.31	5.43	-	2.96	3.62	0.32	2.59	8.06	-	5.49	-	0.41	4.47	12.35	23.75	1.46	0.38	4.96	2.55	7.16	0.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.19
H5435_860_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.31	0.38	0.03	0.2	0.62		0.57		0.04	0.47	1.29	2.48	0.15	0.04	0.52	0.27	0.75	0.06																				8.18	1600.67	33.79	1163.72	1733.11	13.25	16.23	1.45	11.97	37.2	0	24.6	0	1.83	20.03	55.28	106.34	2.62	1.72	22.22	11.4	32.05	2.67	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	14.31	0.31	5.43	-	2.65	3.25	0.29	2.39	7.44	-	4.92	-	0.37	4.01	11.06	21.27	1.31	0.34	4.44	2.28	6.41	0.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	93.01	14.31	0.31	5.43	-	2.96	3.62	0.32	2.59	8.06	-	5.49	-	0.41	4.47	12.35	23.75	1.46	0.38	4.96	2.55	7.16	0.6	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	101.19
H5435_861_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.4	0.49	0.04	0.25	0.79		0.74		0.05	0.6	1.65	3.18	0.2	0.05	0.66	0.34	0.75	0.08																				10.28	1995.41	42.12	1450.71	2160.51	17	20.82	1.86	15.36	47.74	0	31.57	0	2.35	25.7	70.93	136.45	3.36	2.21	28.51	14.63	32.05	3.4	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	17.84	0.39	6.77	-	3.4	4.16	0.37	3.07	9.55	-	6.31	-	0.47	5.14	14.19	27.29	1.68	0.44	5.7	2.93	6.41	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.79	17.84	0.39	6.77	-	3.8	4.65	0.42	3.33	10.34	-	7.05	-	0.53	5.74	15.84	30.47	1.88	0.49	6.37	3.27	7.16	0.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	127.07
H5435_862_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.4	0.49	0.04	0.25	0.79		0.74		0.05	0.6	1.65	3.18	0.2	0.05	0.66	0.34	0.75	0.08																				10.28	1995.41	42.12	1450.71	2160.51	17	20.82	1.86	15.36	47.74	0	31.57	0	2.35	25.7	70.93	136.45	3.36	2.21	28.51	14.63	32.05	3.4	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	17.84	0.39	6.77	-	3.4	4.16	0.37	3.07	9.55	-	6.31	-	0.47	5.14	14.19	27.29	1.68	0.44	5.7	2.93	6.41	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	116.79	17.84	0.39	6.77	-	3.8	4.65	0.42	3.33	10.34	-	7.05	-	0.53	5.74	15.84	30.47	1.88	0.49	6.37	3.27	7.16	0.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	127.07
H5435_863_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.31	0.39	0.03	0.2	0.63		0.58		0.04	0.48	1.31	2.53	0.16	0.04	0.53	0.27	0.75	0.06																				8.32	1785.4	37.69	1298.03	1933.13	13.5	16.53	1.48	12.2	37.9	0	25.07	0	1.87	20.41	56.32	108.34	2.67	1.75	22.64	11.62	32.05	2.72	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	15.96	0.35	6.06	-	2.7	3.31	0.3	2.44	7.58	-	5.01	-	0.37	4.08	11.26	21.67	1.33	0.35	4.53	2.32	6.41	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.58	15.96	0.35	6.06	-	3.01	3.69	0.33	2.64	8.21	-	5.6	-	0.42	4.56	12.58	24.2	1.49	0.39	5.06	2.59	7.16	0.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	104.9
H5435_864_0	2006											0											BP	BP	D	V	Coin	Coin	Coin	Coin	Coin	P	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											0					0.31	0.39	0.03	0.2	0.63		0.58		0.04	0.48	1.31	2.53	0.16	0.04	0.53	0.27	0.75	0.06																				8.32	1785.4	37.69	1298.03	1933.13	13.5	16.53	1.48	12.2	37.9	0	25.07	0	1.87	20.41	56.32	108.34	2.67	1.75	22.64	11.62	32.05	2.72	0	0	0	0	0	0	0	0	0											912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	912 deductible (Days 1-60); 228 (Days 61-90); 456 (Days 91-150)	0 days 1-20; 114 days 21-100	Covered in Full	20 Coinsurance	20 coinsurance	Prosthetics: 20 coinsurance; Supplies: 20 coinsurance	ER: 20 Coinsurance; Urgent Care :20 Coinsurance	Ambulatory Surgical Center: 20 Coinsurance; Outpatient Hospital: 20 Coinsurance	0	Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance		20 Coinsurance	Cardiac Rehabilitation: 20 Coinsurance; Pulmonary Rehabilitation: 20 Coinsurance; Non-Surgical Cases - Outpatient: 20 Coinsurance; Non-Surgical Cases - ASC: 20 Coinsurance	20 coinsurance	Specialist: 20 coinsurance Chiropractic (Medicare-covered): 20 coinsurance	50 Coinsurance	Occupational Therapy: 20 Coinsurance; PT/ Speech Therapy: 20 Coinsurance	Routine Xray: 20 coinsurance; Therapy - Radiation: 20 coinsurance; MRI/CT/MRA/PET/SPEC: 20 coinsurance	Routine Lab: 0-20 coinsurance; Renal Dialysis: 0.2	Inhalation Solutions: 20 coinsurance; Oral Chemo: 20 coinsurance; Anti-Emetics / Antigens: 20 coinsurance; Self Injectibles: 20 coinsurance; Office Based Injectibles: 20 coinsurance; Immunosuppressives: 20 coinsurance	20 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											0	107.29	110.07	56	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0	0.2	0.2	0.2	0.2	0.5	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											110	15.96	0.35	6.06	-	2.7	3.31	0.3	2.44	7.58	-	5.01	-	0.37	4.08	11.26	21.67	1.33	0.35	4.53	2.32	6.41	0.54	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	96.58	15.96	0.35	6.06	-	3.01	3.69	0.33	2.64	8.21	-	5.6	-	0.42	4.56	12.58	24.2	1.49	0.39	5.06	2.59	7.16	0.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	104.9
H5435_865_0	2006											750											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											750					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1785.4	37.69	1298.03	1933.13	13.67	16.74	1.5	12.35	38.38	0	25.39	0	1.89	20.67	57.04	109.72	1.78	1.78	22.92	11.76	26.99	2.18	0	0	0	0	0	0	0	0	0											228 per Admit425 additional lifetime days	228 per Admit	0 [Day(s) 1-20]; 30 [Day(s) 21-100]. Day 101 - Mbr Responsibility	Covered in Full	5 Coinsurance	5 Coinsurance	Prosthetics: 5 Coinsurance; Supplies: 5 Coinsurance	ER: 5 Coinsurance; Urgent Care :5 Coinsurance	Ambulatory Surgical Center: 5 Coinsurance; Outpatient Hospital: 5 Coinsurance	0	Therapy - Radiation: 5 Coinsurance; MRI/CT/MRA/PET/SPEC: 5 Coinsurance		5 Coinsurance	Cardiac Rehabilitation: 5 Coinsurance; Pulmonary Rehabilitation: 5 Coinsurance; Non-Surgical Cases - Outpatient: 5 Coinsurance; Non-Surgical Cases - ASC: 5 Coinsurance	5 Coinsurance	Specialist: 5 Coinsurance Chiropractic (Medicare-covered): 5 Coinsurance	10 Coinsurance	Occupational Therapy: 5 Coinsurance; PT/ Speech Therapy: 5 Coinsurance	Routine Xray: 5 Coinsurance; Therapy - Radiation: 5 Coinsurance; MRI/CT/MRA/PET/SPEC: 5 Coinsurance	Routine Lab: 0 - 5 Coinsurance; Renal Dialysis: 0.05	Inhalation Solutions: 5 Coinsurance; Oral Chemo: 5 Coinsurance; Anti-Emetics / Antigens: 5 Coinsurance; Self Injectibles: 5 Coinsurance; Office Based Injectibles: 5 Coinsurance; Immunosuppressives: 5 Coinsurance	5 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											39.72	27.42	15	0	0.05	0.05	0.05	0.05	0.05	0	0.05	0	0.05	0.05	0.05	0.05	0.1	0.05	0.05	0.05	0.05	0.05	0	0	0	0	0	0	0	0	0											750	29.66	21.45	12.7	0	0.05	0.05	0.05	0.04	0.04	0	0.04	0	0.04	0.04	0.05	0.05	0.1	0.05	0.05	0.05	0.05	0.05	0	0	0	0	0	0	0	0	0											300	4.41	0.07	1.37	-	0.68	0.84	0.07	0.55	1.72	-	1.14	-	0.08	0.93	2.85	5.49	0.18	0.09	1.15	0.59	1.35	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.67	4.41	0.07	1.37	-	0.68	0.84	0.07	0.55	1.72	-	1.14	-	0.08	0.93	2.85	5.49	0.18	0.09	1.15	0.59	1.35	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.67
H5435_866_0	2006											750											D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	O	O	O											750					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1785.4	37.69	1298.03	1933.13	13.67	16.74	1.5	12.35	38.38	0	25.39	0	1.89	20.67	57.04	109.72	1.78	1.78	22.92	11.76	26.99	2.18	0	0	0	0	0	0	0	0	0											228 per Admit425 additional lifetime days	228 per Admit	0 [Day(s) 1-20]; 30 [Day(s) 21-100]. Day 101 - Mbr Responsibility	Covered in Full	5 Coinsurance	5 Coinsurance	Prosthetics: 5 Coinsurance; Supplies: 5 Coinsurance	ER: 5 Coinsurance; Urgent Care :5 Coinsurance	Ambulatory Surgical Center: 5 Coinsurance; Outpatient Hospital: 5 Coinsurance	0	Therapy - Radiation: 5 Coinsurance; MRI/CT/MRA/PET/SPEC: 5 Coinsurance		5 Coinsurance	Cardiac Rehabilitation: 5 Coinsurance; Pulmonary Rehabilitation: 5 Coinsurance; Non-Surgical Cases - Outpatient: 5 Coinsurance; Non-Surgical Cases - ASC: 5 Coinsurance	5 Coinsurance	Specialist: 5 Coinsurance Chiropractic (Medicare-covered): 5 Coinsurance	10 Coinsurance	Occupational Therapy: 5 Coinsurance; PT/ Speech Therapy: 5 Coinsurance	Routine Xray: 5 Coinsurance; Therapy - Radiation: 5 Coinsurance; MRI/CT/MRA/PET/SPEC: 5 Coinsurance	Routine Lab: 0 - 5 Coinsurance; Renal Dialysis: 0.05	Inhalation Solutions: 5 Coinsurance; Oral Chemo: 5 Coinsurance; Anti-Emetics / Antigens: 5 Coinsurance; Self Injectibles: 5 Coinsurance; Office Based Injectibles: 5 Coinsurance; Immunosuppressives: 5 Coinsurance	5 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											39.72	27.42	15	0	0.05	0.05	0.05	0.05	0.05	0	0.05	0	0.05	0.05	0.05	0.05	0.1	0.05	0.05	0.05	0.05	0.05	0	0	0	0	0	0	0	0	0											750	29.66	21.45	12.7	0	0.05	0.05	0.05	0.04	0.04	0	0.04	0	0.04	0.04	0.05	0.05	0.1	0.05	0.05	0.05	0.05	0.05	0	0	0	0	0	0	0	0	0											300	4.41	0.07	1.37	-	0.68	0.84	0.07	0.55	1.72	-	1.14	-	0.08	0.93	2.85	5.49	0.18	0.09	1.15	0.59	1.35	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.67	4.41	0.07	1.37	-	0.68	0.84	0.07	0.55	1.72	-	1.14	-	0.08	0.93	2.85	5.49	0.18	0.09	1.15	0.59	1.35	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.67
H5435_867_0	2006											500											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1785.4	37.69	1298.03	1933.13	232.98	24665.19	24921.81	398.16	357.46	0	1184.42	0	117.12	859.23	8356.58	5673.19	256.76	963.15	4984.53	9364.94	0	0	0	0	0	0	0	0	0	0	0											0 per Admit425 additional lifetime days	0 per Admit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	0	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											150	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5435_868_0	2006											500											D	D	D	V	T	O	O	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O	T	P	P	P	P	P	O	O	O											500					0	0	0	0	0		0		0	0	0	0	0	0	0	0	0	0																				-	1785.4	37.69	1298.03	1933.13	232.98	24665.19	24921.81	398.16	357.46	0	1184.42	0	117.12	859.23	8356.58	5673.19	256.76	963.15	4984.53	9364.94	0	0	0	0	0	0	0	0	0	0	0											0 per Admit425 additional lifetime days	0 per Admit	No copay [Day(s) 1-100]; Day 101 - Mbr Responsibility	Covered in Full	0	0	Prosthetics: 0; Supplies: 0	ER: 0; Urgent Care :0	Ambulatory Surgical Center: 0; Outpatient Hospital: 0	0	Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0		0	Cardiac Rehabilitation: 0; Pulmonary Rehabilitation: 0; Non-Surgical Cases - Outpatient: 0; Non-Surgical Cases - ASC: 0	0	Specialist: 0 Chiropractic (Medicare-covered): 0	0	Occupational Therapy: 0; PT/ Speech Therapy: 0	Routine Xray: 0; Therapy - Radiation: 0; MRI/CT/MRA/PET/SPEC: 0	Routine Lab: 0; Renal Dialysis: 0	Inhalation Solutions: 0; Oral Chemo: 0; Anti-Emetics / Antigens: 0; Self Injectibles: 0; Office Based Injectibles: 0; Immunosuppressives: 0	0 coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered		Acupuncture: Not Covered; Chiropractic : Not Covered											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											150	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5436_001_0	2006																						D	D	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	V	P	P	P	S	O	T	P	P	P	P	P	O	V	Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1193.84	4.2	470.94	1810.67	199.66	0.1	0.02	196.92	38.87	123.22	970.04	87.15	345.61	964.7	5645.81	10961.38	2.56	86.29	3117.45	0	478.84	0	0	0	1.31	0	25.84	0	0	5.11	0											100/Day for Days 1-10	100/Day for Days 1-10	110 for Days 7-100	No Cost Sharing	100/Trip	10/Device	10/Device	50 per ER Visit; 25 per Urgent Care Visit	10/Episode	No Cost Sharing	25 Copayment	No Cost Sharing	No Cost Sharing	25 Copayment for Diagnostic Testing; 10 Copayment for OP Rehab	10/Visit Copayment	20/Visit Copayment	20/Visit Copayment	20/Visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	20/Visit Copayment	20/Visit Copayment	10/Visit Copayment; 40 frame allowance	20/Visit Copayment	No Cost Sharing	Not Applicable	No Cost Sharing	No Cost Sharing											88.77	100	93.49	0	100	0.1	0.1	48.68	0.1	0	25	0	0	0.27	6.99	6.4	20	20	0	0	0	0	0	20	20	10	20	0	0	0	0.3												88.77	100	93.49	0	100	0.1	0.1	48.68	0.1	0	25	0	0	0.27	6.99	6.4	20	20	0	0	0	0	0	20	20	10	20	0	0	0	0.3												8.83	0.03	3.67	-	1.66	0.01	0	0.8	3.89	-	2.02	-	-	0.02	3.29	5.85	0	0.14	-	-	-	-	-	-	0	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.27	8.83	0.03	3.67	-	1.66	0.01	0	0.8	3.89	-	2.02	-	-	0.02	3.29	5.85	0	0.14	-	-	-	-	-	-	0	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.27
H5436_002_0	2006																						D	D	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	V	P	P	P	S	O	T	P	P	P	P	P	O	V	Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1193.84	4.2	470.94	1810.67	199.66	0.1	0.02	196.92	38.87	123.22	970.04	87.15	345.61	964.7	5645.81	10961.38	2.56	86.29	3117.45	0	478.84	0	0	0	1.31	0	25.84	0	0	5.11	0											100/Day for Days 1-10	100/Day for Days 1-10	110 for Days 7-100	No Cost Sharing	100/Trip	10/Device	10/Device	50 per ER Visit; 25 per Urgent Care Visit	10/Episode	No Cost Sharing	25 Copayment	No Cost Sharing	No Cost Sharing	25 Copayment for Diagnostic Testing; 10 Copayment for OP Rehab	10/Visit Copayment	20/Visit Copayment	20/Visit Copayment	20/Visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	20/Visit Copayment	20/Visit Copayment	10/Visit Copayment; 40 frame allowance	20/Visit Copayment	No Cost Sharing	Not Applicable	No Cost Sharing	No Cost Sharing											88.77	100	93.49	0	100	0.1	0.1	48.68	0.1	0	25	0	0	0.27	6.99	6.4	20	20	0	0	0	0	0	20	20	10	20	0	0	0	0.3												88.77	100	93.49	0	100	0.1	0.1	48.68	0.1	0	25	0	0	0.27	6.99	6.4	20	20	0	0	0	0	0	20	20	10	20	0	0	0	0.3												8.83	0.03	3.67	-	1.66	0.01	0	0.8	3.89	-	2.02	-	-	0.02	3.29	5.85	0	0.14	-	-	-	-	-	-	0	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.27	8.83	0.03	3.67	-	1.66	0.01	0	0.8	3.89	-	2.02	-	-	0.02	3.29	5.85	0	0.14	-	-	-	-	-	-	0	-	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.27
H5437_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S	V								P												5000																																										-	1364.72	13.79	1156.09	751.87	154.82	15.59	1.16	136.41	28.55	250.49	198.41	0.3	207.24	16.66	2986.93	6487.27	3.03	767.8	407.67		226.18	667.54																				200/d 7	200/d 7	0/d 1-8 75/d 9-15 125/d 16-100																																							143.69	143.69	77.39	0	100	0.2	0.2	48	200	35	40.13	35	35	35	25	35	35	35	35		45	35			0		0			0													143.69	143.69	77.39	0	100	0.2	0.2	48	200	35	40.13	35	35	35	25	35	35	35	35		45	35			0		0			0													16.34	0.17	7.46	-	1.29	3.12	0.23	0.55	0.48	0.73	0.66	0	0.6	0.05	6.22	18.92	0.01	2.24	1.19	-	0.85	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.05	16.34	0.17	7.46	-	1.29	3.12	0.23	0.55	0.48	0.73	0.66	0	0.6	0.05	6.22	18.92	0.01	2.24	1.19	-	0.85	1.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.05
H5437_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1489.44	15.04	1145.79	1118.7	201.25	1.86	0.02	210.1	42.62	785.63	241.54		57.98	36.65	2318.48	8795.26	0.35	598.37	533.95		256.91	637.29																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													17.83	0.18	9.55	3.26	2.52	0.56	0.01	0.88	0.53	0.53	1.98	-	0.17	0.11	6.76	25.65	0	1.75	1.56	-	1.45	1.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.12	17.83	0.18	9.55	3.26	2.52	0.56	0.01	0.88	0.53	0.53	1.98	-	0.17	0.11	6.76	25.65	0	1.75	1.56	-	1.45	1.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.12
H5437_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1489.18	15.04	1145.59	1118.51	201.22	1.86	0.02	210.06	42.61	785.49	241.49		57.97	36.64	2318.08	8793.75	0.35	598.27	533.86		256.87	637.18																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													17.83	0.18	9.55	3.26	2.52	0.56	0.01	0.88	0.53	0.53	1.98	-	0.17	0.11	6.76	25.65	0	1.74	1.56	-	1.44	1.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.11	17.83	0.18	9.55	3.26	2.52	0.56	0.01	0.88	0.53	0.53	1.98	-	0.17	0.11	6.76	25.65	0	1.74	1.56	-	1.44	1.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.11
H5437_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1489.18	15.04	1145.59	1118.51	201.22	1.86	0.02	210.06	42.61	785.49	241.49		57.97	36.64	2318.08	8793.75	0.35	598.27	533.86		256.87	637.18																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 Coinsurance	20 Coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													143.69	143.69	100	35	150	0.3	0.3	50	150	8.1	98.3		35	35	35	35	35	35	35		67.5	35								0													17.83	0.18	9.55	3.26	2.52	0.56	0.01	0.88	0.53	0.53	1.98	-	0.17	0.11	6.76	25.65	0	1.74	1.56	-	1.44	1.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.11	17.83	0.18	9.55	3.26	2.52	0.56	0.01	0.88	0.53	0.53	1.98	-	0.17	0.11	6.76	25.65	0	1.74	1.56	-	1.44	1.86	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.11
H5439_001_0	2006											1000											A	A	D	V	T	P	P	V	V	P	P	O	coin	P	V	V	V	V	P	V	S	O	T	P	V	P	V	P	O	O	V											2000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	245.56	2.25	880.7	0	205.23	21668.8	18342.54	236.66	229.79	0	743.23	0	0.18	460.83	4574.1	5645.86	189.42	265.68	0	262.25	436.83	701.32	0	1744.2	357	0	0	0	0	0	598.4											50 per admit	50 per admit	50 per admit		25	10	10	50 ER / 25 UC	50 ASC / 50 OP		10		10	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing	10	10 Vision		35 ded 0 coin	10 routine exam						15 Acu/Chiro / 25 Massage											50	50	3.45	0	25	0.58	0.66	41.57	50	0	2.95	0	0.07	25	9.98	13.48	25	24.08	0	9.46	9	9.93	0	28.54	10	0	0	0	0	0	15											3000	39.24	39.24	2.71	0	19.62	0.45	0.51	32.63	39.24	0	2.32	0	0.05	19.62	7.83	10.58	19.62	18.9	0	7.42	7.06	7.79	0	28.54	10	0	0	0	0	0	15											0	0.8	0.01	0.2	-	0.34	0.82	0.79	0.64	0.75	-	0.14	-	0.01	0.75	2.99	4.98	0.31	0.42	-	0.16	0.26	0.46	-	4.15	0.3	-	-	-	-	-	0.75	-	-	-	-	-	-	-	-	-	-	20.01	0.8	0.01	0.2	-	0.34	0.82	0.79	0.64	0.75	-	0.14	-	0.01	0.75	2.99	4.98	0.31	0.42	-	0.16	0.26	0.46	-	4.15	0.3	-	-	-	-	-	0.75	-	-	-	-	-	-	-	-	-	-	20.01
H5440_001_0	2006											1000											D	D	D		P	Coin	Coin	P					Coin	P							Coin																																																															-	2279.1	523.38	889.06		321.49	32.23	28.38	896.93					3.15								12.78																					25 1-72 days	25 1-72 days	15/day 1-100		100	20	20	40					20	15							20																					25	25	15		100	0.2	0.2	40					0.2								0.2																						20.71	20.71	12.43		82.85	0.2	0.2	33.14					0.17								0.2																						3.93	0.9	0.92	-	2.22	6.45	5.68	2.48	-	-	-	-	0.52	-	-	-	-	-	-	-	2.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.66	3.93	0.9	0.92	-	2.22	6.45	5.68	2.48	-	-	-	-	0.52	-	-	-	-	-	-	-	2.56	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.66
H5500_001_0	2006											2500											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin	P	O											7500																																										-	1616.66	121.13	403.37	0	99.04	11.35	7.6	309.55	56.48	9244.63	53.73	0	0.03	0.46	4107.46	3840.84	539.01	3.05	0	0	37.18	677.4	0	0	201.89	0	203.22	0	0	0	0											225	175	100	0	150	30	30	50	20	10	20-Oct	20 (included in g.)	30	20/40/30	10.00/0.00	20	40/30	20	0		30	20.00/0.00			20		20															225	175	100	0	150	0.3	0.3	50	0.2	4	0.13	0	0.3	0.2	10	20	37.5	0.2	0		0.3	20	0		20		20																119.43	92.89	53.08	0	79.62	0.16	0.18	26.54	0.11	2.12	0.07	0	0.16	0.09	10	20	37.5	0.11	0	0	0.16	20	0	0	20	0	20	0	0	0	0												16.09	0.94	1.78	-	0.66	1.81	1.37	0.68	6	1.64	3.82	-	0.01	0.04	3.42	6.4	1.68	0.32	-	-	5.92	1.13	-	-	0.34	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.39	16.09	0.94	1.78	-	0.66	1.81	1.37	0.68	6	1.64	3.82	-	0.01	0.04	3.42	6.4	1.68	0.32	-	-	5.92	1.13	-	-	0.34	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.39
H5501_001_0	2006																						D		Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin			Coin	Coin																																																					-	1454.68	0	19.68	13.52	8.27	7.44	12.96	300.56	26.88	1.52	21.82	0	0.33	21.37	32.27	114.16	2.02	0.88	25.64	32.42	4.6	0.67	0	16	6.01	0.48	0	0	0	1.84	2.94																																																																																														0	0	0	0	0	0	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	1.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.25	-	-	-	-	-	-	-	1.25	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.25
H5506_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional							1200	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							D	D	D	Coin	T	Coin	Coin	V	V	P	P	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	P	V	V	V	P	V	P	P	P	P	P	P	P	P																																																	-	1949.97	11.44	622.04	0	241.43	7.9	28.29	241.23	287.07	0	873.23	3.87	1.5	15.59	3257.74	4565.68	127.39	3.44	742.04	0	9.98	0	0	0	124.7	124.1	1.39	0	0	0	0	1929.25	318.91	11.78	42.84							100/day days 1-5	100/day days 1-5	0/day days 1-5 125/day days 6+		100	0	0	50/visit	200	5	15 flat/20 other	0.2	0.2	0	10	20	VARIES	0	15 flat/20 other		0.2				20	15	20					5	15	5	15							57.96	100.34	88.88	0	100	0.2	0.2	50	200	0	72.82	0.2	0.2	0.2	9.95	19.57	42.33	0.2	32.2	0	0.2	0	0	0	20	15	18.83	0	0	0	0	5	15	5	15								17.84	100.34	27.36	0	100	0.2	0.2	50	61.56	0	72.82	0.2	0.2	0.2	9.95	19.57	42.33	0.2	32.2	0	0.2	0	0	0	20	15	18.83	0	0	0	0	5	15	5	15								2.9	0.1	1.42	-	2.01	1.58	5.66	1.01	1.47	-	5.3	0.77	0.3	3.12	2.7	7.44	0.45	0.69	1.99	-	2	-	-	-	0.21	0.16	0	-	-	-	-	0.8	0.4	0	0.05	-	-	-	-	-	-	42.53	2.9	0.1	1.42	-	2.01	1.58	5.66	1.01	1.47	-	5.3	0.77	0.3	3.12	2.7	7.44	0.45	0.69	1.99	-	2	-	-	-	0.21	0.16	0	-	-	-	-	0.8	0.4	0	0.05	-	-	-	-	-	-	42.53
H5506_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	1406.55	41.72	471.77	0	5.53	9.26	29.1	187.33	29.05	0.67	37.59	3.42	0.35	14.84	27.89	77.33	3.14	5.53	42.16	0.77	17.8	0	0	0	0	0	0	0	0	0	0	2.12	1.59	2.59	0.18							300/day days 1-5	300/day days 1-5	125 days 6+																																							173.88	173.88	88.88	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2	0.2								173.88	173.88	88.88	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2	0.2								20.38	0.6	3.49	-	1.11	1.85	5.82	0.78	5.81	0.13	7.52	0.68	0.07	2.97	5.58	15.47	0.63	1.11	8.43	0.15	3.56	-	-	-	-	-	-	-	-	-	-	0.42	0.32	0.52	0.04	-	-	-	-	-	-	87.44	20.38	0.6	3.49	-	1.11	1.85	5.82	0.78	5.81	0.13	7.52	0.68	0.07	2.97	5.58	15.47	0.63	1.11	8.43	0.15	3.56	-	-	-	-	-	-	-	-	-	-	0.42	0.32	0.52	0.04	-	-	-	-	-	-	87.44
H5506_802_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	1406.55	41.72	471.77	0	5.53	9.26	29.1	187.33	29.05	0.67	37.59	3.42	0.35	14.84	27.89	77.33	3.14	5.53	42.16	0.77	17.8	0	0	0	0	0	0	0	0	0	0	2.12	1.59	2.59	0.18							300/day days 1-5	300/day days 1-5	125 days 6+																																							173.88	173.88	88.88	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2	0.2								173.88	173.88	88.88	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2	0.2								20.38	0.6	3.49	-	1.11	1.85	5.82	0.78	5.81	0.13	7.52	0.68	0.07	2.97	5.58	15.47	0.63	1.11	8.43	0.15	3.56	-	-	-	-	-	-	-	-	-	-	0.42	0.32	0.52	0.04	-	-	-	-	-	-	87.44	20.38	0.6	3.49	-	1.11	1.85	5.82	0.78	5.81	0.13	7.52	0.68	0.07	2.97	5.58	15.47	0.63	1.11	8.43	0.15	3.56	-	-	-	-	-	-	-	-	-	-	0.42	0.32	0.52	0.04	-	-	-	-	-	-	87.44
H5506_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	1406.55	41.72	471.77	0	5.53	9.26	29.1	187.33	29.05	0.67	37.59	3.42	0.35	14.84	27.89	77.33	3.14	5.53	42.16	0.77	17.8	0	0	0	0	0	0	0	0	0	0	2.12	1.59	2.59	0.18							300/day days 1-5	300/day days 1-5	125 days 6+																																							173.88	173.88	88.88	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2	0.2								173.88	173.88	88.88	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2	0.2								20.38	0.6	3.49	-	1.11	1.85	5.82	0.78	5.81	0.13	7.52	0.68	0.07	2.97	5.58	15.47	0.63	1.11	8.43	0.15	3.56	-	-	-	-	-	-	-	-	-	-	0.42	0.32	0.52	0.04	-	-	-	-	-	-	87.44	20.38	0.6	3.49	-	1.11	1.85	5.82	0.78	5.81	0.13	7.52	0.68	0.07	2.97	5.58	15.47	0.63	1.11	8.43	0.15	3.56	-	-	-	-	-	-	-	-	-	-	0.42	0.32	0.52	0.04	-	-	-	-	-	-	87.44
H5506_804_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																	-	1406.55	41.72	471.77	0	5.53	9.26	29.1	187.33	29.05	0.67	37.59	3.42	0.35	14.84	27.89	77.33	3.14	5.53	42.16	0.77	17.8	0	0	0	0	0	0	0	0	0	0	2.12	1.59	2.59	0.18							300/day days 1-5	300/day days 1-5	125 days 6+																																							173.88	173.88	88.88	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2	0.2								173.88	173.88	88.88	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2	0.2								20.38	0.6	3.49	-	1.11	1.85	5.82	0.78	5.81	0.13	7.52	0.68	0.07	2.97	5.58	15.47	0.63	1.11	8.43	0.15	3.56	-	-	-	-	-	-	-	-	-	-	0.42	0.32	0.52	0.04	-	-	-	-	-	-	87.44	20.38	0.6	3.49	-	1.11	1.85	5.82	0.78	5.81	0.13	7.52	0.68	0.07	2.97	5.58	15.47	0.63	1.11	8.43	0.15	3.56	-	-	-	-	-	-	-	-	-	-	0.42	0.32	0.52	0.04	-	-	-	-	-	-	87.44
H5507_001_0	2006											4200											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2309.54	149.2	676.52	0	123.22	11.96	6.57	302.88	69.93	9831.32	51.47	0	0.52	1.5	4395.03	3937.61	613.62	2.31	0	0	26.9	263.32	0	0	33.58	0	219.87	0	0	0	0											250	175	75	0	100	20	20	50	20	10	20-Oct	20 (included in g.)	20	20 / 40 / 30	15 / 0	30	40 / 30	20	0	0	20	0 / 30			30		30															250	175	75.01		33.33	20	20	50	20	4	15		20	18	15	30	37.5	20			20	30			30		30																158.44	110.91	47.54	0	21.13	12.7	14.7	31.69	13	2.54	10	0	13	12	15	30	37.5	13	0	0	13	30	0	0	30	0	17.72	0	0	0	0												30.49	1.38	2.68	-	0.22	1.52	0.96	0.8	8.86	2.08	4.89	-	0.07	0.18	5.49	9.84	1.92	0.29	-	-	3.41	0.66	-	-	0.08	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.15	30.49	1.38	2.68	-	0.22	1.52	0.96	0.8	8.86	2.08	4.89	-	0.07	0.18	5.49	9.84	1.92	0.29	-	-	3.41	0.66	-	-	0.08	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.15
H5508_001_0	2006																						D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	S																																																															-	1090.83	62.38			60.96			245.23	305.52			47.16		464.03	2808.34	3208.81	216.31	134.9		478.27	541.26																					100/Admit	100/Admit			25			25	50			50		50	10	10	10	10		10	5																					19.76	12.95	0	0	25	0	0	25	50	0	0	50	0	50	10	10	10	10	0	10	5																						19.76	12.95	0	0	25	0	0	25	50	0	0	50	0	50	10	10	10	10	0	10	5																						1.8	0.07	-	-	0.13	-	-	0.51	1.27	-	-	0.2	-	1.93	2.34	2.67	0.18	0.11	-	0.4	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.84	1.8	0.07	-	-	0.13	-	-	0.51	1.27	-	-	0.2	-	1.93	2.34	2.67	0.18	0.11	-	0.4	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.84
H5508_002_0	2006																						D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	S																																																															-	1090.83	62.38			60.96			245.23	305.52			47.16		464.03	2808.34	3208.81	216.31	134.9		478.27	541.26																					100/Admit	100/Admit			25			25	50			50		50	10	10	10	10		10	5																					19.76	12.95	0	0	25	0	0	25	50	0	0	50	0	50	10	10	10	10	0	10	5																						19.76	12.95	0	0	25	0	0	25	50	0	0	50	0	50	10	10	10	10	0	10	5																						1.8	0.07	-	-	0.13	-	-	0.51	1.27	-	-	0.2	-	1.93	2.34	2.67	0.18	0.11	-	0.4	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.84	1.8	0.07	-	-	0.13	-	-	0.51	1.27	-	-	0.2	-	1.93	2.34	2.67	0.18	0.11	-	0.4	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	11.84
H5509_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other						2000	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	T	Coin	Coin	V	V	P	P	Coin	Coin	V	V	V	V	V	P	P	Coin	P	V	V	V	P	V	P	P	P	V	P	P	P	P	V																																																-	1489.76	47.71	606.82	0	162.09	11.67	0.94	409.91	526.86	0	303.06	0	0	130.45	3873.87	3289.6	187.06	669.39	0	0.17	8.35	0	0	0	47.98	0	0.47	0	0	0	133.9	0	0.46	0	0	0						220/day days 1-5	100/day	50/day days 8+		100	0.2	0.2	50/visit	150		Varies			Varies	15	30	Varies	15/30		15	0.2				30		30				15		75			30						172.92	96.49	32.46	0	100	0.2	0.2	50	150	0	97.78	0	0	29.88	15	30	29.91	29.87	0	15	0.2	0	0	0	30	0	8.63	0	0	0	15	0	75	0	0	0							154.09	96.49	32.46	0	100	0.2	0.2	50	150	0	97.78	0	0	29.88	15	30	29.91	29.87	0	15	0.2	0	0	0	30	0	8.63	0	0	0	15	0	75	0	0	0							19.13	0.38	1.64	-	1.35	2.33	0.19	1.71	6.59	-	2.47	-	-	0.32	4.84	8.22	0.47	1.67	-	0	1.67	-	-	-	0.12	-	0	-	-	-	0.17	-	0	-	-	-	-	-	-	-	-	53.27	19.13	0.38	1.64	-	1.35	2.33	0.19	1.71	6.59	-	2.47	-	-	0.32	4.84	8.22	0.47	1.67	-	0	1.67	-	-	-	0.12	-	0	-	-	-	0.17	-	0	-	-	-	-	-	-	-	-	53.27
H5509_003_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	T	Coin	Coin	V	V	P	Coin	Coin	Coin	V	V	V	V	V	P	V	Coin	P	V	V	V	P	V	P	P	P	P	P	P	P	P	V																																																-	1452.52	46.51	591.65	0	158.04	11.67	0.94	399.67	513.69	0	5.64	0	0	164.54	3873.87	3724.14	187.23	655.8	0	0.17	2.81	0	0	0	243.85	0	0.47	0	0	0	133.9	0	205.33	0	0	0						190/day days 1-10	100 days 1-90	50 days 1-100		150	0.2	0.2	50/visit	190		0.15			Varies	10	Varies	Varies	Varies		Varies	0.2				20		Varies				Varies		100			30						155.61	96.49	50	0	150	0.2	0.2	50	190	0	0.15	0	0	26.81	10	20.06	39.83	29.87	0	15	0.2	0	0	0	20	0	8.63	0	0	0	24.99	0	100	0	0	0							155.61	96.49	50	0	150	0.2	0.2	50	190	0	0.15	0	0	26.81	10	20.06	39.83	29.87	0	15	0.2	0	0	0	20	0	8.63	0	0	0	24.99	0	100	0	0	0							18.84	0.37	2.47	-	1.98	2.33	0.19	1.67	8.13	-	0.85	-	-	0.37	3.23	6.23	0.62	1.63	-	0	0.56	-	-	-	0.41	-	0	-	-	-	0.28	-	1.71	-	-	-	-	-	-	-	-	51.85	18.84	0.37	2.47	-	1.98	2.33	0.19	1.67	8.13	-	0.85	-	-	0.37	3.23	6.23	0.62	1.63	-	0	0.56	-	-	-	0.41	-	0	-	-	-	0.28	-	1.71	-	-	-	-	-	-	-	-	51.85
H5509_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V																																																-	1357.19	67.63	482.61	0	6.63	11.24	1.23	373.99	46.18	3.18	20.98	0.23	0.06	13.64	32.63	95.3	2.71	5.43	29.62	1.68	35.38	0.14	0	0	0	0	0	0	0	0.86	0	0	0.09	2.94	0	0						275/day days 1-5	275/day days 1-5	100/day days 7+																																							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63	22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63
H5509_802_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V																																																-	1357.19	67.63	482.61	0	6.63	11.24	1.23	373.99	46.18	3.18	20.98	0.23	0.06	13.64	32.63	95.3	2.71	5.43	29.62	1.68	35.38	0.14	0	0	0	0	0	0	0	0.86	0	0	0.09	2.94	0	0						275/day days 1-5	275/day days 1-5	100/day days 7+																																							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63	22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63
H5509_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V																																																-	1357.19	67.63	482.61	0	6.63	11.24	1.23	373.99	46.18	3.18	20.98	0.23	0.06	13.64	32.63	95.3	2.71	5.43	29.62	1.68	35.38	0.14	0	0	0	0	0	0	0	0.86	0	0	0.09	2.94	0	0						275/day days 1-5	275/day days 1-5	100/day days 7+																																							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63	22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63
H5509_804_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V																																																-	1357.19	67.63	482.61	0	6.63	11.24	1.23	373.99	46.18	3.18	20.98	0.23	0.06	13.64	32.63	95.3	2.71	5.43	29.62	1.68	35.38	0.14	0	0	0	0	0	0	0	0.86	0	0	0.09	2.94	0	0						275/day days 1-5	275/day days 1-5	100/day days 7+																																							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63	22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63
H5509_805_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V																																																-	1357.19	67.63	482.61	0	6.63	11.24	1.23	373.99	46.18	3.18	20.98	0.23	0.06	13.64	32.63	95.3	2.71	5.43	29.62	1.68	35.38	0.14	0	0	0	0	0	0	0	0.86	0	0	0.09	2.94	0	0						275/day days 1-5	275/day days 1-5	100/day days 7+																																							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63	22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63
H5509_806_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V																																																-	1357.19	67.63	482.61	0	6.63	11.24	1.23	373.99	46.18	3.18	20.98	0.23	0.06	13.64	32.63	95.3	2.71	5.43	29.62	1.68	35.38	0.14	0	0	0	0	0	0	0	0.86	0	0	0.09	2.94	0	0						275/day days 1-5	275/day days 1-5	100/day days 7+																																							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							201.58	113.43	64.93	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0.2	0	0	0.2	0.2	0	0							22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63	22.8	0.64	2.61	-	1.33	2.25	0.25	1.56	9.24	0.64	4.2	0.05	0.01	2.73	6.53	19.06	0.54	1.09	5.92	0.34	7.08	0.03	-	-	-	-	-	-	-	0.17	-	-	0.02	0.59	-	-	-	-	-	-	-	89.63
H5510_001_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				5000																																										-	1514.83	15.3	1140.94	1417.82	122.15	3.84	0.04	190.75	42.13	265.24	169.99	0	33.16	44.34	460.72	7262.83	0.33	492.19	1.95	0	251.33	460.43			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	15.44	0.16	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.66	0.92	-	0.08	0.11	0.58	18.16	0	1.23	0	-	0.94	1.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.45	15.44	0.16	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.66	0.92	-	0.08	0.11	0.58	18.16	0	1.23	0	-	0.94	1.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.45
H5510_002_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				3500																																										-	1529.07	15.45	1140.94	1417.82	122.15	3.84	0.04	190.75	42.13	268.24	171.53	0	33.54	44.85	466.77	7420.72	0.33	502.89	1.99	0	251.33	460.43			0	0	0	0	0	0	0											250/admission	250/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0												40.78	40.78	70.85	20	100	0.2	0.2	48	100	20	60	0	20	20	10	20	20	20	20	0	45	20			0	0	0	0	0	0	0											0	5.2	0.05	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.45	0.86	-	0.06	0.07	0.39	12.37	0	0.84	0	-	0.94	0.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34	5.2	0.05	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.45	0.86	-	0.06	0.07	0.39	12.37	0	0.84	0	-	0.94	0.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34
H5510_003_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				5000																																										-	1514.83	15.3	1140.94	1417.82	122.15	3.84	0.04	190.75	42.13	265.24	169.99	0	33.16	44.34	460.72	7262.83	0.33	492.19	1.95	0	251.33	460.43			0	0	0	0	0	0	0											750/admission	750/admission	0/d 1-9 75/d 10-19 125 20-100 days																																							122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0												122.35	122.35	70.85	20	100	0.2	0.2	48	100	30	65	0	30	30	15	30	30	30	30	0	45	30			0	0	0	0	0	0	0											0	15.44	0.16	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.66	0.92	-	0.08	0.11	0.58	18.16	0	1.23	0	-	0.94	1.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.45	15.44	0.16	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.66	0.92	-	0.08	0.11	0.58	18.16	0	1.23	0	-	0.94	1.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.45
H5510_004_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				5000																																										-	1530.67	15.46	1140.94	1417.82	122.15	3.84	0.04	190.75	42.13	271.98	172.83	0	34.01	45.47	525.12	7499.66	0.34	508.24	2.01	0	251.33	460.43			0	0	0	0	0	0	0											50/day 250 max	50/day 250 max	0/d 1-9 75/d 10-19 125 20-100 days																																							30.34	30.34	70.85	20	100	0.2	0.2	48	100	15	57.5	0	15	15	0	15	15	15	15	0	45	15			0	0	0	0	0	0	0												30.34	30.34	70.85	20	100	0.2	0.2	48	100	15	57.5	0	15	15	0	15	15	15	15	0	45	15			0	0	0	0	0	0	0											0	3.87	0.04	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.34	0.83	-	0.04	0.06	-	9.37	0	0.64	0	-	0.94	0.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.71	3.87	0.04	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.34	0.83	-	0.04	0.06	-	9.37	0	0.64	0	-	0.94	0.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	28.71
H5510_005_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				5000																																										-	1535.33	15.51	1140.94	1417.82	122.15	3.84	0.04	190.75	42.13	275.73	172.85	0	34.48	46.1	525.12	7657.55	0.34	518.94	2.06	0	251.33	460.43			0	0	0	0	0	0	0											0 copay	0 copay	0/d 1-9 75/d 10-19 125 20-100 days																																							0	0	70.85	20	100	0.2	0.2	48	100	10	55	0	10	10	0	10	10	10	10	0	45	10			0	0	0	0	0	0	0												0	0	70.85	20	100	0.2	0.2	48	100	10	55	0	10	10	0	10	10	10	10	0	45	10			0	0	0	0	0	0	0											0	-	-	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.23	0.79	-	0.03	0.04	-	6.38	0	0.43	0	-	0.94	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.24	-	-	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.23	0.79	-	0.03	0.04	-	6.38	0	0.43	0	-	0.94	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.24
H5510_006_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O																				3500																																										-	1535.33	15.51	1140.94	1417.82	122.15	3.84	0.04	190.75	42.13	275.73	172.77	0	34.48	46.1	525.12	7657.55	0.34	518.94	2.06	0	251.33	460.43			0	0	0	0	0	0	0											0 Copay	0 Copay	0/d 1-9 75/d 10-19 125 20-100 days																																							0	0	70.85	20	100	0.2	0.2	48	100	10	55	0	10	10	0	10	10	10	10	0	45	10			0	0	0	0	0	0	0												0	0	70.85	20	100	0.2	0.2	48	100	10	55	0	10	10	0	10	10	10	10	0	45	10			0	0	0	0	0	0	0											0	-	-	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.23	0.79	-	0.03	0.04	-	6.38	0	0.43	0	-	0.94	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.24	-	-	6.74	2.36	1.02	0.77	0.01	0.76	0.35	0.23	0.79	-	0.03	0.04	-	6.38	0	0.43	0	-	0.94	0.38	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	21.24
H5510_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1619.55	16.36	1120.87	1472.24	131.02	4.12	0.04	202.39	41.69	297.1	182.33		35.56	47.55	438.08	7705.51	0.34	522.19	2.07		251.33	493.87																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																				0	19.39	0.2	9.34	4.29	1.64	1.24	0.01	0.84	0.52	0.21	1.41	-	0.1	0.14	1.28	22.47	0	1.52	0.01	-	1.41	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.48	19.39	0.2	9.34	4.29	1.64	1.24	0.01	0.84	0.52	0.21	1.41	-	0.1	0.14	1.28	22.47	0	1.52	0.01	-	1.41	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.48
H5510_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1619.55	16.36	1120.87	1472.24	131.02	4.12	0.04	202.39	41.69	297.1	182.33		35.56	47.55	438.08	7705.51	0.34	522.19	2.07		251.33	493.87																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																				0	19.39	0.2	9.34	4.29	1.64	1.24	0.01	0.84	0.52	0.21	1.41	-	0.1	0.14	1.28	22.47	0	1.52	0.01	-	1.41	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.48	19.39	0.2	9.34	4.29	1.64	1.24	0.01	0.84	0.52	0.21	1.41	-	0.1	0.14	1.28	22.47	0	1.52	0.01	-	1.41	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.48
H5510_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	V		S	O																																																														-	1619.55	16.36	1120.87	1472.24	131.02	4.12	0.04	202.39	41.69	297.1	182.33		35.56	47.55	438.08	7705.51	0.34	522.19	2.07		251.33	493.87																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered							20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.6	92.8		35	35	35	35	35	35	35		67.5	35																				0	19.39	0.2	9.34	4.29	1.64	1.24	0.01	0.84	0.52	0.21	1.41	-	0.1	0.14	1.28	22.47	0	1.52	0.01	-	1.41	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.48	19.39	0.2	9.34	4.29	1.64	1.24	0.01	0.84	0.52	0.21	1.41	-	0.1	0.14	1.28	22.47	0	1.52	0.01	-	1.41	1.44	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.48
H5512_001_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P												5000																																										-	1822.99	18.41	935.35	1380.46	239.64	4.83	0.05	189.78	21.15	422.97	386.48	250.5	57.29	15.08	3264.07	7034	0.42	548.16	5.29	0	251.33	590.83						0														75/Day 1-10	75/Day 1-10	0/day 1-5 75 6-14 125 15-100																																							61.23	61.23	86.25	35	100	0	0	46.75	100	35	40.13	35	35	35	25	35	35	35	35	0	45	35	0	0	0	0	0	0	0	0													61.23	61.23	86.25	35	100	0	0	46.75	100	35	40.13	35	35	35	25	35	35	35	35		45	35								0													9.3	0.09	6.72	4.03	2	-	-	0.74	0.18	1.23	1.29	0.73	0.17	0.04	6.8	20.52	0	1.6	0.02	-	0.94	1.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.12	9.3	0.09	6.72	4.03	2	-	-	0.74	0.18	1.23	1.29	0.73	0.17	0.04	6.8	20.52	0	1.6	0.02	-	0.94	1.72	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.12
H5512_002_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P												3500																																										-	1834.05	18.53	935.35	1449.87	239.64	4.83	0.05	189.78	21.15	429.57	389.99	250.5	58.18	15.31	3494.86	7265.89	0.44	566.23	5.47	0	251.33	590.83			0			0		0												50/Day 1-10	50/Day 1-10	0/day 1-5 75 6-14 125 15-100																																							40.82	40.82	86.25	20	100	0	0	46.75	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20			0			0		0													40.82	40.82	86.25	20	100	0	0	46.75	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20			0			0		0													6.24	0.06	6.72	2.42	2	-	-	0.74	0.18	0.72	0.98	0.42	0.1	0.03	2.91	12.11	0	0.94	0.01	-	0.94	0.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.5	6.24	0.06	6.72	2.42	2	-	-	0.74	0.18	0.72	0.98	0.42	0.1	0.03	2.91	12.11	0	0.94	0.01	-	0.94	0.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.5
H5512_003_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P												5000																																										-	1527.28	15.43	1051.35	1501.09	150.79	4.8	0.05	200.47	35.08	580.12	472.04	2.29	178.71	19.49	3452.06	7506.94	1.13	1388.09	2.81	0	251.33	499																				750/Stay	750/Stay	0/day 1-5 75 6-14 125 15-100																																							122.95	122.95	86.25	35	100	0.2	0.2	46.75	100	35	40.13	35	35	35	25	35	35	35	35	0	45	35	0	0	0	0	0			0													122.95	122.95	86.25	35	100	0.2	0.2	46.75	100	35	40.13	35	35	35	25	35	35	35	35	0	45	35								0													15.65	0.16	7.56	4.38	1.26	0.96	0.01	0.78	0.29	1.69	1.58	0.01	0.52	0.06	7.19	21.9	0	4.05	0.01	-	0.94	1.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.44	15.65	0.16	7.56	4.38	1.26	0.96	0.01	0.78	0.29	1.69	1.58	0.01	0.52	0.06	7.19	21.9	0	4.05	0.01	-	0.94	1.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	70.44
H5512_004_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P												3500																																										-	1527.28	15.43	1051.35	1501.09	150.79	4.8	0.05	200.47	35.08	589.17	476.32	2.33	181.5	19.49	3696.14	7754.42	1.16	1433.86	2.91	0	251.33	499						0														750/Stay	750/Stay	0/day 1-5 75 6-14 125 15-100																																							122.95	122.95	86.25	35	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20			0			0		0													122.95	122.95	86.25	35	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20		45	20																					15.65	0.16	7.56	4.38	1.26	0.96	0.01	0.78	0.29	0.98	1.2	0	0.3	0.03	3.08	12.92	0	2.39	0	-	0.94	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.74	15.65	0.16	7.56	4.38	1.26	0.96	0.01	0.78	0.29	0.98	1.2	0	0.3	0.03	3.08	12.92	0	2.39	0	-	0.94	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.74
H5512_005_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P												5000																																										-	1949.24	19.69	1148.46	2230	200.25	4.54	0.05	202.6	20.1	343.6	398.95	0.32	158.76	51.11	3339.36	7026.47	0.59	862.69	7.98	0	251.33	512.68						0														750/Stay	750/Stay	0/day 1-5 75 6-14 125 15-100																																							122.95	122.95	86.25	35	100	0.2	0.2	46.75	100	35	40.13	35	35	35	25	35	35	35	35	0	45	35		0	0		0	0		0	0												122.95	122.95	86.25	35	100	0.2	0.2	46.75	100	35	40.13	35	35	35	25	35	35	35	35		45	35								0													19.97	0.2	8.25	6.5	1.67	0.91	0.01	0.79	0.17	1	1.33	0	0.46	0.15	6.96	20.49	0	2.52	0.02	-	0.94	1.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.85	19.97	0.2	8.25	6.5	1.67	0.91	0.01	0.79	0.17	1	1.33	0	0.46	0.15	6.96	20.49	0	2.52	0.02	-	0.94	1.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	73.85
H5512_006_0	2006																						A	A	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S				V					P												3500																																										-	1949.24	19.69	1148.46	2230	200.25	4.54	0.05	202.6	20.1	347.01	401.54	0.32	160.34	51.62	3529.09	7180.9	0.6	881.65	8.16	0	251.33	512.68						0														750/stay	750/stay	0/day 1-5 75 6-14 125 15-100																																							122.95	122.95	86.25	35	100	0.2	0.2	46.75	100	25	33.55	25	25	25	15	25	25	25	25	0	45	25		0	0	0	0	0	0	0	0												122.95	122.95	86.25	35	100	0.2	0.2	46.75	100	25	33.55	25	25	25	15	25	25	25	25	0	45	25								0													19.97	0.2	8.25	6.5	1.67	0.91	0.01	0.79	0.17	0.72	1.12	0	0.33	0.11	4.41	14.96	0	1.84	0.02	-	0.94	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64	19.97	0.2	8.25	6.5	1.67	0.91	0.01	0.79	0.17	0.72	1.12	0	0.33	0.11	4.41	14.96	0	1.84	0.02	-	0.94	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64
H5512_007_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																					5000																																										-	1765.87		1803.98	1485.57	328.34	10.81		229.95	51.54	247.94	184.84		86.29	59.61	5383.24	5819.92	0.67	439.2	27.39	614.11	285.6																					750 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	30	53.94		30	30	15	30	30	30	3000	30	45																					122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						18	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.62	0.83	-	0.22	0.15	6.73	14.55	0	1.1	0.07	1.54	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.78	18	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.62	0.83	-	0.22	0.15	6.73	14.55	0	1.1	0.07	1.54	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.78
H5512_008_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																					5000																																										-	1765.87		1803.98	1485.57	328.34	10.81		229.95	51.54	247.94	184.84		86.29	59.61	5383.24	5819.92	0.67	439.2	27.39	614.11	285.6																					750 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	30	53.94		30	30	15	30	30	30	3000	30	45																					122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						18	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.62	0.83	-	0.22	0.15	6.73	14.55	0	1.1	0.07	1.54	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.78	18	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.62	0.83	-	0.22	0.15	6.73	14.55	0	1.1	0.07	1.54	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.78
H5512_009_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																					3500																																										-	1782.47		1803.98	1485.57	328.34	10.81		229.95	51.54	250.75	187.71		87.26	60.29	5453.99	5946.44	0.68	448.75	27.98	627.46	285.6																					250 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	20	47.36		20	20	10	20	20	20	2000	20	45																					40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						6.06	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.42	0.74	-	0.15	0.1	4.54	9.91	0	0.75	0.05	1.05	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.73	6.06	-	12.18	2.48	2.74	2.16	-	0.92	0.43	0.42	0.74	-	0.15	0.1	4.54	9.91	0	0.75	0.05	1.05	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.73
H5512_010_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																					5000																																										-	1661.91		856.72	998	268.01	11.35		274.54	34.05	458.25	247.44		75.82	20.56	3953.82	8091.69	0.47	775.86	35.39	34.16	285.6																					750 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	30	53.94		30	30	15	30	30	30	3000	30	45																					122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						16.94	-	5.78	1.66	2.23	2.27	-	1.1	0.28	1.15	1.11	-	0.19	0.05	4.94	20.23	0	1.94	0.09	0.09	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.13	16.94	-	5.78	1.66	2.23	2.27	-	1.1	0.28	1.15	1.11	-	0.19	0.05	4.94	20.23	0	1.94	0.09	0.09	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	61.13
H5512_011_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																					5000																																										-	1664.19		856.72	1934.26	268.01	11.35		274.54	34.05	460.83	277.61		94.78	20.67	4506.51	8179.64	0.48	784.29	35.78	34.53	285.6																					150/day 8 days		0 1-7 75 8-14 125 15-100	20	100	0		48	100	25	47.36		25	25	0	25	25	25	2500	25	45																					113.69		81.02	20	100	0.2		48	100	25	47.36		25	25	0	25	25	25	25	25	45																						113.69		81.02	20	100	0.2		48	100	25	47.36		25	25	0	25	25	25	25	25	45																						15.77	-	5.78	3.22	2.23	2.27	-	1.1	0.28	0.96	1.1	-	0.2	0.04	-	17.04	0	1.63	0.07	0.07	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.85	15.77	-	5.78	3.22	2.23	2.27	-	1.1	0.28	0.96	1.1	-	0.2	0.04	-	17.04	0	1.63	0.07	0.07	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.85
H5512_012_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																					3500																																										-	1677.54		856.72	1934.26	268.01	11.52		274.54	34.05	463.42	277.61		95.31	20.79	4005.79	8267.59	0.48	792.73	36.16	34.9	285.6																					250 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	20	47.36		20	20	10	20	20	20	2000	20	45																					40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						5.7	-	5.78	3.22	2.23	2.3	-	1.1	0.28	0.77	1.1	-	0.16	0.03	3.34	13.78	0	1.32	0.06	0.06	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.32	5.7	-	5.78	3.22	2.23	2.3	-	1.1	0.28	0.77	1.1	-	0.16	0.03	3.34	13.78	0	1.32	0.06	0.06	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.32
H5512_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1302.61	13.16	1148.46	933.76	179.5	2.27	0.02	166.53	20.1	264.76	237.18	0.32	63.89	42.5	3825.52	4609.65	0.24	239.71	424.43	0	251.33	420.86						0														200 1-7 days	200 1-7 days	100 Days 1-100							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35	0	67.5	35	0	0	0	0	0	0	0	0													143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35		67.5	35								0													15.6	0.16	9.57	2.72	2.24	0.68	0.01	0.69	0.25	0.29	2.44	0	0.19	0.12	11.16	13.44	0	0.7	1.24	-	1.41	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.15	15.6	0.16	9.57	2.72	2.24	0.68	0.01	0.69	0.25	0.29	2.44	0	0.19	0.12	11.16	13.44	0	0.7	1.24	-	1.41	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.15
H5512_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1302.61	13.16	1148.46	933.76	179.5	2.27	0.02	166.53	20.1	264.76	237.18	0.32	63.89	42.5	3825.52	4609.65	0.24	239.71	424.43	0	251.33	420.86						0														200 1-7 days	200 1-7 days	100 Days 1-100							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35	0	67.5	35	0	0	0	0	0	0	0	0													143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35		67.5	35								0													15.6	0.16	9.57	2.72	2.24	0.68	0.01	0.69	0.25	0.29	2.44	0	0.19	0.12	11.16	13.44	0	0.7	1.24	-	1.41	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.15	15.6	0.16	9.57	2.72	2.24	0.68	0.01	0.69	0.25	0.29	2.44	0	0.19	0.12	11.16	13.44	0	0.7	1.24	-	1.41	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.15
H5512_803_0	2006																						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V		S	O								P													0	0							0																																	-	1302.61	13.16	1148.46	933.76	179.5	2.27	0.02	166.53	20.1	264.76	237.18	0.32	63.89	42.5	3825.52	4609.65	0.24	239.71	424.43	0	251.33	420.86						0														200 1-7 days	200 1-7 days	100 Days 1-100							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35	0	67.5	35	0	0	0	0	0	0	0	0													143.69	143.69	100	35	150	0.3	0.3	50	150	13.16	123.61	35	35	35	35	35	35	35	35		67.5	35								0													15.6	0.16	9.57	2.72	2.24	0.68	0.01	0.69	0.25	0.29	2.44	0	0.19	0.12	11.16	13.44	0	0.7	1.24	-	1.41	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.15	15.6	0.16	9.57	2.72	2.24	0.68	0.01	0.69	0.25	0.29	2.44	0	0.19	0.12	11.16	13.44	0	0.7	1.24	-	1.41	1.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.15
H5514_001_0	2006																						A	A	A		T			V			Coin						V		Coin																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	332.47	4.79	78.02	0	217.77	0	0	218.03	0	0	18.69	0	0	0	0	0	359.15	0	34.39	0	0	0	0	0	0	0	0	0	0	0	0																		25 or 50									25 or 50																									500	500	500	0	50	0	0	45.26	0	0	0.2	0	0	0	0	0	46.25	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0												500	500	500	0	50	0	0	45.26	0	0	0.2	0	0	0	0	0	46.25	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0												13.85	0.2	3.25	-	0.91	-	-	0.82	-	-	3.74	-	-	-	-	-	1.38	-	6.88	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.03	13.85	0.2	3.25	-	0.91	-	-	0.82	-	-	3.74	-	-	-	-	-	1.38	-	6.88	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	31.03
H5515_001_0	2006											2400											D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	Coin	P	P	Coin	V			V		V															none																																										-	2166.82	220.13	1204.49		482.61	4.12	10.2	204.9	35.89	7073.22	53.25	0.6	3.14	0.18	6275.15	4872.25	877.35	15.21			18.69	2018.08			14.97		86.09															195	175	95		100	30	30	50	30	10	30-Oct	30	30	30/40/30	May-00	20	40/30	30			30	0/20			20		20															195	175	95		100	0.3	0.3	50	0.3	10	0.2	0.3	0.3	0.25	5	20	37.5	0.3			0.3	20			20		20																94.8	85.08	46.19		48.62	0.15	0.16	24.31	0.15	4.86	0.1	0.15	0.15	0.15	5	20	37.5	0.15			0.15	20			20		20																17.12	1.56	4.64	-	1.96	0.6	1.67	0.42	5.23	2.87	5.14	0.09	0.46	0.03	2.61	8.12	2.74	2.22	-	-	2.73	3.36	-	-	0.02	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.72	17.12	1.56	4.64	-	1.96	0.6	1.67	0.42	5.23	2.87	5.14	0.09	0.46	0.03	2.61	8.12	2.74	2.22	-	-	2.73	3.36	-	-	0.02	-	0.14	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.72
H5515_002_0	2006											2700											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	1813.49	254.61	572.92		85.01	10.06	6.32	283.61	54.01	11535.67	41.58			0.53	4806.49	4166.53	1022.43	8.35			14.17	1277.67			33.94		238.89															295	17500	150		100	0	0	50	0	10	30-Oct	30 (included in g.)	0.3	30 / 40 / 30	Oct-00	25	40 / 30	0			0.3	0 / 25			25		25															295	175	150		100	0.3	0.3	50	0.3	4	0.22			0.22	10	25	37.5	0.3			0.3	25			25		25																159.52	94.63	81.11		54.07	0.16	0.19	27.04	0.16	2.16	0.12			0.13	10	25	37.5	0.16			0.16	25			25		16.86																24.11	2.01	3.87	-	0.38	1.63	1.22	0.64	8.76	2.08	4.86	-	-	0.07	4.01	8.68	3.2	1.35	-	-	2.3	2.66	-	-	0.07	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.23	24.11	2.01	3.87	-	0.38	1.63	1.22	0.64	8.76	2.08	4.86	-	-	0.07	4.01	8.68	3.2	1.35	-	-	2.3	2.66	-	-	0.07	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	72.23
H5516_001_0	2006											3100											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	V	V	V											6000																																										-	2453.43	21.99	736.49		108.03	12.42	5.52	411.01	65.52	11243.51	40.9		4.29	1.2	4917.29	4225.89	2.47	4.44			28.47	1148.87			177.42		220.59															250	17500	125	0	150	0	0	50	0	10	20-Oct	20 (included in g)	0.3	30/40 / 20	15/0	25	30/40	0	0	0	0.3	0/25			25		25															250	175	125	0	150	0.3	0.3	50	0.2	10	20-Oct	20 -included in g	0.3	30/40 / 20	15/0	25	30/40	0.2			0.3	0/25			25		25																129.73	94.38	67.42		80.9	0.16	0.19	26.97	0.11	2.16	0.07		0.16	0.11	15	25	37.5	0.11			0.16	24.96			25		25																26.52	0.17	4.14	-	0.73	2.01	1.06	0.92	7.07	2.02	2.96	-	0.69	0.13	6.15	8.8	0.01	0.48	-	-	4.61	2.39	-	-	0.37	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.69	26.52	0.17	4.14	-	0.73	2.01	1.06	0.92	7.07	2.02	2.96	-	0.69	0.13	6.15	8.8	0.01	0.48	-	-	4.61	2.39	-	-	0.37	-	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	71.69
H5517_001_0	2006																						D	D	D	Coin	T	Coin	Coin	V	V	P	P	Coin	Coin	Coin	V	V	V	V	P	P	Coin	P	T	V	V	P	V	P	P	P	P																																																					-	2514.29	37.85	0	0	407.99	11.96	2.64	473.73	534.58	0	0	0	0	0.34	4713.91	6611.99	131.29	661.27	0	3.13	8.5	0	0	0	0	0	0	0	0	0	0											250/admit	250/admit			25	0	0	50	50					VARIES	15	15	35	15		15	VARIES																					67.81	55.37	0	0	25	0.2	0.2	50	50	0	0	0	0	0.23	15	15	35	15	0	15	0.19	0	0	0	0	0	0	0	0	0	0												67.81	55.37	0	0	25	0.2	0.2	50	50	0	0	0	0	0.23	15	15	35	15	0	15	0.19	0	0	0	0	0	0	0	0	0	0												14.21	0.17	-	-	0.85	2.39	0.53	1.97	2.23	-	-	-	-	0.08	5.89	8.26	0.38	0.83	-	0	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.41	14.21	0.17	-	-	0.85	2.39	0.53	1.97	2.23	-	-	-	-	0.08	5.89	8.26	0.38	0.83	-	0	1.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.41
H5517_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							A	A	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin																																																		-	2345.35	35.1	1055.79	0	9.24	11.09	2.45	439.25	49.32	22.79	38.81	3.89	0.23	23.24	42.34	136.01	1.07	7.29	28.42	8.34	50.41	0.38	0	0	0	0	0	0	0	0	0	0	0	13.27	0							500/admit	500/admit	100 Days 7+																																							104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09	20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09
H5517_802_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							A	A	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin																																																		-	2345.35	35.1	1055.79	0	9.24	11.09	2.45	439.25	49.32	22.79	38.81	3.89	0.23	23.24	42.34	136.01	1.07	7.29	28.42	8.34	50.41	0.38	0	0	0	0	0	0	0	0	0	0	0	13.27	0							500/admit	500/admit	100 Days 7+																																							104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09	20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09
H5517_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							A	A	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin																																																		-	2345.35	35.1	1055.79	0	9.24	11.09	2.45	439.25	49.32	22.79	38.81	3.89	0.23	23.24	42.34	136.01	1.07	7.29	28.42	8.34	50.41	0.38	0	0	0	0	0	0	0	0	0	0	0	13.27	0							500/admit	500/admit	100 Days 7+																																							104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09	20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09
H5517_804_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							A	A	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin																																																		-	2345.35	35.1	1055.79	0	9.24	11.09	2.45	439.25	49.32	22.79	38.81	3.89	0.23	23.24	42.34	136.01	1.07	7.29	28.42	8.34	50.41	0.38	0	0	0	0	0	0	0	0	0	0	0	13.27	0							500/admit	500/admit	100 Days 7+																																							104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09	20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09
H5517_805_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							A	A	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin																																																		-	2345.35	35.1	1055.79	0	9.24	11.09	2.45	439.25	49.32	22.79	38.81	3.89	0.23	23.24	42.34	136.01	1.07	7.29	28.42	8.34	50.41	0.38	0	0	0	0	0	0	0	0	0	0	0	13.27	0							500/admit	500/admit	100 Days 7+																																							104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09	20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09
H5517_806_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional								Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay							A	A	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin																																																		-	2345.35	35.1	1055.79	0	9.24	11.09	2.45	439.25	49.32	22.79	38.81	3.89	0.23	23.24	42.34	136.01	1.07	7.29	28.42	8.34	50.41	0.38	0	0	0	0	0	0	0	0	0	0	0	13.27	0							500/admit	500/admit	100 Days 7+																																							104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								104.92	228.47	26.96	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0.2	0								20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09	20.51	0.67	2.37	-	1.85	2.22	0.49	1.83	9.86	4.56	7.76	0.78	0.05	4.65	8.47	27.2	0.21	1.46	5.68	1.67	10.08	0.08	-	-	-	-	-	-	-	-	-	-	-	2.65	-	-	-	-	-	-	-	115.09
H5518_001_0	2006											4800											D	D	D	V	P	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2100.53	171.14	1344.75	0	212.79	19.34	4.6	504.31	61.92	10463.37	49.58	0	0.83	0.75	4553.29	3810.49	720.7	1.46	0	0	27.43	817.84	0	0	136.38	0	244.59	0	0	0	0											295	17500	150	0	50	0	0	50 / 35	0	10	20-Oct	0.2	0.3	20/40/30	15/0	30	40 / 30	0	0	0	0.3	0/30			30		30															295	175	150		16.67	0.2	0.2	45.89	0.2	4	0.15		0.3	0.17	15	30	37.5	0.2			0.3	30			30		30																182.66	108.36	92.88	0	10.32	0.12	0.16	28.41	0.12	2.48	0.1	0	0.19	0.11	15	30	37.5	0.12	0	0	0.19	30	0	0	30	0	30	0	0	0	0												31.97	1.55	10.41	-	0.18	2.4	0.73	1.19	7.67	2.16	4.73	-	0.15	0.08	5.69	9.53	2.25	0.18	-	-	5.09	2.04	-	-	0.34	-	0.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.96	31.97	1.55	10.41	-	0.18	2.4	0.73	1.19	7.67	2.16	4.73	-	0.15	0.08	5.69	9.53	2.25	0.18	-	-	5.09	2.04	-	-	0.34	-	0.61	-	-	-	-	-	-	-	-	-	-	-	-	-	-	88.96
H5520_001_0	2006											1500											A	A	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	176.02	1.82	417.45	0	191.38	21145.11	17878.85	329.14	319.98	2092.72	22.9	0	0.15	608.32	3801.12	4708.41	145.72	201.33	17.01	215.69	0	539.57	0	535.12	342.61	0	0	0	0	0	534.42											Per Admit	Per Admit	100 / Admit		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	100 ASC / 100 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	6.9	0	25	0.39	0.42	41.56	100	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	85.1	85.1	5.87	0	21.28	0.34	0.36	35.37	85.1	4.26	0.06	0	0.17	21.28	8.45	11.41	21.28	21.28	0	8.09	0	8.51	0	35	10	0	0	0	0	0	17											0	1.25	0.01	0.2	-	0.34	0.59	0.54	0.97	2.27	0.74	1.26	-	0.03	1.08	2.68	4.48	0.26	0.36	0.05	0.15	-	0.38	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	20.23	1.25	0.01	0.2	-	0.34	0.59	0.54	0.97	2.27	0.74	1.26	-	0.03	1.08	2.68	4.48	0.26	0.36	0.05	0.15	-	0.38	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	20.23
H5520_002_0	2006											1500											D	D	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	773.53	11.44	429.61	0	196.95	21760.77	18399.41	338.72	329.3	2153.66	23.56	0	0.15	626.03	3911.79	4845.51	149.97	207.19	17.5	221.97	0	555.28	0	535.12	342.61	0	0	0	0	0	534.42											Per Day: 1-2	Per Day: 1-2	100 / Day Days 1-2		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	200 ASC / 200 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	13.17	0	25	0.39	0.42	41.56	200	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	77.77	77.77	10.24	0	19.44	0.31	0.33	32.32	155.55	3.89	0.05	0	0.16	19.44	7.72	10.42	19.44	19.44	0	7.4	0	7.78	0	35	10	0	0	0	0	0	17											0	5.01	0.07	0.37	-	0.32	0.56	0.5	0.91	4.27	0.7	1.19	-	0.02	1.01	2.52	4.21	0.24	0.34	0.04	0.14	-	0.36	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	25.39	5.01	0.07	0.37	-	0.32	0.56	0.5	0.91	4.27	0.7	1.19	-	0.02	1.01	2.52	4.21	0.24	0.34	0.04	0.14	-	0.36	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	25.39
H5520_003_0	2006											1500											A	A	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	167.36	1.73	396.93	0	181.97	20105.51	16999.84	312.95	304.25	1989.83	21.77	0	0.14	578.41	3614.23	4476.93	138.56	191.43	16.17	205.09	0	513.04	0	535.12	342.61	0	0	0	0	0	534.42											Per Admit	Per Admit	100 / Admit		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	100 ASC / 100 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	6.9	0	25	0.39	0.42	41.56	100	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	86.2	86.2	5.94	0	21.55	0.34	0.36	35.82	86.2	4.31	0.06	0	0.17	21.55	8.56	11.55	21.55	21.55	0	8.2	0	8.62	0	35	10	0	0	0	0	0	17											0	1.2	0.01	0.2	-	0.33	0.57	0.52	0.93	2.19	0.71	1.21	-	0.02	1.04	2.58	4.31	0.25	0.34	0.05	0.14	-	0.37	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	19.58	1.2	0.01	0.2	-	0.33	0.57	0.52	0.93	2.19	0.71	1.21	-	0.02	1.04	2.58	4.31	0.25	0.34	0.05	0.14	-	0.37	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	19.58
H5520_004_0	2006											1500											D	D	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	735.28	10.88	408.37	0	187.21	20684.81	17489.66	321.97	313.02	2047.17	22.4	0	0.14	595.08	3718.37	4605.92	142.55	196.95	16.64	211	0	527.82	0	535.12	342.61	0	0	0	0	0	534.42											Per Day: 1-2	Per Day: 1-2	100 / Day Days 1-2		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	200 ASC / 200 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	13.17	0	25	0.39	0.42	41.56	200	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	79.11	79.11	10.42	0	19.78	0.31	0.33	32.88	158.22	3.96	0.05	0	0.16	19.78	7.86	10.6	19.78	19.78	0	7.52	0	7.91	0	35	10	0	0	0	0	0	17											0	4.85	0.07	0.35	-	0.31	0.54	0.49	0.88	4.13	0.67	1.15	-	0.02	0.98	2.43	4.07	0.23	0.32	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.63	4.85	0.07	0.35	-	0.31	0.54	0.49	0.88	4.13	0.67	1.15	-	0.02	0.98	2.43	4.07	0.23	0.32	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.63
H5520_801_0	2006											1500											D	D	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	743.25	11	412.79	0	189.24	20909.07	17679.27	325.46	316.41	2069.36	22.64	0	0.15	601.53	3758.68	4655.86	144.1	199.08	16.82	213.28	0	533.55	0	535.12	342.61	0	0	0	0	0	534.42											Per Day: 1-2	Per Day: 1-2	100 / Day Days 1-2		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	200 ASC / 200 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	13.17	0	25	0.39	0.42	41.56	200	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	78.84	78.84	10.39	0	19.71	0.31	0.33	32.77	157.68	3.94	0.05	0	0.16	19.71	7.83	10.57	19.71	19.71	0	7.5	0	7.88	0	35	10	0	0	0	0	0	17											0	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.16	0.68	1.16	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.8	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.16	0.68	1.16	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.8
H5520_802_0	2006											1500											D	D	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	743.25	11	412.79	0	189.24	20909.07	17679.27	325.46	316.41	2069.36	22.64	0	0.15	601.53	3758.68	4655.86	144.1	199.08	16.82	213.28	0	533.55	0	535.12	342.61	0	0	0	0	0	534.42											Per Day: 1-2	Per Day: 1-2	100 / Day Days 1-2		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	200 ASC / 200 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	13.17	0	25	0.39	0.42	41.56	200	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	78.84	78.84	10.39	0	19.71	0.31	0.33	32.77	157.68	3.94	0.05	0	0.16	19.71	7.83	10.57	19.71	19.71	0	7.5	0	7.88	0	35	10	0	0	0	0	0	17											0	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.16	0.68	1.16	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.8	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.16	0.68	1.16	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.8
H5520_803_0	2006											1500											D	D	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	742.28	10.98	412.25	0	189	20881.68	17656.11	325.04	316	2066.65	22.61	0	0.15	600.74	3753.76	4649.76	143.91	198.82	16.79	213	0	532.85	0	535.12	342.61	0	0	0	0	0	534.42											Per Day: 1-2	Per Day: 1-2	100 / Day Days 1-2		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	200 ASC / 200 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	13.17	0	25	0.39	0.42	41.56	200	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	78.87	78.87	10.39	0	19.72	0.31	0.33	32.78	157.74	3.94	0.05	0	0.16	19.72	7.83	10.57	19.72	19.72	0	7.5	0	7.89	0	35	10	0	0	0	0	0	17											0	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.15	0.68	1.15	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.77	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.15	0.68	1.15	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.77
H5520_804_0	2006											1500											D	D	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	743.25	11	412.79	0	189.24	20909.07	17679.27	325.46	316.41	2069.36	22.64	0	0.15	601.53	3758.68	4655.86	144.1	199.08	16.82	213.28	0	533.55	0	535.12	342.61	0	0	0	0	0	534.42											Per Day: 1-2	Per Day: 1-2	100 / Day Days 1-2		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	200 ASC / 200 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	13.17	0	25	0.39	0.42	41.56	200	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	78.84	78.84	10.39	0	19.71	0.31	0.33	32.77	157.68	3.94	0.05	0	0.16	19.71	7.83	10.57	19.71	19.71	0	7.5	0	7.88	0	35	10	0	0	0	0	0	17											0	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.16	0.68	1.16	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.8	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.16	0.68	1.16	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.8
H5520_805_0	2006											1500											D	D	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	743.25	11	412.79	0	189.24	20909.07	17679.27	325.46	316.41	2069.36	22.64	0	0.15	601.53	3758.68	4655.86	144.1	199.08	16.82	213.28	0	533.55	0	535.12	342.61	0	0	0	0	0	534.42											Per Day: 1-2	Per Day: 1-2	100 / Day Days 1-2		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	200 ASC / 200 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	13.17	0	25	0.39	0.42	41.56	200	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	78.84	78.84	10.39	0	19.71	0.31	0.33	32.77	157.68	3.94	0.05	0	0.16	19.71	7.83	10.57	19.71	19.71	0	7.5	0	7.88	0	35	10	0	0	0	0	0	17											0	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.16	0.68	1.16	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.8	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.16	0.68	1.16	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.8
H5520_806_0	2006											1500											D	D	D	V	T	P	P	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	S	O	T	P	V	P	V	P	O	O	V											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	742.28	10.98	412.25	0	189	20881.68	17656.11	325.04	316	2066.65	22.61	0	0.15	600.74	3753.76	4649.76	143.91	198.82	16.79	213	0	532.85	0	535.12	342.61	0	0	0	0	0	534.42											Per Day: 1-2	Per Day: 1-2	100 / Day Days 1-2		25 per run	20 - 600 per	20 - 600 per	50 ER / 25 UC	200 ASC / 200 OP		0 - 600 per		20 - 600 per	25 OP SA / 25 Cardiac Rehab	10 PCP	10 SCP / 15 Chiro / 25 Podiatrist	25 MH	25 Therapy		10 Hearing / 10 Preventive		10 Vision		35 ded 0 coins							15 Accu/ 25 Massage											100	100	13.17	0	25	0.39	0.42	41.56	200	5	0.06	0	0.2	25	9.94	13.4	25	25	0	9.51	0	10	0	35	10	0	0	0	0	0	17											4500	78.87	78.87	10.39	0	19.72	0.31	0.33	32.78	157.74	3.94	0.05	0	0.16	19.72	7.83	10.57	19.72	19.72	0	7.5	0	7.89	0	35	10	0	0	0	0	0	17											0	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.15	0.68	1.15	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.77	4.88	0.07	0.36	-	0.31	0.54	0.49	0.89	4.15	0.68	1.15	-	0.02	0.99	2.45	4.1	0.24	0.33	0.04	0.13	-	0.35	-	1.56	0.29	-	-	-	-	-	0.76	-	-	-	-	-	-	-	-	-	-	24.77
H5521_001_0	2006																						D		D	V	T	Coin		V	V	P	P		P	P	V	V	V	V	V	V	S				V		V															5000																																										-	1325.15		977.55	1213.47	178.26	9.84		204.15	89.35	863.19	853.63		21.51	25.45	3408.01	5388.19	1	708.43	3.58	80.17	285.6																					750/admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	30	53.94		30	30	15	30	30	30	3000	30	45																					122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						13.51	-	6.6	2.02	1.49	1.97	-	0.82	0.74	2.16	3.84	-	0.05	0.06	4.26	13.47	0	1.77	0.01	0.2	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.05	13.51	-	6.6	2.02	1.49	1.97	-	0.82	0.74	2.16	3.84	-	0.05	0.06	4.26	13.47	0	1.77	0.01	0.2	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.05
H5521_002_0	2006																						D		D	V	T	Coin		V	V	P	P		P	P	V	V	V	V	V	V	S				V		V															5000																																										-	1325.15		977.55	1213.47	178.26	9.84		204.15	89.35	863.19	853.63		21.51	25.45	3408.01	5388.19	1	708.43	3.58	80.17	285.6																					750/admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	30	53.94		30	30	15	30	30	30	3000	30	45																					122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						13.51	-	6.6	2.02	1.49	1.97	-	0.82	0.74	2.16	3.84	-	0.05	0.06	4.26	13.47	0	1.77	0.01	0.2	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.05	13.51	-	6.6	2.02	1.49	1.97	-	0.82	0.74	2.16	3.84	-	0.05	0.06	4.26	13.47	0	1.77	0.01	0.2	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	54.05
H5521_003_0	2006																						D		D	V	T	Coin		V	V	P	P		P	P	V	V	V	V	V	V	S				V		V															3500																																										-	1359.3		1044.36	1213.47	178.26	9.99		204.15	90.69	872.94	858.24		21.76	25.74	3452.8	5505.33	1	723.84	3.66	81.91	285.6																					250 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	20	47.36		20	20	10	20	20	20	2000	20	45																					40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						4.62	-	7.05	2.02	1.49	2	-	0.82	0.76	1.45	3.39	-	0.04	0.04	2.88	9.18	0	1.21	0.01	0.14	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.14	4.62	-	7.05	2.02	1.49	2	-	0.82	0.76	1.45	3.39	-	0.04	0.04	2.88	9.18	0	1.21	0.01	0.14	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	38.14
H5521_004_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S				V		V															5000																																										-	1845.09		1030.62	1791.42	193	12.3		216.97	153.17	790.68	997.56		64.74	19.13	4247.65	7613.28	2	495.08	2.91	9.9	285.6																					750 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	30	53.94		30	30	15	30	30	30	3000	30	45																					122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						18.81	-	6.96	2.99	1.61	2.46	-	0.87	1.28	1.98	4.48	-	0.16	0.05	5.31	19.03	0.01	1.24	0.01	0.02	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	68.33	18.81	-	6.96	2.99	1.61	2.46	-	0.87	1.28	1.98	4.48	-	0.16	0.05	5.31	19.03	0.01	1.24	0.01	0.02	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	68.33
H5521_005_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S				V		V															5000																																										-	1845.09		1030.62	1791.42	193	12.3		216.97	153.17	790.68	997.56		64.74	19.13	4247.65	7613.28	2	495.08	2.91	9.9	285.6																					750 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	30	53.94		30	30	15	30	30	30	3000	30	45																					122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						122.35		81.02	20	100	0.2		48	100	30	53.94		30	30	15	30	30	30	30	30	45																						18.81	-	6.96	2.99	1.61	2.46	-	0.87	1.28	1.98	4.48	-	0.16	0.05	5.31	19.03	0.01	1.24	0.01	0.02	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	68.33	18.81	-	6.96	2.99	1.61	2.46	-	0.87	1.28	1.98	4.48	-	0.16	0.05	5.31	19.03	0.01	1.24	0.01	0.02	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	68.33
H5521_006_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S				V		V															3500																																										-	1892.65		1030.62	1791.42	193	12.46		216.97	153.17	799.61	1002.95		65.48	19.35	4303.47	7778.79	2	505.85	2.98	10.12	285.6																					250 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	20	47.36		20	20	10	20	20	20	2000	20	45																					40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45																						6.43	-	6.96	2.99	1.61	2.49	-	0.87	1.28	1.33	3.96	-	0.11	0.03	3.59	12.96	0	0.84	0	0.02	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.54	6.43	-	6.96	2.99	1.61	2.49	-	0.87	1.28	1.33	3.96	-	0.11	0.03	3.59	12.96	0	0.84	0	0.02	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	46.54
H5521_007_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																					5000																																										-	1936.71		1337.3	1237.69	246.96	12.3		262.1	78.19	485.93	316.29		139.83	309.02	5724.78	4835.08	0.81	84.15	0.2	361.16	285.6																					750/admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	35	57.23		35	35	20	35	35	35	3500	35	45																					122.35		81.02	20	100	0.2		48	100	35	57.23		35	35	20	35	35	35	35	35	45																						122.35		81.02	20	100	0.2		48	100	35	57.23		35	35	20	35	35	35	35	35	45																						19.75	-	9.03	2.06	2.06	2.46	-	1.05	0.65	1.42	1.51	-	0.41	0.9	9.54	14.1	0	0.25	0	1.05	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.31	19.75	-	9.03	2.06	2.06	2.46	-	1.05	0.65	1.42	1.51	-	0.41	0.9	9.54	14.1	0	0.25	0	1.05	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	67.31
H5521_008_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																					5000																																										-	1946.69		1337.3	1237.69	246.96	12.3		262.1	78.19	489.23	319.53		140.78	311.12	6742.52	4941.35	0.83	86	0.21	369.1	285.6																					150/day up to 8 days		0 1-7 75 8-14 125 15-100	20	100	0		48	100	25	50.65		25	25	0	25	25	25	2500	25	45																					113.69		81.02	20	100	0.2		48	100	25	50.65		25	25	0	25	25	25	25	25	45				0		0			0													113.69		81.02	20	100	0.2		48	100	25	50.65		25	25	0	25	25	25	25	25	45				0		0			0													18.44	-	9.03	2.06	2.06	2.46	-	1.05	0.65	1.02	1.35	-	0.29	0.65	-	10.29	0	0.18	0	0.77	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.38	18.44	-	9.03	2.06	2.06	2.46	-	1.05	0.65	1.02	1.35	-	0.29	0.65	-	10.29	0	0.18	0	0.77	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.38
H5521_009_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	S																					3500																																										-	1986.62		1337.3	1237.69	246.96	12.38		262.1	78.19	491.98	319.72		141.57	312.87	5993.35	4994.48	0.84	86.92	0.21	373.07	285.6																					250 per admission		0 1-7 75 8-14 125 15-100	20	100	0		48	100	20	47.36		20	20	10	20	20	20	2000	20	45				0		0															40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45				0		0																40.78		81.02	20	100	0.2		48	100	20	47.36		20	20	10	20	20	20	20	20	45				0		0																6.75	-	9.03	2.06	2.06	2.48	-	1.05	0.65	0.82	1.26	-	0.24	0.52	4.99	8.32	0	0.14	0	0.62	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.07	6.75	-	9.03	2.06	2.06	2.48	-	1.05	0.65	0.82	1.26	-	0.24	0.52	4.99	8.32	0	0.14	0	0.62	1.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.07
H5521_801_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	Coin																					5000																																										-	1985.5		1392.45	1221.18	254.49	12.3		267.18	79.73	500.75	325.93		144.1	318.45	5404.16	4982.59	0.83	86.72	0.21	372.18	7.42																					200/day up to 7 days		35/day	35	150	0		50	150	35	46.97		35	35	35	35	35	35	3500	35	0.2																					143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																						143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																					0	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.58	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.48	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.58
H5521_802_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	Coin																					5000																																										-	1985.5		1392.45	1221.18	254.49	12.3		267.18	79.73	500.75	325.93		144.1	318.45	5404.16	4982.59	0.83	86.72	0.21	372.18	7.34																					200/day up to 7 days		35/day	35	150	0		50	150	35	46.97		35	35	35	35	35	35	3500	35	0.2																					143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																						143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																					0	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.57	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.57
H5521_803_0	2006																						D		D	V	T	Coin		P	P	P	P		P	P	V	V	V	V	V	V	Coin																					5000																																										-	1985.5		1392.45	1221.18	254.49	12.3		267.18	79.73	500.75	325.93		144.1	318.45	5404.16	4982.59	0.83	86.72	0.21	372.18	7.34																					200/day up to 7 days		35/day	35	150	0		50	150	35	46.97		35	35	35	35	35	35	3500	35	0.2																					143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																						143.69		35	35	150	0.3		50	150	35	46.97		35	35	35	35	35	35	35	35	0.2																					0	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.57	23.77	-	4.06	3.56	3.18	3.69	-	1.11	1	1.46	1.28	-	0.42	0.93	15.76	14.53	0	0.25	0	1.09	1.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	77.57
H5522_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other						1000	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	Coin	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	0	0	27.39	0	273.68	0	0	266.57	0	0	0	0	0	0	3708.75	4697.37	129.49	552.54	0	5.54	975.75	0	0	0	106.23	0	189.87	0	0	0	192.88	0	0	0	0	0.14								20 days 21+		25			50							10	25	Varies	10		25	Varies				10		15				25					50						0	0	0.05	0	25	0	0	50	0	0	0	0	0	0	10	25	15	10	0	25	34.47	0	0	0	10	0	15	0	0	0	25	0	0	0	0	50							0	0	0.04	0	23.3	0	0	46.61	0	0	0	0	0	0	9.32	23.3	13.98	9.32	0	23.3	32.13	0	0	0	9.32	0	15	0	0	0	23.3	0	0	0	0	46.61							-	-	1.19	-	0.53	-	-	1.04	-	-	-	-	-	-	2.88	9.12	0.15	0.43	-	0.01	2.61	-	-	-	0.08	-	0.24	-	-	-	0.37	-	-	-	-	0	-	-	-	-	-	18.66	-	-	1.19	-	0.53	-	-	1.04	-	-	-	-	-	-	2.88	9.12	0.15	0.43	-	0.01	2.61	-	-	-	0.08	-	0.24	-	-	-	0.37	-	-	-	-	0	-	-	-	-	-	18.66
H5522_002_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other						1800	Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						D	D	D	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	S	V	T	V	V	P	V	P	P	P	V	V	V	V	V	V																																																-	1799.95	0	821.28	0	258.98	9.21	5.53	240.45	352.1	0	459.33	0	0	0	3537.11	4373.22	126.94	509.33	420.79	5.73	923.59	0	0	0	106.23	0	0	0	0	0	0	0	0	0	82.41	0.13						50 days 1-5		25 days 8+		50	0	0	50	50		Varies				10	20	Varies	10	1500	20	Varies				20										15	50						35.5	0	14.75	0	50	0.15	0.15	50	50	0	15.02	0	0	0	10	20	24.78	10	15	20	27.2	0	0	0	20	0	0	0	0	0	0	0	0	0	15	50							31.52	0	13.1	0	50	0.15	0.15	50	44.4	0	13.34	0	0	0	10	20	24.78	8.88	15	20	27.2	0	0	0	20	0	0	0	0	0	0	0	0	0	15	50							4.73	-	0.9	-	1.08	1.38	0.83	1	1.3	-	0.51	-	-	-	2.95	7.29	0.26	0.38	0.53	0.01	2.09	-	-	-	0.18	-	-	-	-	-	-	-	-	-	0.1	0	-	-	-	-	-	25.51	4.73	-	0.9	-	1.08	1.38	0.83	1	1.3	-	0.51	-	-	-	2.95	7.29	0.26	0.38	0.53	0.01	2.09	-	-	-	0.18	-	-	-	-	-	-	-	-	-	0.1	0	-	-	-	-	-	25.51
H5522_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	P	P	V	V	V	Coin	V	V																																																-	2045.95	38.14	790.91	0	9.54	11.36	6.2	247.34	421.16	2.34	11.74	0	0.78	0	4324.68	5731.51	123.75	744.49	21.94	2.89	27.53	0	0	0	106.23	0	201.22	0	0	0	360.33	0	0	6.21	0	0						250 per admit	250 per admit	114 per day 21+		20 coins	20 coins	20 coins	50 per visit	100 per visit	20 coins	20 coins		20 coins		35 per visit	35 per visit	35 per visit	35 per visit	20 coins	35 per visit	20 coins				35 per visit		35 per visit				35 per visit			20 coins								45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11	7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11
H5522_802_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	P	P	V	V	V	Coin	V	V																																																-	2045.95	38.14	790.91	0	9.54	11.36	6.2	247.34	421.16	2.34	11.74	0	0.78	0	4324.68	5731.51	123.75	744.49	21.94	2.89	27.53	0	0	0	106.23	0	201.22	0	0	0	360.33	0	0	6.21	0	0						250 per admit	250 per admit	114 per day 21+		20 coins	20 coins	20 coins	50 per visit	100 per visit	20 coins	20 coins		20 coins		35 per visit	35 per visit	35 per visit	35 per visit	20 coins	35 per visit	20 coins				35 per visit		35 per visit				35 per visit			20 coins								45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11	7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11
H5522_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	P	P	V	V	V	Coin	V	V																																																-	2045.95	38.14	790.91	0	9.54	11.36	6.2	247.34	421.16	2.34	11.74	0	0.78	0	4324.68	5731.51	123.75	744.49	21.94	2.89	27.53	0	0	0	106.23	0	201.22	0	0	0	360.33	0	0	6.21	0	0						250 per admit	250 per admit	114 per day 21+		20 coins	20 coins	20 coins	50 per visit	100 per visit	20 coins	20 coins		20 coins		35 per visit	35 per visit	35 per visit	35 per visit	20 coins	35 per visit	20 coins				35 per visit		35 per visit				35 per visit			20 coins								45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11	7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11
H5522_804_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	P	P	V	V	V	Coin	V	V																																																-	2045.95	38.14	790.91	0	9.54	11.36	6.2	247.34	421.16	2.34	11.74	0	0.78	0	4324.68	5731.51	123.75	744.49	21.94	2.89	27.53	0	0	0	106.23	0	201.22	0	0	0	360.33	0	0	6.21	0	0						250 per admit	250 per admit	114 per day 21+		20 coins	20 coins	20 coins	50 per visit	100 per visit	20 coins	20 coins		20 coins		35 per visit	35 per visit	35 per visit	35 per visit	20 coins	35 per visit	20 coins				35 per visit		35 per visit				35 per visit			20 coins								45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11	7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11
H5522_805_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	P	P	V	V	V	Coin	V	V																																																-	2045.95	38.14	790.91	0	9.54	11.36	6.2	247.34	421.16	2.34	11.74	0	0.78	0	4324.68	5731.51	123.75	744.49	21.94	2.89	27.53	0	0	0	106.23	0	201.22	0	0	0	360.33	0	0	6.21	0	0						250 per admit	250 per admit	114 per day 21+		20 coins	20 coins	20 coins	50 per visit	100 per visit	20 coins	20 coins		20 coins		35 per visit	35 per visit	35 per visit	35 per visit	20 coins	35 per visit	20 coins				35 per visit		35 per visit				35 per visit			20 coins								45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11	7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11
H5522_806_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	OP Facility - Other							Lab - Copay	Radiology - Copay	Lab - Copay	Radiology - Copay	Urgent Care						A	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	V	P	P	P	V	V	V	Coin	V	V																																																-	2045.95	38.14	790.91	0	9.54	11.36	6.2	247.34	421.16	2.34	11.74	0	0.78	0	4324.68	5731.51	123.75	744.49	21.94	2.89	27.53	0	0	0	106.23	0	201.22	0	0	0	360.33	0	0	6.21	0	0						250 per admit	250 per admit	114 per day 21+		20 coins	20 coins	20 coins	50 per visit	100 per visit	20 coins	20 coins		20 coins		35 per visit	35 per visit	35 per visit	35 per visit	20 coins	35 per visit	20 coins				35 per visit		35 per visit				35 per visit			20 coins								45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							45.42	121.19	31.81	0	0.2	0.2	0.2	50	100	0.2	0.2	0	0.2	0	35	35	35	35	0.2	35	0.2	0	0	0	35	0	35	0	0	0	35	0	0	0.2	0	0							7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11	7.74	0.39	2.1	-	1.91	2.27	1.24	1.03	3.51	0.47	2.35	-	0.16	-	12.61	16.72	0.36	2.17	4.39	0.01	5.51	-	-	-	0.31	-	0.59	-	-	-	1.05	-	-	1.24	-	-	-	-	-	-	-	68.11
H5523_001_0	2006																											coin	coin																																																																													-	1539.7	129.69	2126.06	478.58	332.75	4.96	2.48	339.46	258.62	0	595.19	0	46.51	1810.92	0	0	275.72	0	3855.03	29635.45	0	1026.61	0	0	95.23	83.05																																																																																																			38.86	38.86	5	0	0	0.2	0.2	37.14	100	0	0	0	0	2.23	0	0	20	0	0	4.45	0	0.36	0	0	15	0																	4.99	0.42	0.89	-	-	0.99	0.5	1.05	2.16	-	-	-	-	0.34	-	-	0.46	-	-	10.99	-	0.03	-	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.92	4.99	0.42	0.89	-	-	0.99	0.5	1.05	2.16	-	-	-	-	0.34	-	-	0.46	-	-	10.99	-	0.03	-	-	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.92
H5524_001_0	2006	Ambulance										2000	Air										D		D		T	Coin		P	P		P				V	V	V				Coin	O	T		V							T										0																																										-	1177.86		1194.31		99.66	7.05		311.6	307.18		448.16	27.79			7813.03	1881.75	260.55				28.97	25.48	397.03		185.28							2.9										100/D first 10 Days		0/D (0-10 Days); 25 (11-90 Days)		100 CP/Trip (0 admit)	20 Coins. 1K OP max		50 CP / Visit	200 CP / Surg		150 CP / (MRI CT Test)	100/D first 10 Days; 2K OP			10 CP / Visit	30 CP / Visit	30 CP / Visit				20 Coins. 1K OP max	100/D first 10 Days	3.50 / Trip		30 CP / Visit							250 CP / Trip										100		25		100	0.2		50	200		150	100			10	30	30				0.2	100	3.5		30							250										2000	100		25		100	0.2		50	200		150	100			10	30	30				0.2	100	3.5		30							250											9.82	-	2.49	-	0.83	1.41	-	1.3	5.12	-	5.6	0.23	-	-	6.51	4.7	0.65	-	-	-	5.79	0.21	0.12	-	0.46	-	-	-	-	-	-	0.06	-	-	-	-	-	-	-	-	-	45.31	9.82	-	2.49	-	0.83	1.41	-	1.3	5.12	-	5.6	0.23	-	-	6.51	4.7	0.65	-	-	-	5.79	0.21	0.12	-	0.46	-	-	-	-	-	-	0.06	-	-	-	-	-	-	-	-	-	45.31
H5525_001_0	2006											1000											A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V															2400																																										-	284.84	3.77			0.23	11.95	6.23	319.77				0.32		133.86	4012.87	3134.41	285.59			0	38.25	681.07	0.07	0.23	67.7		17.29																																																													0.1															0.1																						150	150	0	0	50	0.09	0.1	49.01	0	0	0	20	0	20	10	15	20	0	0	15	0.09	15	25	30	12.5	0	12.5	0	0	0	0											0	3.56	0.05	-	-	0	1.08	0.62	1.31	-	-	-	0	-	0.22	3.34	3.92	0.48	-	-	-	3.44	0.85	0	0	0.07	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.96	3.56	0.05	-	-	0	1.08	0.62	1.31	-	-	-	0	-	0.22	3.34	3.92	0.48	-	-	-	3.44	0.85	0	0	0.07	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.96
H5525_002_0	2006											1000											A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V															2400																																										-	284.84	3.77			0.23	11.95	6.23	319.77				0.32		133.86	4012.87	3134.41	285.59			0	38.25	681.07	0.07	0.23	67.7		17.29																																																													0.1															0.1																						150	150	0	0	50	0.09	0.1	49.01	0	0	0	20	0	20	10	15	20	0	0	15	0.09	15	25	30	12.5	0	12.5	0	0	0	0											0	3.56	0.05	-	-	0	1.08	0.62	1.31	-	-	-	0	-	0.22	3.34	3.92	0.48	-	-	-	3.44	0.85	0	0	0.07	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.96	3.56	0.05	-	-	0	1.08	0.62	1.31	-	-	-	0	-	0.22	3.34	3.92	0.48	-	-	-	3.44	0.85	0	0	0.07	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.96
H5525_003_0	2006											1000											A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	Coin	V		V															2400																								5.81																		5.81	284.84	3.77			0.23	11.95	6.23	319.77				0.32		133.86	4012.87	3134.41	285.59			0	38.25	681.07	0.07	35.95	74.47		17.29																																																													0.1															0.1																						150	150	0	0	50	0.09	0.1	49.01	0	0	0	20	0	20	10	15	20	0	0	15	0.09	15	25	0.43	12.5	0	12.5	0	0	0	0											0	3.56	0.05	-	-	0	1.08	0.62	1.31	-	-	-	0	-	0.22	3.34	3.92	0.48	-	-	-	3.44	0.85	0	15.45	0.08	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.41	3.56	0.05	-	-	0	1.08	0.62	1.31	-	-	-	0	-	0.22	3.34	3.92	0.48	-	-	-	3.44	0.85	0	21.26	0.08	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.22
H5525_004_0	2006											1000											A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V															2400																																										-	284.84	3.77			0.23	11.95	6.23	319.77				0.32		133.86	4012.87	3134.41	285.59			0	38.25	681.07	0.07	0.23	67.7		17.29																																																													0.1															0.1																						150	150	0	0	50	0.09	0.1	49.01	0	0	0	20	0	20	10	15	20	0	0	15	0.09	15	25	30	12.5	0	12.5	0	0	0	0											0	3.56	0.05	-	-	0	1.08	0.62	1.31	-	-	-	0	-	0.22	3.34	3.92	0.48	-	-	-	3.44	0.85	0	0	0.07	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.96	3.56	0.05	-	-	0	1.08	0.62	1.31	-	-	-	0	-	0.22	3.34	3.92	0.48	-	-	-	3.44	0.85	0	0	0.07	-	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.96
H5525_801_0	2006											1000											A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V															2400																																										-	284.14	3.76			0.23	11.95	6.23	319.15				0.32		133.85	3944.49	3081	280.72				38.25	659.21	0.07	0.23	65.15		16.72																																																													0.2															0.2																						300	300	0	0	50	0.18	0.2	49.26	0	0	0	30	0	30	20	30	30	0	0	30	0.18	30	25	30	25	0	25	0	0	0	0												7.1	0.09	-	-	0	2.15	1.25	1.31	-	-	-	0	-	0.33	6.57	7.7	0.7	-	-	-	6.89	1.65	0	0	0.14	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.92	7.1	0.09	-	-	0	2.15	1.25	1.31	-	-	-	0	-	0.33	6.57	7.7	0.7	-	-	-	6.89	1.65	0	0	0.14	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.92
H5525_802_0	2006											1000											A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V															2400																																										-	284.14	3.76			0.23	11.95	6.23	319.15				0.32		133.85	3944.49	3081	280.72				38.25	659.21	0.07	0.23	65.15		16.72																																																													0.2															0.2																						300	300	0	0	50	0.18	0.2	49.26	0	0	0	30	0	30	20	30	30	0	0	30	0.18	30	25	30	25	0	25	0	0	0	0												7.1	0.09	-	-	0	2.15	1.25	1.31	-	-	-	0	-	0.33	6.57	7.7	0.7	-	-	-	6.89	1.65	0	0	0.14	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.92	7.1	0.09	-	-	0	2.15	1.25	1.31	-	-	-	0	-	0.33	6.57	7.7	0.7	-	-	-	6.89	1.65	0	0	0.14	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.92
H5525_805_0	2006											1000											A	A			T	Coin	Coin	V				V		V	V	V	V				Coin	V	T	V	V		V															2400																																										-	284.14	3.76			0.23	11.95	6.23	319.15				0.32		133.85	3944.49	3081	280.72				38.25	659.21	0.07	0.23	65.15		16.72																																																													0.2															0.2																						300	300	0	0	50	0.18	0.2	49.26	0	0	0	30	0	30	20	30	30	0	0	30	0.18	30	25	30	25	0	25	0	0	0	0												7.1	0.09	-	-	0	2.15	1.25	1.31	-	-	-	0	-	0.33	6.57	7.7	0.7	-	-	-	6.89	1.65	0	0	0.14	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.92	7.1	0.09	-	-	0	2.15	1.25	1.31	-	-	-	0	-	0.33	6.57	7.7	0.7	-	-	-	6.89	1.65	0	0	0.14	-	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	35.92
H5526_001_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	256.69	13.71	13.24	43.91	703.75	6.13	2.97	290.44	286.02	709.89	1883.15	7.92	0	936.49	4792.23	5946.65	2.33	797.14	1068.69	1343.37	3.83				0	663.18	14.89																																																								250	250	250	15	50	0.3	0.3	50	100	100	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															none	250	250	250	15	50	0.3	0.3	50	100	100	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15																5.35	0.29	0.28	0.05	2.93	1.84	0.89	1.21	2.38	5.92	2.35	3.96	-	1.17	5.99	7.43	1.16	1	1.34	1.68	0.77	-	-	-	-	0.83	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.83	5.35	0.29	0.28	0.05	2.93	1.84	0.89	1.21	2.38	5.92	2.35	3.96	-	1.17	5.99	7.43	1.16	1	1.34	1.68	0.77	-	-	-	-	0.83	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.83
H5526_002_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	282.45	2.96	60.08	107.93	826.96	13.36	1.05	253.5	482	709.93	2.37	0.06	0.12	849.21	5259.88	4678.21	0.02	568.24	1493.65	1460.38	0				0	809.86	0.48																																																								250	250	250	15	50	0.3	0.3	50	15	15	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															none	250	250	250	15	50	0.3	0.3	50	15	15	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15																5.88	0.06	1.25	0.13	3.45	4.01	0.31	1.06	0.6	0.89	0	0.03	0	1.06	6.57	5.85	0.01	0.71	1.87	1.83	0	-	-	-	-	1.01	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.59	5.88	0.06	1.25	0.13	3.45	4.01	0.31	1.06	0.6	0.89	0	0.03	0	1.06	6.57	5.85	0.01	0.71	1.87	1.83	0	-	-	-	-	1.01	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.59
H5526_003_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	255.2	13.63	13.16	43.66	699.65	6.1	2.96	288.75	284.36	705.75	1872.18	7.87	0	931.03	4764.31	5911.99	2.32	792.5	1062.46	1335.55	3.81				0	659.31	14.81																																																								250	250	250	15	50	0.3	0.3	50	100	100	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															none	250	250	250	15	50	0.3	0.3	50	100	100	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															0	5.32	0.28	0.27	0.05	2.92	1.83	0.89	1.2	2.37	5.88	2.34	3.94	-	1.16	5.96	7.39	1.16	0.99	1.33	1.67	0.76	-	-	-	-	0.82	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.55	5.32	0.28	0.27	0.05	2.92	1.83	0.89	1.2	2.37	5.88	2.34	3.94	-	1.16	5.96	7.39	1.16	0.99	1.33	1.67	0.76	-	-	-	-	0.82	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.55
H5526_004_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	295.67	6.11	59.81	95.89	1212.32	14.69	1.23	256.56	509.31	763.49	0.88	0.05	0	787.4	5526.07	4881.81	0.01	533.91	1548.35	1452.78	0				0	731.8	0																																																								250	250	250	15	50	0.3	0.3	50	15	15	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															none	250	250	250	15	50	0.3	0.3	50	15	15	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															0	6.16	0.13	1.25	0.12	5.05	4.41	0.37	1.07	0.64	0.95	0	0.03	-	0.98	6.91	6.1	0	0.67	1.94	1.82	0	-	-	-	-	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.5	6.16	0.13	1.25	0.12	5.05	4.41	0.37	1.07	0.64	0.95	0	0.03	-	0.98	6.91	6.1	0	0.67	1.94	1.82	0	-	-	-	-	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.5
H5526_005_0	2006											none												A	Coin		T	Coin	Coin	V	V			Coin	V	V							Coin																					none																																										-		2.21	35.12		826.96	13.5	1.06	253.5	424.16			0.07	0.09	731.06							5.01																							Oct-40																																								500	0.17		50	0.2	0.2	50	50			0.5	20	50							0.2																					none		500	0.17		50	0.2	0.2	50	50			0.5	20	50							0.2																						-	0.09	6.04	-	3.45	2.7	0.21	1.06	1.77	-	-	0.04	0	3.05	-	-	-	-	-	-	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.39	-	0.09	6.04	-	3.45	2.7	0.21	1.06	1.77	-	-	0.04	0	3.05	-	-	-	-	-	-	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.39
H5526_006_0	2006											none												A	Coin		T	Coin	Coin	V	V			Coin	V	V							Coin																					none																																										-		2.21	35.12		826.96	13.5	1.06	253.5	424.16			0.07	0.09	731.06							5.01																							Oct-40																																								500	0.17		50	0.2	0.2	50	50			0.5	20	50							0.2																					none		500	0.17		50	0.2	0.2	50	50			0.5	20	50							0.2																						-	0.09	6.04	-	3.45	2.7	0.21	1.06	1.77	-	-	0.04	0	3.05	-	-	-	-	-	-	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.39	-	0.09	6.04	-	3.45	2.7	0.21	1.06	1.77	-	-	0.04	0	3.05	-	-	-	-	-	-	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.39
H5526_007_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	255.2	13.63	13.16	43.66	699.65	6.1	2.96	288.75	284.36	705.75	1872.18	7.87	0	931.03	4764.31	5911.99	2.32	792.5	1062.46	1335.55	3.81				0	659.31	14.81																																																								250	250	250	15	50	0.3	0.3	50	100	100	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															none	250	250	250	15	50	0.3	0.3	50	100	100	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															0	5.32	0.28	0.27	0.05	2.92	1.83	0.89	1.2	2.37	5.88	2.34	3.94	-	1.16	5.96	7.39	1.16	0.99	1.33	1.67	0.76	-	-	-	-	0.82	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.55	5.32	0.28	0.27	0.05	2.92	1.83	0.89	1.2	2.37	5.88	2.34	3.94	-	1.16	5.96	7.39	1.16	0.99	1.33	1.67	0.76	-	-	-	-	0.82	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.55
H5526_008_0	2006											none											A	A	A	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	Coin	V	V	V	Coin				V	V	V															none																																										-	295.44	6.11	59.77	95.82	1211.38	14.68	1.22	256.36	508.92	762.9	0.88	0.05	0	786.79	5521.79	4878.03	0.01	533.5	1547.15	1451.65	0				0	731.24	0																																																								250	250	250	15	50	0.3	0.3	50	15	15	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															none	250	250	250	15	50	0.3	0.3	50	15	15	15	0.5	15	15	15	15	0.5	15	15	15	0.2				15	15	15															0	6.16	0.13	1.25	0.12	5.05	4.4	0.37	1.07	0.64	0.95	0	0.03	-	0.98	6.9	6.1	0	0.67	1.93	1.81	0	-	-	-	-	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.47	6.16	0.13	1.25	0.12	5.05	4.4	0.37	1.07	0.64	0.95	0	0.03	-	0.98	6.9	6.1	0	0.67	1.93	1.81	0	-	-	-	-	0.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.47
H5527_001_0	2006											3800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2538.65	147.79	1264.99	0	258.82	13.74	6.84	648.48	69.53	11774.94	52.96	0	0.53	0.57	4040.02	4265.45	621.04	5.58	0	0	11.63	1498.69	0	0	110.4	0	217.36	0														280	17500	120	0	100	0	0	50	0	0	0 / 20	20 (included in g.)	0.2	20 / 40 / 30	Oct-00	20	40 / 30	0	0	0	0.2	0 / 20			20		20															280	175	120		100	0.2	0.2	50	0.2	0	0.13		0.2	0.16	10	20	37.5	0.2			0.2	20			20	0	20																158.71	99.19	68.02	0	56.68	0.11	0.14	28.34	0.11	0	0.08	0	0.11	0.1	10	20	37.5	0.11	0	0	0.11	20	0	0	20	0	18.72	0															33.58	1.22	7.17	-	1.22	1.56	0.92	1.53	7.88	-	3.98	-	0.06	0.05	3.37	7.11	1.94	0.63	-	-	1.32	2.5	-	-	0.18	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.57	33.58	1.22	7.17	-	1.22	1.56	0.92	1.53	7.88	-	3.98	-	0.06	0.05	3.37	7.11	1.94	0.63	-	-	1.32	2.5	-	-	0.18	-	0.34	-	-	-	-	-	-	-	-	-	-	-	-	-	-	76.57
H5528_001_0	2006											Unlimited											A	A	D	V	T	Coin		V	V	V	V			V	V	V	V	V	V	V	Coin					V																Unlimited																																										-	251.84	12.75	537.25	1670.28	163.55	4.1		227.36	238.43	478.53	30.99			58.39	3456.52	3275.51	291.94	635.73	297.42	2528.82	2.11					207.08																		100 days per benefit period								20 Copay for Radiation Therapy			10 Copay for Outpatient Rehab Outpatient Substance Abuse																																																																					Unlimited	0	0	0	0	50	0.2	0.2	50	0	0	20			10	0	10	10	10	10	10	0.2					10																0	-	-	-	-	0.68	0.82	-	0.95	-	-	0.05	-	-	0.05	-	2.73	0.24	0.53	0.25	2.11	0.42	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9	-	-	-	-	0.68	0.82	-	0.95	-	-	0.05	-	-	0.05	-	2.73	0.24	0.53	0.25	2.11	0.42	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	9
H5528_002_0	2006											Unlimited											A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin					V																Unlimited																																										-	246.22	12.47	525.26	1633.01	159.9	4.01		222.29	233.11	467.86	30.3			57.09	3379.4	3202.43	285.42	621.54	290.79	2472.4	2.06					202.46																	100 Per day day 1-5	100 days per benefit period								20 Copay for Radiation Therapy			20 Copay for Outpatient Rehab Outpatient Substance Abuse																																																																					Unlimited	0	450	50	0	50	0.2	0.2	50	70	0	20			20	0	20	25	20	20	20	0.2					10																0	-	0.47	2.19	-	0.67	0.8	-	0.93	1.36	-	0.05	-	-	0.1	-	5.34	0.59	1.04	0.48	4.12	0.41	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.71	-	0.47	2.19	-	0.67	0.8	-	0.93	1.36	-	0.05	-	-	0.1	-	5.34	0.59	1.04	0.48	4.12	0.41	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	18.71
H5528_003_0	2006											Unlimited											A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin					V																Unlimited																																										-	246.22	12.47	525.26	1633.01	159.9	4.01		222.29	233.11	467.86	30.3			57.09	3379.4	3202.43	285.42	621.54	290.79	2472.4	2.06					202.46																50 Per day day 1-5	100 Per day day 1-5	100 days per benefit period								20 Copay for Radiation Therapy			20 Copay for Outpatient Rehab Outpatient Substance Abuse																																																																					Unlimited	200	450	50	10	50	0.2	0.2	50	70	0	20			20	10	20	25	20	20	20	0.2					10																0	4.1	0.47	2.19	1.36	0.67	0.8	-	0.93	1.36	-	0.05	-	-	0.1	2.82	5.34	0.59	1.04	0.48	4.12	0.41	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.99	4.1	0.47	2.19	1.36	0.67	0.8	-	0.93	1.36	-	0.05	-	-	0.1	2.82	5.34	0.59	1.04	0.48	4.12	0.41	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.99
H5528_004_0	2006											Unlimited											A	A	D	V	T	Coin		V	V	V	V			V	V	V	V	V	V	V	Coin					V																Unlimited																																										-	250.21	14.69	604.57	1401.33	183.88	4.13		227.25	227.71	431.5	35.77			56.37	3375.86	3192.19	309.59	566.7	513.76	2514.31	2.23					198.79																50 Per day day 1-5	100 Per day day 1-5	100 days per benefit period								20 Copay for Radiation Therapy			20 Copay for Outpatient Rehab Outpatient Substance Abuse																																																																					Unlimited	200	450	25	0	50	0.2		50	75	0	20			20	0	20	20	20	25	20	0.2					10																0	4.17	0.55	1.26	-	0.77	0.83	-	0.95	1.42	-	0.06	-	-	0.09	-	5.32	0.52	0.94	1.07	4.19	0.45	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.75	4.17	0.55	1.26	-	0.77	0.83	-	0.95	1.42	-	0.06	-	-	0.09	-	5.32	0.52	0.94	1.07	4.19	0.45	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.75
H5528_005_0	2006											Unlimited											A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin					V																Unlimited																																										-	250.22	14.69	604.57	1401.33	183.88	4.13		227.25	227.71	431.5	35.77			56.37	3375.86	3192.19	309.59	566.7	513.76	2514.31	2.23					198.79																50 Per day day 1-5	100 Per day day 1-5	100 for days 21-100								20 Copay for Radiation Therapy			20 Copay for Outpatient Rehab Outpatient Substance Abuse																																																																					Unlimited	200	450	22.3	10	50	0.2	0.2	50	100	0	20			20	10	20	25	20	20	20	0.2					10																0	4.17	0.55	1.12	1.17	0.77	0.83	-	0.95	1.9	-	0.06	-	-	0.09	2.81	5.32	0.64	0.94	0.86	4.19	0.45	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.98	4.17	0.55	1.12	1.17	0.77	0.83	-	0.95	1.9	-	0.06	-	-	0.09	2.81	5.32	0.64	0.94	0.86	4.19	0.45	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.98
H5528_008_0	2006											Unlimited											A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin					V																Unlimited																																										-	250.22	14.69	604.57	1401.33	183.88	4.13		227.25	227.71	431.5	35.77			56.37	3375.86	3192.19	309.59	566.7	513.76	2514.31	2.23					198.79																50 Per day day 1-5	100 Per day day 1-5	100 for days 21-100								20 Copay for Radiation Therapy			20 Copay for Outpatient Rehab Outpatient Substance Abuse																																																																					Unlimited	200	450	22.3	10	50	0.2	0.2	50	50	0	20			20	10	20	25	20	20	20	0.2					10																0	4.17	0.55	1.12	1.17	0.77	0.83	-	0.95	0.95	-	0.06	-	-	0.09	2.81	5.32	0.64	0.94	0.86	4.19	0.45	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.03	4.17	0.55	1.12	1.17	0.77	0.83	-	0.95	0.95	-	0.06	-	-	0.09	2.81	5.32	0.64	0.94	0.86	4.19	0.45	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	26.03
H5528_801_0	2006											Unlimited											Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					Unlimited																																										-	263.3	6.4	19.51	9.46	2.06	4.2		222.29	26.4	11.52	14.43			14.19	27.91	88.29	2.12	6.32	29.11	47.04	2.13																					Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	119.5 for Days 21-100																																							0.05	0.05	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					Unlimited	0.05	0.05	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						14.35	0.35	3.17	-	0.48	0.98	-	0.93	6.15	2.68	3.36	-	-	3.31	6.5	20.57	0.49	1.47	6.78	10.96	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.03	14.35	0.35	3.17	-	0.48	0.98	-	0.93	6.15	2.68	3.36	-	-	3.31	6.5	20.57	0.49	1.47	6.78	10.96	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.03
H5528_802_0	2006											Unlimited											Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					Unlimited																																										-	263.3	6.4	19.51	9.46	2.06	4.2		222.29	26.4	11.52	14.43			14.19	27.91	88.29	2.12	6.32	29.11	47.04	2.13																					Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	119.5 for Days 21-100																																							0.05	0.05	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					Unlimited	0.05	0.05	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						14.35	0.35	3.17	-	0.48	0.98	-	0.93	6.15	2.68	3.36	-	-	3.31	6.5	20.57	0.49	1.47	6.78	10.96	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.03	14.35	0.35	3.17	-	0.48	0.98	-	0.93	6.15	2.68	3.36	-	-	3.31	6.5	20.57	0.49	1.47	6.78	10.96	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.03
H5528_803_0	2006											Unlimited											Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					Unlimited																																										-	207.8	7.11	21.64	8.5	2.42	4.13		227.25	21.48	8.04	14.66			12.72	27.02	87.4	2.49	5.77	31.76	46.66	2.23																					Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	119.5 for Days 21-100																																							0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					Unlimited	0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						13.12	0.45	3.75	-	0.56	0.96	-	0.95	5	1.87	3.42	-	-	2.96	6.3	20.36	0.58	1.34	7.4	10.87	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.42	13.12	0.45	3.75	-	0.56	0.96	-	0.95	5	1.87	3.42	-	-	2.96	6.3	20.36	0.58	1.34	7.4	10.87	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.42
H5528_804_0	2006											Unlimited											Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					Unlimited																																										-	207.8	7.11	21.64	8.5	2.42	4.13		227.25	21.48	8.04	14.66			12.72	27.02	87.4	2.49	5.77	31.76	46.66	2.23																					Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	119.5 for Days 21-100																																							0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					Unlimited	0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						13.12	0.45	3.75	-	0.56	0.96	-	0.95	5	1.87	3.42	-	-	2.96	6.3	20.36	0.58	1.34	7.4	10.87	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.42	13.12	0.45	3.75	-	0.56	0.96	-	0.95	5	1.87	3.42	-	-	2.96	6.3	20.36	0.58	1.34	7.4	10.87	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.42
H5528_805_0	2006											Unlimited											Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					Unlimited																																										-	263.3	6.4	19.51	9.46	2.06	4.2		222.29	26.4	11.52	14.43			14.19	27.91	88.29	2.12	6.32	29.11	47.04	2.13																					Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	119.5 for Days 21-100																																							0.05	0.05	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					Unlimited	0.05	0.05	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						14.35	0.35	3.17	-	0.48	0.98	-	0.93	6.15	2.68	3.36	-	-	3.31	6.5	20.57	0.49	1.47	6.78	10.96	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.03	14.35	0.35	3.17	-	0.48	0.98	-	0.93	6.15	2.68	3.36	-	-	3.31	6.5	20.57	0.49	1.47	6.78	10.96	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.03
H5528_806_0	2006											Unlimited											Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					Unlimited																																										-	263.3	6.4	19.51	9.46	2.06	4.2		222.29	26.4	11.52	14.43			14.19	27.91	88.29	2.12	6.32	29.11	47.04	2.13																					Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	119.5 for Days 21-100																																							0.05	0.05	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					Unlimited	0.05	0.05	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						14.35	0.35	3.17	-	0.48	0.98	-	0.93	6.15	2.68	3.36	-	-	3.31	6.5	20.57	0.49	1.47	6.78	10.96	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.03	14.35	0.35	3.17	-	0.48	0.98	-	0.93	6.15	2.68	3.36	-	-	3.31	6.5	20.57	0.49	1.47	6.78	10.96	0.5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	83.03
H5528_807_0	2006											Unlimited											Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					Unlimited																																										-	207.8	7.11	21.64	8.5	2.42	4.13		227.25	21.48	8.04	14.66			12.72	27.02	87.4	2.49	5.77	31.76	46.66	2.23																					Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	119.5 for Days 21-100																																							0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					Unlimited	0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						13.12	0.45	3.75	-	0.56	0.96	-	0.95	5	1.87	3.42	-	-	2.96	6.3	20.36	0.58	1.34	7.4	10.87	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.42	13.12	0.45	3.75	-	0.56	0.96	-	0.95	5	1.87	3.42	-	-	2.96	6.3	20.36	0.58	1.34	7.4	10.87	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.42
H5528_808_0	2006											Unlimited											Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					Unlimited																																										-	207.8	7.11	21.64	8.5	2.42	4.13		227.25	21.48	8.04	14.66			12.72	27.02	87.4	2.49	5.77	31.76	46.66	2.23																					Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	Deductible for days 1-60: 956; Days 61-90:239 per day; Days 91-150:478 per day	119.5 for Days 21-100																																							0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					Unlimited	0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																						13.12	0.45	3.75	-	0.56	0.96	-	0.95	5	1.87	3.42	-	-	2.96	6.3	20.36	0.58	1.34	7.4	10.87	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.42	13.12	0.45	3.75	-	0.56	0.96	-	0.95	5	1.87	3.42	-	-	2.96	6.3	20.36	0.58	1.34	7.4	10.87	0.52	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	80.42
H5529_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	300.58	5	283.77		237	9.42	3.18	273.09	352.72	647.9	945.75	40.13	101.5	0.48	4841.19	1573.19	5.32	375.76			202.39				21.95		144.35					760.59	19.86	89.16	330.98	95.9	0.03	726.84	2.88			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels				50 max		50 max					20 copay	50 copay	20 copay	20 copay	20 copay	20 coinsurance	20 copay	20 copay			750	750	75		75	0.2	0.2	50	250	51.31	59.45	250	34.28	20	20	20	20	20			26.71				50		50					20	50	20	20	20	0.2	20	20			4000	602.59	670.82	72.12		72.12	0.2	0.2	48.08	240.41	49.34	57.17	240.41	32.97	19.23	19.23	19.23	19.23	19.23			25.69				48.08		48.08					19.23	48.08	19.23	19.23	19.23	0.2	19.23	19.23			0	15.09	0.28	1.71	-	1.42	1.88	0.64	1.09	7.07	2.66	4.51	0.8	0.28	0	7.76	2.52	0.01	0.6	-	-	0.43	-	-	-	0.09	-	0.58	-	-	-	-	1.22	0.08	0.14	0.53	0.15	0.01	1.16	0	-	-	52.73	15.09	0.28	1.71	-	1.42	1.88	0.64	1.09	7.07	2.66	4.51	0.8	0.28	0	7.76	2.52	0.01	0.6	-	-	0.43	-	-	-	0.09	-	0.58	-	-	-	-	1.22	0.08	0.14	0.53	0.15	0.01	1.16	0	-	-	52.73
H5529_002_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	1788.49	39.34	284.73		237.7	9.4	3.18	273.86	353.64	649.91	948.14	40.26	101.14	0.5	4998.09	1623.18	5.52	387.03			202.97				21.99		144.65					785.13	19.91	90.74	342.15	98.85	0.03	751.49	2.99			175/day with 1750 yearly max	175/day with 1750 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	175 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	175 copay	15/35 copay for in-home/facility	15 Copay	15 Copay	15 Copay	15 Copay	15 Copay			15/40/30/80 copay levels				50 max		50 max					15 Copay	50 copay	15 Copay	15 Copay	15 Copay	20 coinsurance	15 Copay	15 Copay			175	175	75		75	0.2	0.2	50	175	51.31	59.45	175	34.28	15	15	15	15	15			26.22				50		50					15	50	15	15	15	0.2	15	15			4000	106.54	131.54	71.85		71.85	0.2	0.2	47.9	167.66	49.16	56.96	167.66	32.84	14.37	14.37	14.37	14.37	14.37			25.12				47.9		47.9					14.37	47.9	14.37	14.37	14.37	0.2	14.37	14.37				15.88	0.43	1.7	-	1.42	1.88	0.64	1.09	4.94	2.66	4.5	0.56	0.28	0	5.99	1.94	0.01	0.46	-	-	0.42	-	-	-	0.09	-	0.58	-	-	-	-	0.94	0.08	0.11	0.41	0.12	0.01	0.9	0	-	-	48.05	15.88	0.43	1.7	-	1.42	1.88	0.64	1.09	4.94	2.66	4.5	0.56	0.28	0	5.99	1.94	0.01	0.46	-	-	0.42	-	-	-	0.09	-	0.58	-	-	-	-	0.94	0.08	0.11	0.41	0.12	0.01	0.9	0	-	-	48.05
H5529_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			none																																										-	297.56	3.32	315.94		254.97	8.69	3.94	235.15	438.52	659.52	1146.03	40.3	61.94	0	5421.05	1895.41	0.91	678.5			232.85											783.03	24.41	87.13	427.51	122.22	0.03	847.11	5.21			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels											20 copay	50 copay	20 copay	20 copay	20 copay	20 coinsurance	20 copay	20 copay			750	750	75		75	0.2	0.2	50	250	51.72	59.66	250	35	20	20	20	20	20			30.66											20	50	20	20	20	0.2	20	20			4000	601.89	700.81	72.34		72.34	0.2	0.2	48.23	241.14	49.88	57.55	241.14	33.76	19.29	19.29	19.29	19.29	19.29			29.57											19.29	48.23	19.29	19.29	19.29	0.2	19.29	19.29				14.93	0.19	1.9	-	1.54	1.74	0.79	0.95	8.81	2.74	5.5	0.81	0.17	-	8.71	3.05	0	1.09	-	-	0.57	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.36	0.01	-	-	57.25	14.93	0.19	1.9	-	1.54	1.74	0.79	0.95	8.81	2.74	5.5	0.81	0.17	-	8.71	3.05	0	1.09	-	-	0.57	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.36	0.01	-	-	57.25
H5529_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			none																																										-	297.56	3.32	315.94		254.97	8.69	3.94	235.15	438.52	659.52	1146.03	40.3	61.94	0	5421.05	1895.41	0.91	678.5			232.85											783.03	24.41	87.13	427.51	122.22	0.03	847.11	5.21			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels											20 copay	50 copay	20 copay	20 copay	20 copay	20 coinsurance	20 copay	20 copay			750	750	75		75	0.2	0.2	50	250	51.72	59.66	250	35	20	20	20	20	20			30.66											20	50	20	20	20	0.2	20	20			4000	601.89	700.81	72.34		72.34	0.2	0.2	48.23	241.14	49.88	57.55	241.14	33.76	19.29	19.29	19.29	19.29	19.29			29.57											19.29	48.23	19.29	19.29	19.29	0.2	19.29	19.29				14.93	0.19	1.9	-	1.54	1.74	0.79	0.95	8.81	2.74	5.5	0.81	0.17	-	8.71	3.05	0	1.09	-	-	0.57	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.36	0.01	-	-	57.25	14.93	0.19	1.9	-	1.54	1.74	0.79	0.95	8.81	2.74	5.5	0.81	0.17	-	8.71	3.05	0	1.09	-	-	0.57	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.36	0.01	-	-	57.25
H5530_001_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	299.87	4.84	274.05		234.35	9.44	3.17	271.4	354.19	634.86	953.55	39.2	132.92	0.45	4839.14	1583.71	5.03	385.78			200.58				23.6		148.91					761.41	20.16	103.82	325.85	103.86	0.02	714.23	2.73			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels				50 max		50 max					20 copay	50 copay	20 copay	20 copay	20 copay	20 coinsurance	20 copay	20 copay			750	750	75		75	0.2	0.2	50	250	51.35	59.65	250	31.64	20	20	20	20	20			26.93				50		50					20	50	20	20	20	0.2	20	20			4000	603.14	673.3	72.12		72.12	0.2	0.2	48.08	240.41	49.38	57.37	240.41	30.43	19.23	19.23	19.23	19.23	19.23			25.9				48.08		48.08					19.23	48.08	19.23	19.23	19.23	0.2	19.23	19.23			0	15.07	0.27	1.65	-	1.41	1.89	0.63	1.09	7.1	2.61	4.56	0.79	0.34	0	7.76	2.54	0.01	0.62	-	-	0.43	-	-	-	0.09	-	0.6	-	-	-	-	1.22	0.08	0.17	0.52	0.17	0	1.14	0	-	-	52.75	15.07	0.27	1.65	-	1.41	1.89	0.63	1.09	7.1	2.61	4.56	0.79	0.34	0	7.76	2.54	0.01	0.62	-	-	0.43	-	-	-	0.09	-	0.6	-	-	-	-	1.22	0.08	0.17	0.52	0.17	0	1.14	0	-	-	52.75
H5530_002_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			D	D	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S				V		V					V	V	V	V	V	Coin	V	V			none																																										-	1799.26	38.13	275.67		235.59	9.45	3.17	272.79	355.9	638.36	958.06	39.42	132.71	0.47	4999.44	1634.82	5.23	397.33			201.62				22.91		143.93					786.49	20.25	105.49	337.25	107.14	0.02	739.37	2.83			175/day with 1750 yearly max	175/day with 1750 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	175 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	175 copay	15/35 copay for in-home/facility	15 Copay	15 Copay	15 Copay	15 Copay	15 Copay			15/40/30/80 copay levels				50 max		50 max					15 Copay	50 copay	15 Copay	15 Copay	15 Copay	20 coinsurance	15 Copay	15 Copay			175	175	75		75	0.2	0.2	50	175	51.35	59.65	175	31.64	15	15	15	15	15			26.93				50		50					15	50	15	15	15	0.2	15	15			4000	105.89	133.32	71.86		71.86	0.2	0.2	47.91	167.67	49.19	57.15	167.67	30.32	14.37	14.37	14.37	14.37	14.37			25.8				47.91		47.91					14.37	47.91	14.37	14.37	14.37	0.2	14.37	14.37				15.88	0.42	1.65	-	1.41	1.89	0.63	1.09	4.97	2.62	4.56	0.55	0.34	0	5.99	1.96	0.01	0.48	-	-	0.43	-	-	-	0.09	-	0.57	-	-	-	-	0.94	0.08	0.13	0.4	0.13	0	0.89	0	-	-	48.12	15.88	0.42	1.65	-	1.41	1.89	0.63	1.09	4.97	2.62	4.56	0.55	0.34	0	5.99	1.96	0.01	0.48	-	-	0.43	-	-	-	0.09	-	0.57	-	-	-	-	0.94	0.08	0.13	0.4	0.13	0	0.89	0	-	-	48.12
H5530_801_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			none																																										-	297.56	3.32	315.94		254.97	8.65	3.75	235.16	438.52	659.52	1146.04	40.3	61.94	0	5421.06	1895.41	0.91	678.5			232.85											783.03	24.41	87.13	427.51	122.22	0.03	847.11	5.21			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels											20 copay	50 copay	20 copay	20 copay	20 copay	20 coinsurance	20 copay	20 copay			750	750	75		75	0.2	0.2	50	250	51.72	59.66	250	35	20	20	20	20	20			30.66											20	50	20	20	20	0.2	20	20			4000	601.87	700.79	72.34		72.34	0.2	0.2	48.23	241.13	49.88	57.54	241.13	33.76	19.29	19.29	19.29	19.29	19.29			29.57											19.29	48.23	19.29	19.29	19.29	0.2	19.29	19.29				14.92	0.19	1.9	-	1.54	1.73	0.75	0.95	8.81	2.74	5.5	0.81	0.17	-	8.71	3.05	0	1.09	-	-	0.57	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.36	0.01	-	-	57.2	14.92	0.19	1.9	-	1.54	1.73	0.75	0.95	8.81	2.74	5.5	0.81	0.17	-	8.71	3.05	0	1.09	-	-	0.57	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.36	0.01	-	-	57.2
H5530_803_0	2006	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional			none	Rehab Services	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Education	Vision Exam Diagnostic	Hearing Exam Diagnostic			A	A	D		T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V			S											V	V	V	V	V	Coin	V	V			none																																										-	297.56	3.32	315.94		254.97	8.65	3.75	235.16	438.52	659.52	1146.04	40.3	61.94	0	5421.06	1895.41	0.91	678.5			232.85											783.03	24.41	87.13	427.51	122.22	0.03	847.11	5.21			750/admit with 1500 yearly max	750/admit with 1500 yearly max	75/day for days 21 to 100		75 copay	20 coinsurance	20 coinsurance	50 copay	250 copay	50/100 copay for Lower/Higher Tier	50/100 copay for Lower/Higher Tier	250 copay	15/35 copay for in-home/facility	20 copay	20 copay	20 copay	20 copay	20 copay			15/40/30/80 copay levels											20 copay	50 copay	20 copay	20 copay	20 copay	20 coinsurance	20 copay	20 copay			750	750	75		75	0.2	0.2	50	250	51.72	59.66	250	35	20	20	20	20	20			30.66											20	50	20	20	20	0.2	20	20			4000	601.87	700.79	72.34		72.34	0.2	0.2	48.23	241.13	49.88	57.54	241.13	33.76	19.29	19.29	19.29	19.29	19.29			29.57											19.29	48.23	19.29	19.29	19.29	0.2	19.29	19.29				14.92	0.19	1.9	-	1.54	1.73	0.75	0.95	8.81	2.74	5.5	0.81	0.17	-	8.71	3.05	0	1.09	-	-	0.57	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.36	0.01	-	-	57.2	14.92	0.19	1.9	-	1.54	1.73	0.75	0.95	8.81	2.74	5.5	0.81	0.17	-	8.71	3.05	0	1.09	-	-	0.57	-	-	-	-	-	-	-	-	-	-	1.26	0.1	0.14	0.69	0.2	0.01	1.36	0.01	-	-	57.2
H5531_001_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P												5000	0	0							0																																	-	1411.56	14.26	1123.11	1066.98	191.95	1.77	0.02	203.94	41.08	715.12	223.52	0.38	55.25	34.92	3494.53	8388.65	0.23	570.71	509.27	0	251.33	607.83						0														750/admin	750/admin	0/d 1-8 75/d 9-15 125/d 16-100																																							122.35	122.35	77.39	35	100	0.2	0.2	46.75	100	35	40.13	35	35	35	25	35	35	35	35	0	45	35	0	0	0	0	0	0	0	0	0												0	0	77.39	35	100	0.2	0.2	46.75	0	35	40.13	35	35	35	25	35	35	35	35		45	35								0													-	-	7.24	3.11	1.6	0.35	0	0.79	-	2.09	0.75	0	0.16	0.1	7.28	24.47	0	1.66	1.49	-	0.94	1.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.82	-	-	7.24	3.11	1.6	0.35	0	0.79	-	2.09	0.75	0	0.16	0.1	7.28	24.47	0	1.66	1.49	-	0.94	1.77	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	53.82
H5531_002_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P												3500	17.58	0.18							0.17																																	17.93	1426.11	14.41	1123.11	1120.63	191.95	1.77	0.02	203.94	41.08	724.03	218.42	0.33	55.94	35.35	3741.62	8665.2	0.24	589.52	526.06	0	251.33	607.83						0														500/admin	500/admin	0/d 1-5 75/d 6-14 125/d 15-100																																							81.57	81.57	86.25	20	100	0.2	0.2	46.75	100	20	30.26	20	20	20	10	20	20	20	20	0	45	20																					45.2	45.2	86.25	20	100	0.2	0.2	46.75	55.42	20	30.26	20	20	20	10	20	20	20	20		45	20								0													5.37	0.05	8.07	1.87	1.6	0.35	0	0.79	0.19	1.21	0.55	0	0.09	0.06	3.12	14.44	0	0.98	0.88	-	0.94	1.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	41.59	22.95	0.23	8.07	1.87	1.6	0.35	0	0.79	0.36	1.21	0.55	0	0.09	0.06	3.12	14.44	0	0.98	0.88	-	0.94	1.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	59.53
H5531_801_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1578.83	15.95	1314.94	1010.64	196.47	2.32	0.02	196.45	36.36	561.69	228.75	0.38	132.12	30.28	4484.29	8369.78	1.59	728.15	513.05	0	251.33	745.88						0														200/day for 7 days	200/day for 7 days	100/day for 100 days							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.5	104.9	35	35	35	35	35	35	35	35	0	67.5	35	0	0	0	0	0	0	0	0	0												0	0	100	35	150	0.3	0.3	50	0	8.5	104.9	35	35	35	35	35	35	35	35		67.5	35								0													-	-	10.96	2.95	2.46	0.69	0.01	0.82	-	0.4	2	0	0.39	0.09	13.08	24.41	0	2.12	1.5	-	1.41	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.46	-	-	10.96	2.95	2.46	0.69	0.01	0.82	-	0.4	2	0	0.39	0.09	13.08	24.41	0	2.12	1.5	-	1.41	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.46
H5531_802_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1578.83	15.95	1314.94	1010.64	196.47	2.32	0.02	196.45	36.36	561.69	228.75	0.38	132.12	30.28	4484.29	8369.78	1.59	728.15	513.05	0	251.33	745.88						0														200/day for 7 days	200/day for 7 days	100/day for 100 days							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.5	104.9	35	35	35	35	35	35	35	35	0	67.5	35	0	0	0	0	0	0	0	0	0												0	0	100	35	150	0.3	0.3	50	0	8.5	104.9	35	35	35	35	35	35	35	35		67.5	35								0													-	-	10.96	2.95	2.46	0.69	0.01	0.82	-	0.4	2	0	0.39	0.09	13.08	24.41	0	2.12	1.5	-	1.41	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.46	-	-	10.96	2.95	2.46	0.69	0.01	0.82	-	0.4	2	0	0.39	0.09	13.08	24.41	0	2.12	1.5	-	1.41	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.46
H5531_803_0	2006																						D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	V	V	V	V	V		S									P													0	0							0																																	-	1578.83	15.95	1314.94	1010.64	196.47	2.32	0.02	196.45	36.36	561.69	228.75	0.38	132.12	30.28	4484.29	8369.78	1.59	728.15	513.05	0	251.33	745.88						0														200/day for 7 days	200/day for 7 days	100/day for 100 days							20 Coinsurance	20 Coinsurance										20 Coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	8.5	104.9	35	35	35	35	35	35	35	35	0	67.5	35	0	0	0	0	0	0	0	0	0												0	0	100	35	150	0.3	0.3	50	0	8.5	104.9	35	35	35	35	35	35	35	35		67.5	35								0													-	-	10.96	2.95	2.46	0.69	0.01	0.82	-	0.4	2	0	0.39	0.09	13.08	24.41	0	2.12	1.5	-	1.41	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.46	-	-	10.96	2.95	2.46	0.69	0.01	0.82	-	0.4	2	0	0.39	0.09	13.08	24.41	0	2.12	1.5	-	1.41	2.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	65.46
H5532_001_0	2006											2800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P	Coin																																																							-	2205.03	122.63	1087.72	0	118.19	21.51	10.21	334.48	78.13	18.15	51.13	0	0.19	2.26	4472.97	4064.92	384.71	4.91	0	0	40.61	1642.91	0	0	25.86	0	199.44	0	0	0	0											225	17500	100	0	150	0	0	50	0	10	20-Oct	20 (incl in g)	0.3	40/30 / 20	10	25	40/30	0	0	0	0.3	25 /0			25		25															225	175	100	0	150	0.3	0.34	50	0.2	0	0.11	0	0.3	0.04	10	25	37.5	0.2	0	0	0.3	25	0	0	25	0	25	0	0	0	0												111.96	87.08	49.76	0	74.64	0.15	0.17	24.88	0.1	0	0.05	0	0.15	0.02	10	25	37.5	0.1	0	0	0.15	25	0	0	25	0	25	0	0	0	0												20.57	0.89	4.51	-	0.74	3.21	1.73	0.69	7.78	-	2.77	-	0.03	0.05	3.73	8.47	1.2	0.49	-	-	6.06	3.42	-	-	0.05	-	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.8	20.57	0.89	4.51	-	0.74	3.21	1.73	0.69	7.78	-	2.77	-	0.03	0.05	3.73	8.47	1.2	0.49	-	-	6.06	3.42	-	-	0.05	-	0.42	-	-	-	-	-	-	-	-	-	-	-	-	-	-	66.8
H5533_001_0	2006																						A					Coin		V							V						S			Coin	V		V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	341.43					23.4		524.23							11389.05						997.68			4.56	304.13		43.63															100 per admit					0		50							15									0.2	15		15															95					0.1		47.5							14.25						10			0.2	14.25		14.25																95					0.1		47.5							14.25						10			0.2	14.25		14.25																2.7	-	-	-	-	2.34	-	2.08	-	-	-	-	-	-	13.52	-	-	-	-	-	0.83	-	-	0.91	0.36	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.8	2.7	-	-	-	-	2.34	-	2.08	-	-	-	-	-	-	13.52	-	-	-	-	-	0.83	-	-	0.91	0.36	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.8
H5533_002_0	2006																						A					Coin		V							V						S			Coin	V		V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	341.43					23.4		524.23							11389.05						997.68			4.56	304.13		43.63															100 per admit					0		50							15									0.2	15		15															95					0.1		47.5							14.25						10			0.2	14.25		14.25																95					0.1		47.5							14.25						10			0.2	14.25		14.25																2.7	-	-	-	-	2.34	-	2.08	-	-	-	-	-	-	13.52	-	-	-	-	-	0.83	-	-	0.91	0.36	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.8	2.7	-	-	-	-	2.34	-	2.08	-	-	-	-	-	-	13.52	-	-	-	-	-	0.83	-	-	0.91	0.36	-	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.8
H5533_801_0	2006																						A		D	V	T	Coin		V	V						V						Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	394.15		1217.59	1124.85	297.71	22.61		517.04	893.11						12893.37						11.29																					500 per stay		50 per day for 100 days	25	100	20		50	100						PCP - 30 Spec.-50						20																					475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						15.6	-	4.81	2.23	2.36	4.3	-	2.05	7.07	-	-	-	-	-	34.7	-	-	-	-	-	2.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.25	15.6	-	4.81	2.23	2.36	4.3	-	2.05	7.07	-	-	-	-	-	34.7	-	-	-	-	-	2.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.25
H5533_802_0	2006																						A		D	V	T	Coin		V	V						V						Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	394.15		1217.59	1124.85	297.71	22.61		517.04	893.11						12893.37						11.29																					500 per stay		50 per day for 100 days	25	100	20		50	100						PCP - 30 Spec.-50						20																					475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						15.6	-	4.81	2.23	2.36	4.3	-	2.05	7.07	-	-	-	-	-	34.7	-	-	-	-	-	2.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.25	15.6	-	4.81	2.23	2.36	4.3	-	2.05	7.07	-	-	-	-	-	34.7	-	-	-	-	-	2.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.25
H5533_803_0	2006																						A		D	V	T	Coin		V	V						V						Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	394.15		1217.59	1124.85	297.71	22.61		517.04	893.11						12893.37						11.29																					500 per stay		50 per day for 100 days	25	100	20		50	100						PCP - 30 Spec.-50						20																					475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						475		47.36	23.75	95	0.19		47.5	95						32.3						0.19																						15.6	-	4.81	2.23	2.36	4.3	-	2.05	7.07	-	-	-	-	-	34.7	-	-	-	-	-	2.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.25	15.6	-	4.81	2.23	2.36	4.3	-	2.05	7.07	-	-	-	-	-	34.7	-	-	-	-	-	2.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	75.25
H5575_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	337.25	23.11			23.58	5.6	10.23	14.07	10.24	28.36	6.49	1.11	0.85	75.05		18.01	18.59	1.41	16.61	74.87	28.69	0.13																				FFS Med Ded/Coin	FFS Med Ded/Coin		FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin		FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin	FFS Med Ded/Coin																				0.08	0.08			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.08	0.08			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23																				110	26.88	1.84	-	-	5.49	1.31	2.38	3.28	2.39	6.61	1.51	0.26	0.2	17.49	-	4.2	4.33	0.33	3.87	17.44	6.68	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	106.51	26.88	1.84	-	-	5.49	1.31	2.38	3.28	2.39	6.61	1.51	0.26	0.2	17.49	-	4.2	4.33	0.33	3.87	17.44	6.68	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	106.51
H5580_001_0	2006											2000											Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																											-	385.26	33.42	57.01	0	27.23	19.81	17.66	25.48	25.67	17.51	13.38	1.22	0	42.1	24.34	26.89	7.44	4.71	22.14	103.5	31.07	0.12	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	FFS Ded Co	0.07	0.07	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0.07	0.07	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		26.93	2.34	8.07	-	6.34	4.62	4.12	5.94	5.98	4.08	3.12	0.28	-	9.81	5.67	6.26	1.73	1.1	5.16	24.12	7.24	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.92	26.93	2.34	8.07	-	6.34	4.62	4.12	5.94	5.98	4.08	3.12	0.28	-	9.81	5.67	6.26	1.73	1.1	5.16	24.12	7.24	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	132.92
H5586_001_0	2006																						A	A			T	O	O	V	V						V	V	V	V	V	V																																																																-	1163.9	21.34			103.2	3582.24	95.41	1257.97	396.52						2905.78	8771.89	351.22	439.86	2351.02	7588.08																						100 for first 2 days	100 for first 2 days				DME only	Prosthetics only																																			100	100			50	10	50	50	50						10	10	10	10	10	10																							100	100			50	10	50	50	50						10	10	10	10	10	10																							9.7	0.18	-	-	0.43	2.99	0.4	5.24	1.65	-	-	-	-	-	2.42	7.31	0.29	0.37	1.96	6.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.26	9.7	0.18	-	-	0.43	2.99	0.4	5.24	1.65	-	-	-	-	-	2.42	7.31	0.29	0.37	1.96	6.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.26
H5587_001_0	2006											0											Ded	Ded	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0																																										-	2023.07	54.79	997.46	2611.04	20.7	14.46	2.49	17.02	50.43	10.93	36.43	1.78	0.75	34.65	55.39	120.16	2.02	1.68	1.2	25.46	2.81	0.49																				Medicare ded	Medicare ded	Medicare copay	0 copay	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins	Medicare ded & coins																				145.65	47.81	61.51	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	145.65	47.81	61.51	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					24.56	0.22	5.11	-	4.76	3.33	0.57	3.91	11.6	2.51	8.38	0.41	0.17	7.97	12.74	27.64	0.46	0.39	0.28	5.86	0.65	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.62	24.56	0.22	5.11	-	4.76	3.33	0.57	3.91	11.6	2.51	8.38	0.41	0.17	7.97	12.74	27.64	0.46	0.39	0.28	5.86	0.65	0.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	121.62
H5602_001_0	2006																						D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	V	Coin	Coin																																																														-	988.97	19.5	487.82	9.06	174.18	3.95	3.22	190.63	52.06	28.27	2.05	0.01	0.22	0.47	3934.46	2209.5	1.34	3.27	0	0	21.35	2.67																				150 day for 1st 5 days	150 day for 1st 5 days	35 day for days 11+	15 Coinsurance	150 Copay	25 Coinsurance	25 Coinsurance	50 per visit	15 Coinsurance	15 Coinsurance	15 Coinsurance	50 Coinsurance	15 Coinsurance	15 Coinsurance	10 Per Visit	35 Per Visit	50 Coinsurance	15 Coinsurance	15 Coinsurance	35 Per Visit	25 Coinsurance	15 Coinsurance																																																														150	150	35	0.15	150	0.25	0.25	50	0.15	0.15	0.15	0.5	0.15	0.15	10	35	0.5	0.15	0	0	0.25	0.15																					12.36	0.24	1.42	1.36	2.18	0.99	0.81	0.79	7.81	4.24	0.31	0.01	0.03	0.07	3.28	6.44	0.67	0.49	-	-	5.34	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.24	12.36	0.24	1.42	1.36	2.18	0.99	0.81	0.79	7.81	4.24	0.31	0.01	0.03	0.07	3.28	6.44	0.67	0.49	-	-	5.34	0.4	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.24
H5604_003_0	2006																						D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V			Coin																																																															-	2342.27	91.06	2022.16		328.51	15.83	21.77	337.09	319.12		1061.29			19.18	6512.52	6896.43	468.65	511.59			38.81																					135 Days 1-5	135 Days 1-5	75 Days 11-100					50 ER/25 UC			10Ther/75 Complex/50 Other			20 MH/SA 15 CORF				15 Ther/30 Chiro																								105.3	105.3	21		100	0.2	0.2	49.98	50		55.34			20	10	10	20	20.83			0.2																						105.3	105.3	21		100	0.2	0.2	49.98	50		55.34			20	10	10	20	20.83			0.2																						20.55	0.8	3.54	-	2.74	3.17	4.35	1.4	1.33	-	4.89	-	-	0.03	5.43	5.75	0.78	0.89	-	-	7.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.41	20.55	0.8	3.54	-	2.74	3.17	4.35	1.4	1.33	-	4.89	-	-	0.03	5.43	5.75	0.78	0.89	-	-	7.76	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	63.41
H5608_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	341.88	30.79	84.85	0	12.69	19.32	36.35	102.29	25.55	21.69	17.61	3.01	0	60.53	18.76	20.92	19.94	3.47	15.43	90.88	13.97	0.22	0	0	0	0	0	0	0	0	0																																																				0.07	0.07	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.16	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												23.52	2.12	13.29	-	2.96	4.5	8.47	23.83	5.95	5.05	4.1	0.7	-	14.1	4.37	4.87	4.65	0.81	3.6	21.18	3.25	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	151.38	23.52	2.12	13.29	-	2.96	4.5	8.47	23.83	5.95	5.05	4.1	0.7	-	14.1	4.37	4.87	4.65	0.81	3.6	21.18	3.25	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	151.38
H5628_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	303.11	24.92	83.83	71.11	17.32	33.2	22.31	7.56	20.58	10.78	21.81	0	22.22	16.47	52.12	86.3	8.09	1.63	15.76	21.04	12.23	11.63	0	0	0	0	0	3.14	0	1.25	11.02																																																				0.07	0.07	0.17	0	0.23	0.01	0.57	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.01	0.57	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												22.5	1.85	14.6	-	4.04	0.29	12.65	1.76	4.79	2.51	5.08	-	5.18	3.84	11.94	20.11	1.88	0.38	3.67	4.9	2.85	2.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	127.54	22.5	1.85	14.6	-	4.04	0.29	12.65	1.76	4.79	2.51	5.08	-	5.18	3.84	11.94	20.11	1.88	0.38	3.67	4.9	2.85	2.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	127.54
H5637_001_0	2006																						Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	319.29	24.01			26.83	6.38	11.64	16.01	11.65	32.27	7.38	1.27	0.96	85.39		20.49	21.15	1.61	18.89	85.18	32.64	0.14																																																													0.07	0.07			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07			0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23																				110	21.97	1.65	-	-	6.25	1.49	2.71	3.73	2.71	7.52	1.72	0.29	0.22	19.9	-	4.77	4.93	0.37	4.4	19.85	7.6	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	112.13	21.97	1.65	-	-	6.25	1.49	2.71	3.73	2.71	7.52	1.72	0.29	0.22	19.9	-	4.77	4.93	0.37	4.4	19.85	7.6	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	112.13
H5649_001_0	2006											Unlimited											D	D	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	P	P	O	P	P	P	P	P	P	P	P	P	P											n/a	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	987.98	14.08	474.91	0	209.35	2.39	3706.17	236.63	230.87	0	0	0	0	228.92	5213.02	4573.97	224.18	485.72	0	1562.29	0	711.64	0	837	0	0	0	0	0	0	1262.91											Days 1 - 8	Days 1 - 5	Days 21 - 100																																							100	100	50	0	100	1	0.35	50	100	0	0	0	0	10	5.15	10.24	30	10	0	10	0	10	0	30	0	0	0	0	0	0	9.78											n/a	100	100	50	0	100	1	0.35	50	100	0	0	0	0	10	5.15	10.24	30	10	0	10	0	10	0	30	0	0	0	0	0	0	9.78												8.23	0.12	1.98	-	1.74	2.39	0.11	0.99	1.92	-	-	-	-	0.19	2.24	3.9	0.56	0.4	-	1.3	-	0.59	-	2.09	-	-	-	-	-	-	1.03	-	-	-	-	-	-	-	-	-	-	29.8	8.23	0.12	1.98	-	1.74	2.39	0.11	0.99	1.92	-	-	-	-	0.19	2.24	3.9	0.56	0.4	-	1.3	-	0.59	-	2.09	-	-	-	-	-	-	1.03	-	-	-	-	-	-	-	-	-	-	29.8
H5652_001_0	2006											1500	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						14.85	15.37	394.28	344.22	1983.58	702.65	49.87		963.44		6084.74	421.52	730.73							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.76		30	21.49	24.19							30		30				30																	0.15	0.19	36.27	36.27	36.27	18.14	36.27		36.2		30	21.49	21							30		21.76				30												-	-	-	-	-	2.15	2.91	1.19	1.04	6	1.06	0.15	-	2.91	-	15.21	0.75	1.28	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	35.74	-	-	-	-	-	2.15	2.91	1.19	1.04	6	1.06	0.15	-	2.91	-	15.21	0.75	1.28	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	35.74
H5652_002_0	2006											1500	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						14.85	15.37	394.28	344.22	1983.55	702.64	49.87		963.43		6084.67	421.51	730.72							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.76		30	21.49	24.19							30		30				30																	0.15	0.19	36.27	36.27	36.27	18.14	36.27		36.2		30	21.49	21							30		21.76				30												-	-	-	-	-	2.15	2.91	1.19	1.04	6	1.06	0.15	-	2.91	-	15.21	0.75	1.28	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	35.74	-	-	-	-	-	2.15	2.91	1.19	1.04	6	1.06	0.15	-	2.91	-	15.21	0.75	1.28	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	35.74
H5665_001_0	2006											0											Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0																																										-	559.12	12.31	136.16		10.45	31.25	16.66	1330.34	49.32	22.9	38.82		3.05	39.71	98.89	184.44	4.61	4.38	50.68	67.89	7.52	8.65																				6.127 eff. coins	6.127 eff. coins	15.75 eff. coins		23.3 effective coins	23.3 effective coins	23.3 effective coins	50 copay	23.3 effective coins	23.3 effective coins	23.3 effective coins		23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins																				0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	0.06	0.06	0.16		0.23	0.23	0.23	50	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	34.26	0.75	21.45	-	2.43	7.28	3.88	5.54	11.49	5.34	9.05	-	0.71	9.25	23.04	42.97	1.07	1.02	11.81	15.82	1.75	2.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	210.94	34.26	0.75	21.45	-	2.43	7.28	3.88	5.54	11.49	5.34	9.05	-	0.71	9.25	23.04	42.97	1.07	1.02	11.81	15.82	1.75	2.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	210.94
H5665_002_0	2006											0											D	D	A		T	Coin	Coin	V	V	V	V		Coin	O	V	V	V	V	V	V	O	O																				0																																										-	2043.46	99.24	1948		503.25	31.08	16.58	2247	731.3	1015.73	822.38		1.87	145.13	11456	10146	796	759	3875	7786.2	409.8	1326																				125 days 1-5	125 days 1-5	50 copay		50 copay	10 coin	10 coin	25 copay	100 copay	20 copay	20 copay		20 coin	20 copay	7.50 OV copay	20 OV copay	20 copay	20 copay	20 copay	20 copay	20 copay	20 vision copay																				125	125	50		50	0.1	0.1	25	100	20	20		0.2	20	7.5	20	20	20	20	20	20	20																				0	125	125	50		50	0.1	0.1	25	100	20	20		0.2	20	7.5	20	20	20	20	20	20	20																					21.29	1.03	8.12	-	2.1	3.11	1.66	4.68	6.09	1.69	1.37	-	0.37	0.24	7.16	16.91	1.33	1.27	6.46	12.98	0.68	2.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	100.74	21.29	1.03	8.12	-	2.1	3.11	1.66	4.68	6.09	1.69	1.37	-	0.37	0.24	7.16	16.91	1.33	1.27	6.46	12.98	0.68	2.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	100.74
H5665_003_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5665_801_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	517.38	11.55	136.16	47.96	10.4	31.08	16.58	1299.02	48.2	22.36	37.96	0	3	38.8	99.26	185.08	4.62	4.39	50.87	68.16	7.34	8.66																				6.127 eff. coins	6.127 eff. coins	15.75 eff. coins		23.3 effective coins	23.3 effective coins	23.3 effective coins	50 copay	23.3 effective coins	23.3 effective coins	23.3 effective coins		23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins	23.3 effective coins																				0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.06	0.06	0.16	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				123	31.7	0.71	21.45	-	2.42	7.24	3.86	5.41	11.23	5.21	8.84	-	0.7	9.04	23.13	43.12	1.08	1.02	11.85	15.88	1.71	2.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	207.63	31.7	0.71	21.45	-	2.42	7.24	3.86	5.41	11.23	5.21	8.84	-	0.7	9.04	23.13	43.12	1.08	1.02	11.85	15.88	1.71	2.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	207.63
H5678_001_0	2006											1500	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						12.5	13.18	352.22	329.98	1762.28	669.65	46.27		875.91		5694.45	351.61	702.75							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.75		30	21.76	24.25							30		30				30																	0.15	0.19	37.46	37.46	37.46	18.73	37.46		37.37		30	21.76	21.37							30		22.48				30												-	-	-	-	-	1.87	2.51	1.1	1.03	5.5	1.05	0.14	-	2.73	-	14.24	0.64	1.25	-	-	-	-	-	-	0.31	-	0.41	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	33.15	-	-	-	-	-	1.87	2.51	1.1	1.03	5.5	1.05	0.14	-	2.73	-	14.24	0.64	1.25	-	-	-	-	-	-	0.31	-	0.41	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	33.15
H5678_002_0	2006											1500	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						12.5	13.18	352.22	329.98	1762.28	669.65	46.27		875.91		5694.45	351.61	702.75							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.75		30	21.76	24.25							30		30				30																	0.15	0.19	37.46	37.46	37.46	18.73	37.46		37.37		30	21.76	21.37							30		22.48				30												-	-	-	-	-	1.87	2.51	1.1	1.03	5.5	1.05	0.14	-	2.73	-	14.24	0.64	1.25	-	-	-	-	-	-	0.31	-	0.41	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	33.15	-	-	-	-	-	1.87	2.51	1.1	1.03	5.5	1.05	0.14	-	2.73	-	14.24	0.64	1.25	-	-	-	-	-	-	0.31	-	0.41	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	33.15
H5683_801_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1125.7	23.85	1178.47	549.3	173.23	18.62	1.4	488.15	343.79				21.09	2243.06	6438.59	11852.44					4.45			0	0		0					59.25	1.26	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	100 per day (1-20) 100 per day (21-100)	0	100	25	25	30-50	50-200				0	30-100	20-50	30-50					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.34	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.34	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0				0	19.14	0.41	0.86	-	1.44	4.66	0.35	1.65	2.85	-	-	-	-	5.11	11.05	30.02	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.01	0.02	-	-	-	-	-	-	-	-	79.46	19.14	0.41	0.86	-	1.44	4.66	0.35	1.65	2.85	-	-	-	-	5.11	11.05	30.02	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.01	0.02	-	-	-	-	-	-	-	-	79.46
H5683_802_0	2006	Inpatient Facility	Inpatient Facility	Professional	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Acute Level 2	Mental Health Level 2	Physician Administered Injectibles		Other	PCP	Specialist excl. MH				D	D	D	V	T	Coin	Coin	V	V				P	V	V	V					Coin			Coin	V	V	V	V				D	D	O	V	V	V	V					0	0	0	0	0	0	0	0	0				0	0	0	0					0											0	0	0	0	0	0	0				-	1125.7	23.85	1178.47	549.3	173.23	18.62	1.4	488.15	343.79				21.09	2243.06	6438.59	11852.44					4.45			0	0		0					59.25	1.26	0	0	0	0	0				300 per day (1-5)	300 per day (1-5)	100 per day (1-20) 100 per day (21-100)	0	100	25	25	30-50	50-200				0	30-100	20-50	30-50					20			0	0		0					300 per day (1-5)	300 per day (1-5)	0	0	0	0	0				204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.34	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0					204.06	204.06	8.81	0	100	0.25	0.25	40.6	99.5				0	27.34	20.59	30.39					20			0	0		0					204.06	204.06	0	0	0	0	0				0	19.14	0.41	0.86	-	1.44	4.66	0.35	1.65	2.85	-	-	-	-	5.11	11.05	30.02	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.01	0.02	-	-	-	-	-	-	-	-	79.46	19.14	0.41	0.86	-	1.44	4.66	0.35	1.65	2.85	-	-	-	-	5.11	11.05	30.02	-	-	-	-	0.89	-	-	-	-	-	-	-	-	-	-	1.01	0.02	-	-	-	-	-	-	-	-	79.46
H5685_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin																																																												-	474.16	54.83	52.51	67.72	14.7	29.29	15.73	540.75	26.27	13.79	27.85	0	3.3	49.91	70.72	104.04	6.91	2.44	22.38	24.18	15.57	3.15		10																		6.59	6.59	18.13	0	23.3	23.3	23.3	50	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3		50																		6.59	6.59	18.13	0	23.3	23.3	23.3	50	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3		50																			6.59	6.59	18.13	0	23.3	23.3	23.3	50	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3	23.3		50																		0	31.25	3.61	9.52	-	3.43	6.82	3.67	2.25	6.12	3.21	6.49	-	0.77	11.63	16.48	24.24	1.61	0.57	5.21	5.63	3.63	0.73	-	5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	151.88	31.25	3.61	9.52	-	3.43	6.82	3.67	2.25	6.12	3.21	6.49	-	0.77	11.63	16.48	24.24	1.61	0.57	5.21	5.63	3.63	0.73	-	5	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	151.88
H5696_001_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional						1900	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab						D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	V	V	V	V	Coin	O	T	V	V	P	V	P	V	O	O	V	V	V	V	V						none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							1363.45	87.03	699.43	3569.99	172.12	6.23	3.23	263.16	206.49	303.67	126.53	25.31	25.31	25.31	2771.61	2679.22	461.93	923.87	461.93	9238.7	4.2	0	0	991.2	1162.28	498.12	472.36	0	0	11444.49	0	423.69	137.66	184.77	277.16	1293.42						200 1 to 5 days	200 1 to 5 days	200 days 6 to 100	0	100	0	20	60x50+40x50	200	0	27	25	0	25	0	30	35*35+65*25	30	27	30	20	0	0	0	0	0	0	0	0	0	0	0	200	30	30	0						133.18	133.18	127.71	0	100	0	0.2	50	200	0	27.4	25	0	25	0	30	28.5	30	27.4	30	0.2	0	0	0	0	0	0	0	0	0	0	0	200	30	30	0						none	132.18	132.18	126.75	0	99.25	0	0.2	49.63	198.5	0	27.19	24.81	0	24.81	0	29.78	28.29	29.78	27.19	29.78	0.2	0	0	0	0	0	0	0	0	0	0	0	198.5	29.78	29.78	0						0	15.02	0.96	7.39	-	1.42	-	0.64	1.09	3.42	-	0.29	0.05	-	0.05	-	6.65	1.09	2.29	1.05	22.92	0.83	-	-	-	-	-	-	-	-	-	-	-	2.28	0.46	0.69	-	-	-	-	-	-	68.58	15.02	0.96	7.39	-	1.42	-	0.64	1.09	3.42	-	0.29	0.05	-	0.05	-	6.65	1.09	2.29	1.05	22.92	0.83	-	-	-	-	-	-	-	-	-	-	-	2.28	0.46	0.69	-	-	-	-	-	-	68.58
H5697_001_0	2006											1500	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						12.71	13.98	324.49	373.35	1599.05	753.95	47.1		867.52		5973.34	219.29	818.28							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.74		30	23.56	24.46							30		30				30																	0.15	0.19	37.67	37.67	37.67	18.84	37.67		37.57		30	23.56	21.72							30		22.6				30												-	-	-	-	-	1.92	2.67	1.02	1.17	5.02	1.18	0.15	-	2.72	-	14.93	0.43	1.48	-	-	-	-	-	-	0.31	-	0.41	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	33.79	-	-	-	-	-	1.92	2.67	1.02	1.17	5.02	1.18	0.15	-	2.72	-	14.93	0.43	1.48	-	-	-	-	-	-	0.31	-	0.41	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	33.79
H5697_002_0	2006											1500	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						12.71	13.98	324.49	373.35	1599.05	753.95	47.1		867.52		5973.34	219.29	818.28							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.74		30	23.56	24.46							30		30				30																	0.15	0.19	37.67	37.67	37.67	18.84	37.67		37.57		30	23.56	21.72							30		22.6				30												-	-	-	-	-	1.92	2.67	1.02	1.17	5.02	1.18	0.15	-	2.72	-	14.93	0.43	1.48	-	-	-	-	-	-	0.31	-	0.41	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	33.79	-	-	-	-	-	1.92	2.67	1.02	1.17	5.02	1.18	0.15	-	2.72	-	14.93	0.43	1.48	-	-	-	-	-	-	0.31	-	0.41	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	33.79
H5698_002_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1593.78	69.38	702.1	0	205.06	763.99	920.23	481.04	320.95	0	207.66	0	0	161.97	4416.35	3522.5	344.56	179.08	0	0	0	0	31.07	0	71.29	0	189.59	0	0	0	0																																																				62.5	136.12	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												62.5	136.12	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												8.3	0.79	1.79	-	0.77	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.36	5.87	0.57	0.45	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.67	8.3	0.79	1.79	-	0.77	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.36	5.87	0.57	0.45	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.67
H5698_003_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1593.78	0	0	0	0	0	0	531.33	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.32	0	78.74	0	209.41	0	0	0	0																																																				15.15	0	0	0	0	0	0	22.63	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5	0	10	0	10	0	0	0	0												15.15	0	0	0	0	0	0	22.63	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5	0	10	0	10	0	0	0	0												2.01	-	-	-	-	-	-	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.01	-	0.07	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.27	2.01	-	-	-	-	-	-	1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.01	-	0.07	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.27
H5698_004_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1660.18	69.38	702.1	0	205.06	763.99	920.23	481.04	320.95	0	207.66	0	0	161.97	0	0	0	179.08	0	0	0	0	31.07	0	71.29	0	189.59	0	0	0	0																																																				62.5	136.12	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												62.5	136.12	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												8.65	0.79	1.79	-	0.77	1.01	0.44	1.77	6.69	-	0.43	-	-	0.13	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.86	8.65	0.79	1.79	-	0.77	1.01	0.44	1.77	6.69	-	0.43	-	-	0.13	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.86
H5698_005_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1777.96	77	702.1	0	201.62	763.99	920.23	459.75	325.51	0	210.61	0	0	164.04	4342.34	3463.47	356	176.07	0	0	0	0	30.55	0	70.1	0	186.41	0	0	0	0																																																				62.5	124.71	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												62.5	124.71	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												9.26	0.8	1.79	-	0.76	2.02	0.91	1.7	6.78	-	1.32	-	-	0.41	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.45	9.26	0.8	1.79	-	0.76	2.02	0.91	1.7	6.78	-	1.32	-	-	0.41	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.45
H5698_006_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1593.78	69.38	702.1	0	205.06	763.99	920.23	481.04	320.95	0	207.66	0	0	161.97	4416.35	3522.5	344.56	179.08	0	0	0	0	31.07	0	71.29	0	189.59	0	0	0	0																																																				62.5	136.12	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												62.5	136.12	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												8.3	0.79	1.79	-	0.77	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.36	5.87	0.57	0.45	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.67	8.3	0.79	1.79	-	0.77	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.36	5.87	0.57	0.45	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.67
H5698_007_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1777.96	77	702.1	0	201.62	763.99	920.23	459.75	325.51	0	210.61	0	0	164.04	4342.34	3463.47	356	176.07	0	0	0	0	30.55	0	70.1	0	186.41	0	0	0	0																																																				62.5	124.71	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												62.5	124.71	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												9.26	0.8	1.79	-	0.76	2.02	0.91	1.7	6.78	-	1.32	-	-	0.41	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.45	9.26	0.8	1.79	-	0.76	2.02	0.91	1.7	6.78	-	1.32	-	-	0.41	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.45
H5698_008_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1842.44	77	702.1	0	201.62	763.99	920.23	459.75	325.51	0	210.61	0	0	164.04	0	0	0	176.07	0	0	0	0	30.55	0	70.1	0	184.97	0	0	0	0																																																				62.5	124.71	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												62.5	124.71	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												9.6	0.8	1.79	-	0.76	1.01	0.44	1.7	6.78	-	0.44	-	-	0.14	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.83	9.6	0.8	1.79	-	0.76	1.01	0.44	1.7	6.78	-	0.44	-	-	0.14	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.83
H5698_009_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1842.44	0	0	0	0	0	0	533.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.74	0	0	0	0	0	0	0	0																																																				15.15	0	0	0	0	0	0	22.63	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0												15.15	0	0	0	0	0	0	22.63	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0												2.33	-	-	-	-	-	-	1.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.35	2.33	-	-	-	-	-	-	1.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.35
H5698_010_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1605.45	75.82	702.1	0	201.62	763.99	920.23	481.04	320.95	0	207.66	0	0	161.97	4342.34	3463.47	356	176.07	0	0	0	0	30.55	0	70.1	0	186.41	0	0	0	0																																																				62.5	132.92	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												62.5	132.92	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												8.36	0.84	1.79	-	0.76	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.55	8.36	0.84	1.79	-	0.76	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.55
H5698_012_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1605.45	75.82	702.1	0	201.62	763.99	920.23	481.04	320.95	0	207.66	0	0	161.97	0	0	0	176.07	0	0	0	0	30.55	0	70.1	0	184.97	0	0	0	0																																																				62.5	132.92	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												62.5	132.92	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												8.36	0.84	1.79	-	0.76	1.01	0.44	1.77	6.69	-	0.43	-	-	0.13	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.61	8.36	0.84	1.79	-	0.76	1.01	0.44	1.77	6.69	-	0.43	-	-	0.13	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.61
H5698_013_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1605.45	75.82	702.1	0	201.62	763.99	920.23	481.04	320.95	0	207.66	0	0	161.97	4342.34	3463.47	356	176.07	0	0	0	0	30.55	0	70.1	0	186.41	0	0	0	0																																																				62.5	132.92	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												62.5	132.92	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												8.36	0.84	1.79	-	0.76	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.55	8.36	0.84	1.79	-	0.76	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.55
H5698_014_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1605.45	0	0	0	0	0	0	557.9	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.74	0	0	0	0	0	0	0	0																																																				15.15	0	0	0	0	0	0	22.63	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0												15.15	0	0	0	0	0	0	22.63	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0												2.03	-	-	-	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.09	2.03	-	-	-	-	-	-	1.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.09
H5698_015_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1593.78	69.38	702.1	0	205.06	763.99	920.23	481.04	320.95	0	207.66	0	0	161.97	4416.35	3522.5	344.56	179.08	0	0	0	0	31.07	0	71.29	0	189.59	0	0	0	0																																																				62.5	136.12	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												62.5	136.12	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												8.3	0.79	1.79	-	0.77	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.36	5.87	0.57	0.45	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.67	8.3	0.79	1.79	-	0.77	2.02	0.91	1.77	6.69	-	1.3	-	-	0.4	7.36	5.87	0.57	0.45	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	39.67
H5698_016_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1777.96	77	702.1	0	201.62	763.99	920.23	459.75	325.51	0	210.61	0	0	164.04	4342.34	3463.47	356	176.07	0	0	0	0	30.55	0	70.1	0	186.41	0	0	0	0																																																				62.5	124.71	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												62.5	124.71	30.67	0	45	31.8	11.89	44.25	250	0	75	0	0	30	20	20	20	30	0	0	0	0	5	0	30	0	30	0	0	0	0												9.26	0.8	1.79	-	0.76	2.02	0.91	1.7	6.78	-	1.32	-	-	0.41	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.45	9.26	0.8	1.79	-	0.76	2.02	0.91	1.7	6.78	-	1.32	-	-	0.41	7.24	5.77	0.59	0.44	-	-	-	-	0.01	-	0.18	-	0.47	-	-	-	-	-	-	-	-	-	-	-	-	-	-	40.45
H5698_017_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1660.18	69.38	702.1	0	205.06	763.99	920.23	481.04	320.95	0	207.66	0	0	161.97	0	0	0	179.08	0	0	0	0	31.07	0	71.29	0	189.59	0	0	0	0																																																				62.5	136.12	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												62.5	136.12	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												8.65	0.79	1.79	-	0.77	1.01	0.44	1.77	6.69	-	0.43	-	-	0.13	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.86	8.65	0.79	1.79	-	0.77	1.01	0.44	1.77	6.69	-	0.43	-	-	0.13	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	22.86
H5698_018_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1842.44	77	702.1	0	201.62	763.99	920.23	459.75	325.51	0	210.61	0	0	164.04	0	0	0	176.07	0	0	0	0	30.55	0	70.1	0	184.97	0	0	0	0																																																				62.5	124.71	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												62.5	124.71	30.67	0	45	15.9	5.77	44.25	250	0	25	0	0	10	0	0	0	10	0	0	0	0	5	0	10	0	10	0	0	0	0												9.6	0.8	1.79	-	0.76	1.01	0.44	1.7	6.78	-	0.44	-	-	0.14	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.83	9.6	0.8	1.79	-	0.76	1.01	0.44	1.7	6.78	-	0.44	-	-	0.14	-	-	-	0.15	-	-	-	-	0.01	-	0.06	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	23.83
H5700_001_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1827.85	106.37	539.7	0	143.51	9.65	8.11	281.55	30.21	0	14.59	1.23	0.01	15.05	3947.05	4064.16	256.2	703.6	11.63	0.91	24.6	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50 days 1-5	50 days 1-5	20 days 10-100	0	100	10	10	50	10 NTE 100 ASC; 10 NTE 200 OPH	0	10 Ther: 20	15	15	15	5	15	20 SA: 20	10 Chiro: 10	0 OF/OP: 10	0 Chemo: 20	20				10	150 Allowance																30.98	30.98	10.3	0	100	0.1	0.1	50	0.1	0	0.12	0.15	0.2	0.11	5	15	20	10	0.1	0.2	0.2	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		30.98	30.98	10.3	0	100	0.1	0.1	50	0.1	0	0.12	0.15	0.2	0.11	5	15	20	10	0.1	0.2	0.2	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		4.72	0.27	0.46	-	1.2	0.96	0.81	1.17	2.95	-	1.71	0.18	0	1.65	1.64	5.08	0.43	0.59	1.16	0.18	4.92	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.2	4.72	0.27	0.46	-	1.2	0.96	0.81	1.17	2.95	-	1.71	0.18	0	1.65	1.64	5.08	0.43	0.59	1.16	0.18	4.92	-	-	-	0.1	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	30.2
H5700_002_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1827.85	106.37	539.7	1666.23	143.51	9.65	8.11	281.55	30.21	0	14.59	1.23	0.01	15.05	4020.05	4064.16	256.2	703.6	11.63	0.91	24.6	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100 days 1-5	100 days 1-5	25 days 10-100	10	100	15	15	50	15 NTE 100 ASC; 15 NTE 200 OPH	0	15 Ther: 20	15	15	15	15	20	25 SA: 25	10 Chiro: 15	0 OF/OP: 15	0 Chemo: 20	20				25	150 Allowance																61.96	61.96	12.87	10	100	0.15	0.15	50	0.12	0	0.16	0.15	0.2	0.11	14.82	20	25	12.96	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		61.96	61.96	12.87	10	100	0.15	0.15	50	0.12	0	0.16	0.15	0.2	0.11	14.82	20	25	12.96	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		9.44	0.55	0.58	1.39	1.2	1.45	1.22	1.17	3.76	-	2.31	0.18	0	1.65	4.96	6.77	0.53	0.76	1.74	0.18	4.92	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.03	9.44	0.55	0.58	1.39	1.2	1.45	1.22	1.17	3.76	-	2.31	0.18	0	1.65	4.96	6.77	0.53	0.76	1.74	0.18	4.92	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.03
H5700_003_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1698.89	89.48	556.44	1502.11	129.16	8.52	7.34	247.62	28.63	0	13.76	1.18	0.01	14.1	3809.82	3890.56	206.97	684.39	11.16	0.88	23.83	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150 days 1-5	150 days 1-5	35 days 10-100	10	100	20	20	50	15 NTE 150 ASC; 15 NTE 300 OPH	0	15 Ther: 20	15	15	15	20	35	35 SA: 35	15 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	100 Allowance																92.94	92.94	18.02	10	100	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.11	19.81	35	35	17.97	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		92.94	92.94	18.02	10	100	0.2	0.2	50	0.15	0	0.16	0.15	0.2	0.11	19.81	35	35	17.97	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		13.16	0.69	0.84	1.25	1.08	1.7	1.47	1.03	4.19	-	2.18	0.18	0	1.59	6.29	11.35	0.6	1.02	1.67	0.18	4.77	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.49	13.16	0.69	0.84	1.25	1.08	1.7	1.47	1.03	4.19	-	2.18	0.18	0	1.59	6.29	11.35	0.6	1.02	1.67	0.18	4.77	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	55.49
H5700_004_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	2062.13	135.25	467.65	0	144.73	11.01	7.65	256.86	38.01	0	16.82	0.34	0.05	14.89	4153.01	5028.23	391.08	821.71	16.46	1.25	28.18	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50 days 1-5	50 days 1-5	20 days 10-100	0	100	10	10	50	15 NTE 100 ASC; 15 NTE 200 OPH	0	10 Ther: 20	15	15	15	10	25	35 SA: 25	15 Chiro: 15	0 OF/OP: 10	0 Chemo: 20	20				25	70 Allowance																30.98	92.94	10.3	0	100	0.1	0.1	50	0.13	0	0.11	0.15	0.2	0.11	10	25	32.5	15	0.1	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		30.98	92.94	10.3	0	100	0.1	0.1	50	0.13	0	0.11	0.15	0.2	0.11	10	25	32.5	15	0.1	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		5.32	1.05	0.4	-	1.21	1.1	0.76	1.07	4.76	-	1.84	0.05	0.01	1.7	3.46	10.48	1.06	1.03	1.65	0.25	5.64	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.09	5.32	1.05	0.4	-	1.21	1.1	0.76	1.07	4.76	-	1.84	0.05	0.01	1.7	3.46	10.48	1.06	1.03	1.65	0.25	5.64	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	43.09
H5700_005_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	2062.13	135.25	467.65	1719.69	144.73	11.01	7.65	256.86	38.01	0	16.82	0.34	0.05	14.89	4226.01	5028.23	391.08	821.71	16.46	1.25	28.18	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100 days 1-5	100 days 1-5	25 days 10-100	10	125	20	15	50	15 NTE 150 ASC; 15 NTE 300 OPH	0	15 Ther: 20	15	15	15	15	30	40 SA: 30	20 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																61.96	108.43	12.87	10	125	0.2	0.15	50	0.15	0	0.15	0.15	0.2	0.12	14.83	30	37.5	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		61.96	108.43	12.87	10	125	0.2	0.15	50	0.15	0	0.15	0.15	0.2	0.12	14.83	30	37.5	20	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		10.65	1.22	0.5	1.43	1.51	2.2	1.15	1.07	5.56	-	2.6	0.05	0.01	1.78	5.22	12.57	1.22	1.37	2.47	0.25	5.64	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.73	10.65	1.22	0.5	1.43	1.51	2.2	1.15	1.07	5.56	-	2.6	0.05	0.01	1.78	5.22	12.57	1.22	1.37	2.47	0.25	5.64	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	58.73
H5700_006_0	2006																						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	P	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P																																											-	1910.13	109.09	497.35	1570.48	128.88	10.02	7.08	224.33	36.22	0	15.63	0.28	0.05	13.84	4013.18	4824.08	310.67	798.41	15.9	1.21	26.74	0	0	0	124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150 days 1-5	150 days 1-5	35 days 10-100	10	150	20	20	50	15 NTE 150 ASC; 15 NTE 300 OPH	0	15 Ther: 20	15	15	15	20	35	50 SA: 25	15 Chiro: 20	0 OF/OP: 15	0 Chemo: 20	20				25	70 Allowance																92.94	123.92	18.02	10	150	0.2	0.2	50	0.15	0	0.15	0.15	0.2	0.11	19.82	35	43.75	17.23	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		92.94	123.92	18.02	10	150	0.2	0.2	50	0.15	0	0.15	0.15	0.2	0.11	19.82	35	43.75	17.23	0.15	0.2	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		14.79	1.13	0.75	1.31	1.61	2	1.42	0.93	5.29	-	2.4	0.04	0.01	1.58	6.63	14.07	1.13	1.15	2.38	0.24	5.35	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.47	14.79	1.13	0.75	1.31	1.61	2	1.42	0.93	5.29	-	2.4	0.04	0.01	1.58	6.63	14.07	1.13	1.15	2.38	0.24	5.35	-	-	-	0.26	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	64.47
H5703_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	254.98	63.55	22.53	0	10.93	23.12	20.51	25.44	23.13	19.05	14.96	2.4	1	38.01	18.99	22.27	16.91	3.84	15.65	80.32	25.87	0																				Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co	Med FFS Ded/Co																				0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					0.08	0.08	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0																					19.79	4.93	3.84	-	2.55	5.39	4.78	5.93	5.39	4.44	3.49	0.56	0.23	8.86	4.43	5.19	3.94	0.89	3.65	18.72	6.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	113	19.79	4.93	3.84	-	2.55	5.39	4.78	5.93	5.39	4.44	3.49	0.56	0.23	8.86	4.43	5.19	3.94	0.89	3.65	18.72	6.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	113
H5729_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	385.1	43.44	244.55	1.13	12.29	53.35	8.61	15.08	24.57	10.32	21.76	0.77	3.42	14.82	36.29	87.29	5.83	13.6	18.06	19.43	11.75	30.3	1.05	0	0.95	1.23	0.48	0	0	0.65	0.38											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																																																																																															-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5732_001_0	2006											no maximum											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	379.37	7.6	57.16	448.86	91.63	5089.28	5201.18	167.21	33.78	290.05	111.26	0	6.4	73.31	7849.61	13163.9	54.12	70.38	807.4	8595.11	50.74	869.59	0	1136.84	124.13	78.11	53.2	5.36	0	250.2	34.06											Tier 1: 0 Tier 2: 75 days 1 - 5	Tier 1: 0 Tier 2: 75 days 1 - 5	Tier 1: 0 Tier 2: Eff. Copay 20 coin.	Tier 1: 0 Tier 2: Eff. Copay 10 coins.		Tier 1: 0 Tier 2: Eff. Copay 15 coins.	Tier 1: 0 Tier 2: Eff. Copay 15 coins.	25	50	Tier 1: 0 Tier 2: Eff. Copay 20 coins.	Tier 1: 0 Tier 2: Eff. Copay 20 coins.		Tier 1: 0 Tier 2: Eff. Copay 20 coins.	Tier 1: 0 Tier 2: Eff. Copay 20 coins.	Tier 1: Eff. Copay 0 to 10 Tier 2: Eff. Copay 0 to 25	Tier 1: Eff. Copay 0 to 10 Tier 2: Eff. Copay 0 to 25	Tier 1: 0 Tier 2: Eff copay 20 coins.	Tier 1: 0 Tier 2: Eff. Copay 5 to 25		Eff. Copay 0 to 25 20 coins.	Tier 1: 0 Tier 2: Eff. Copay 20 coins.	Tier 1: 0 Tier 2: Eff. Copay 5 to 25 20 coins.			Tier 1: 0 Tier 2: Eff. Copay 5 to 25		Tier 1: 0 Tier 2: Eff. Copay 5 to 25				Tier 1: 0 Tier 2: Eff. Copay 0 to 25											48.56	48.56	45.46	11.64	0	0.62	0.67	25	50	9.08	35.34	0	19.13	22.28	9.35	10.25	17.4	12.29	0	3.61	17.43	13.85	0	0	13.74	0	13.42	0	0	0	2.49											no maximum	48.56	48.56	45.46	11.64	0	0.62	0.67	25	50	9.08	35.34	0	19.13	22.28	9.35	10.25	17.4	12.29	0	3.61	17.43	13.85	0	0	13.74	0	13.42	0	0	0	2.49												1.54	0.03	0.22	0.44	-	0.26	0.29	0.35	0.14	0.22	0.33	-	0.01	0.14	6.11	11.24	0.08	0.07	-	2.58	0.07	1	-	-	0.14	-	0.06	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	25.32	1.54	0.03	0.22	0.44	-	0.26	0.29	0.35	0.14	0.22	0.33	-	0.01	0.14	6.11	11.24	0.08	0.07	-	2.58	0.07	1	-	-	0.14	-	0.06	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	25.32
H5736_801_0	2006																						D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V		S	O																																																														-	1526.8	32.18	1088.15	1612.62	216.57	15.71	1.1	319.61	286.94	19.57	7.2	0	578.98	489.66	2748.01	7875.96	211.09	791.82	1563.25		224.85	664.72																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered			30 coinsurance	30 coinsurance			20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	0.2	0.2	0	35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	0.2	0.2	0	35	35	35	35	35	35	35		67.5	35																				0	18.28	0.39	9.07	4.7	2.71	4.71	0.33	1.33	3.59	3.91	1.44	-	1.69	1.43	8.02	22.97	0.62	2.31	4.56	-	1.26	1.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.25	18.28	0.39	9.07	4.7	2.71	4.71	0.33	1.33	3.59	3.91	1.44	-	1.69	1.43	8.02	22.97	0.62	2.31	4.56	-	1.26	1.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.25
H5736_802_0	2006																						D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V		S	O																																																														-	1526.8	32.18	1088.15	1612.62	216.57	15.71	1.1	319.61	286.94	19.57	7.2	0	578.98	489.66	2748.01	7875.96	211.09	791.82	1563.25		224.85	664.72																				200/day days 1-7	200/day days 1-7	100/d 1-100 100+ not covered			30 coinsurance	30 coinsurance			20 coinsurance	20 coinsurance										20 coinsurance																					143.69	143.69	100	35	150	0.3	0.3	50	150	0.2	0.2	0	35	35	35	35	35	35	35		67.5	35																					143.69	143.69	100	35	150	0.3	0.3	50	150	0.2	0.2	0	35	35	35	35	35	35	35		67.5	35																				0	18.28	0.39	9.07	4.7	2.71	4.71	0.33	1.33	3.59	3.91	1.44	-	1.69	1.43	8.02	22.97	0.62	2.31	4.56	-	1.26	1.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.25	18.28	0.39	9.07	4.7	2.71	4.71	0.33	1.33	3.59	3.91	1.44	-	1.69	1.43	8.02	22.97	0.62	2.31	4.56	-	1.26	1.94	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.25
H5750_001_0	2006																						A	A			T	Coin		V	V	V	V			O		V	V	P							V		V																																																									-	220.12	11.75			108.23	19.03		250.56	172.72	251.89	497.37			59.13		9903.8	446.01	1096.08							998.5		262.75															100 per Admission	100 per Admission			50	20 of costs		50 per visit	50 per visit	15 per visit	15 per visit			15 per visit		10 per visit	10 per visit	10 per visit							10 per visit		10 per visit															100	100			50	0.2		50	50	15	15			15		10	10	10							10		10															2700	100	100			50	0.19		50	50	15	15			15		10	10	10							10		10																1.83	0.1	-	-	0.45	3.62	-	1.04	0.72	0.31	0.62	-	-	0.07	-	8.25	0.37	0.91	-	-	-	-	-	-	0.83	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.36	1.83	0.1	-	-	0.45	3.62	-	1.04	0.72	0.31	0.62	-	-	0.07	-	8.25	0.37	0.91	-	-	-	-	-	-	0.83	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.36
H5750_002_0	2006																						A	A			T	Coin		V	V	V	V			O		V	V	P							V		V																																																									-	220.12	11.75			108.23	19.03		250.56	172.72	251.89	497.37			59.13		9903.8	446.01	1096.08							998.5		262.75															100 per Admission	100 per Admission			50	20 of costs		50 per visit	50 per visit	15 per visit	15 per visit			15 per visit		10 per visit	10 per visit	10 per visit							10 per visit		10 per visit															100	100			50	0.2		50	50	15	15			15		10	10	10							10		10															2700	100	100			50	0.19		50	50	15	15			15		10	10	10							10		10																1.83	0.1	-	-	0.45	3.62	-	1.04	0.72	0.31	0.62	-	-	0.07	-	8.25	0.37	0.91	-	-	-	-	-	-	0.83	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.36	1.83	0.1	-	-	0.45	3.62	-	1.04	0.72	0.31	0.62	-	-	0.07	-	8.25	0.37	0.91	-	-	-	-	-	-	0.83	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	19.36
H5754_001_0	2006											1500	0	0	0	0	0	0	0	0	0	0						Coin	Coin	V	V	V	V	V		V		V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						14.04	14.9	361.37	361.16	1767.7	732.65	49.01		917.85		6075.66	317.16	781.35							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.74		30	22.34	24.34							30		30				30																	0.15	0.19	36.93	36.93	36.93	18.46	36.93		36.84		30	22.34	21.37							30		22.16				30												-	-	-	-	-	2.07	2.83	1.11	1.11	5.44	1.13	0.15	-	2.82	-	15.19	0.59	1.39	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	34.92	-	-	-	-	-	2.07	2.83	1.11	1.11	5.44	1.13	0.15	-	2.82	-	15.19	0.59	1.39	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	34.92
H5754_002_0	2006											1500	0	0	0	0	0	0	0	0	0	0						Coin	Coin	V	V	V	V	V		V		V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						14.04	14.9	361.37	361.16	1767.7	732.65	49.01		917.85		6075.66	317.16	781.35							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.74		30	22.34	24.34							30		30				30																	0.15	0.19	36.93	36.93	36.93	18.46	36.93		36.84		30	22.34	21.37							30		22.16				30												-	-	-	-	-	2.07	2.83	1.11	1.11	5.44	1.13	0.15	-	2.82	-	15.19	0.59	1.39	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	34.92	-	-	-	-	-	2.07	2.83	1.11	1.11	5.44	1.13	0.15	-	2.82	-	15.19	0.59	1.39	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	34.92
H5757_001_0	2006											0											D	Coin	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	V	V	Coin	V	P	P	S	O	T	V	V	V	V	V		V	V											0																																										-	1100	7	191	233	222	2	2	464	155	2500	1000	300	25	125	4200	2014	2	750	500	250	1850	204	786	862	300	109	183	100		1015	1015																																																				0	0.05	0	0	10	0.2	0.2	0	15	0	0	0	0	25	0	0	0	0	0	15	30	0	0	0	0	10	0	10		0	0											0	0	0.05	0	0	10	0.2	0.2	0	15	0	0	0	0	25	0	0	0	0	0	15	30	0	0	0	0	10	0	10		0	0											0	-	0.35	-	-	0.19	0.4	0.4	-	0.19	-	-	-	-	0.26	-	-	-	-	-	0.31	4.63	-	-	-	-	0.09	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	6.9	-	0.35	-	-	0.19	0.4	0.4	-	0.19	-	-	-	-	0.26	-	-	-	-	-	0.31	4.63	-	-	-	-	0.09	-	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	6.9
H5760_001_0	2006											2960																		V																					Coin													2960																																										-								396.17																					7.25																				25 per visit																					20 OON Coinsurance																				25																					0.17																					25																					0.17														-	-	-	-	-	-	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.25	-	-	-	-	-	-	-	-	-	-	-	-	2.08	-	-	-	-	-	-	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.25	-	-	-	-	-	-	-	-	-	-	-	-	2.08
H5760_002_0	2006											2960																		V																					Coin													2960																																										-								396.28																					7.25																				25 per visit																					20 OON Coinsurance																				25																					0.17																					25																					0.17														-	-	-	-	-	-	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.25	-	-	-	-	-	-	-	-	-	-	-	-	2.08	-	-	-	-	-	-	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.25	-	-	-	-	-	-	-	-	-	-	-	-	2.08
H5760_003_0	2006											2960																		V																					Coin													2960																																										-								396.23																					7.25																				25 per visit																					20 OON Coinsurance																				25																					0.17																					25																					0.17														-	-	-	-	-	-	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.25	-	-	-	-	-	-	-	-	-	-	-	-	2.08	-	-	-	-	-	-	-	0.83	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.25	-	-	-	-	-	-	-	-	-	-	-	-	2.08
H5760_004_0	2006											2960																		V																					Coin													2960																																										-								461.76																					9.14																				25 per visit																					20 OON Coinsurance																				25																					0.17																					25																					0.17														-	-	-	-	-	-	-	0.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.58	-	-	-	-	-	-	-	-	-	-	-	-	2.54	-	-	-	-	-	-	-	0.96	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.58	-	-	-	-	-	-	-	-	-	-	-	-	2.54
H5774_003_0	2006																						D	D	D	V	T	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	P	P	P	P	P	P	P																																																					-	1508.86	35.38	1251	1845.13	664.96	299.83	74.96	455.34	222.82	777.39	371.69	33.68	0	364.78	6044.28	19350.34	208.8	302.97	3587.52	13664.54	50.99	11.05	0	1511.66	1209.31	188.32	106.71	2.73	0	0	3248.42																																																																																														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5774_004_0	2006																						D	D	D	V	T	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	P	P	P	P	P	P	P																																																					-	1508.86	35.38	1251	1845.13	664.96	299.83	74.96	455.34	222.82	777.39	371.69	33.68	0	364.78	6044.28	19350.34	208.8	302.97	3587.52	13664.54	50.99	11.05	0	755.83	483.72	85.6	106.71	2.73	0	0	499.72																																																																																														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.39	0	0	0	10	0	0	0	0	0	0	0											0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5	-	-	-	0.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5	-	-	-	0.63	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.63
H5774_005_0	2006																						D	D	D	V	T	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	P	P	P	P	P	P	P																																																					-	1484.45	35.38	1251	1845.13	664.96	299.83	74.96	455.34	222.82	3900.16	371.69	33.68	0	364.78	6044.28	19350.34	208.8	302.97	3587.52	13664.54	50.99	11.05	0	0	1209.31	188.32	0	0	0	0	3248.42											100 per stay copay	100 per stay copay			10 per trip copay		20 Coinsurance	25 per Visit		5 Lab Copay						5 Office Visit Copay	5 Office Visit Copay	5 Office Visit Copay	5 per service copay												Urgent Care 5 Copay																																																					14.43	14.43	0	0	10	0	98.22	25	0	2	0.15	0	0	0	0	1.31	5	5	5	0	0	4.91	0	0	0	0	0	0	0	0	0.1												1.79	0.04	-	-	0.55	-	0.61	0.95	-	0.65	0	-	-	-	-	2.12	0.09	0.13	1.49	-	-	0	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	8.45	1.79	0.04	-	-	0.55	-	0.61	0.95	-	0.65	0	-	-	-	-	2.12	0.09	0.13	1.49	-	-	0	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	8.45
H5774_006_0	2006																						D	D	D	V	T	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	P	P	P	P	P	P	P																																																					-	1484.45	35.38	1251	1845.13	664.96	299.83	74.96	455.34	222.82	3900.16	371.69	33.68	0	364.78	6044.28	19350.34	208.8	302.97	3587.52	13664.54	50.99	11.05	0	1511.66	1209.31	188.32	106.71	2.73	0	0	3248.42																	20 Coinsurance	25 per Visit																							Urgent Care 5 Copay																																																					0	0	0	0	0	0	98.22	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.1											0	-	-	-	-	-	-	0.61	0.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	1.59	-	-	-	-	-	-	0.61	0.95	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	0.03	-	-	-	-	-	-	-	-	-	-	1.59
H5774_802_0	2006																						D	D	D	V	T	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	P	P	P	P	P	P	P																																																					-	1508.86	35.38	1251	1845.13	664.96	299.83	74.96	455.34	222.82	777.39	371.69	33.68	0	364.78	6044.28	19350.34	208.8	302.97	3587.52	13664.54	50.99	11.05	0	1511.66	1209.31	188.32	106.71	2.73	0	0	3248.42																																																																																														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5774_804_0	2006																						D	D	D	V	T	P	P	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	P	P	P	P	P	P	P																																																					-	1508.86	35.38	1251	1845.13	664.96	299.83	74.96	455.34	222.82	777.39	371.69	33.68	0	364.78	6044.28	19350.34	208.8	302.97	3587.52	13664.54	50.99	11.05	0	1511.66	1209.31	188.32	106.71	2.73	0	0	3248.42																																																																																														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5810_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	413.89	32.38	66.88	52.92	17.07	32.36	22.13	7.86	21.33	10.87	22.21	0	23.55	17.38	90.05	117.08	14.36	2.97	24.62	37.49	12.97	20.22	0	0	0	0	0	0	0	1.25	21.48																																																				0.06	0.06	0.16	0	0.23	0.01	0.56	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.06	0.06	0.16	0	0.23	0.01	0.56	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												23.48	1.84	10.41	-	3.98	0.28	12.42	1.83	4.97	2.53	5.17	-	5.49	4.05	20.98	27.28	3.35	0.69	5.74	8.73	3.02	4.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	150.94	23.48	1.84	10.41	-	3.98	0.28	12.42	1.83	4.97	2.53	5.17	-	5.49	4.05	20.98	27.28	3.35	0.69	5.74	8.73	3.02	4.71	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	150.94
H5811_001_0	2006																						D	D	D	V	T	Coin	Coin	V	P					V	V	V	V	V		V		V			V	V					V																																																					-	1106	30	963		262	21.63	1.51	410	419				13	1097	4582	4629	227	278		1551		642			397						45											200 Copay per day 3600 Annual Max	200 Copay per day 3600 Annual Max	50 Copay per Day		100 Copay	20 Coinsurance	20 Coinsurance	50 ER 20 UC Copay	100 Copay				20 Copay	20 Copay	20 Copay	20 Copay	20 Copay	20 Copay		20 Copay		20 Copay			20 Copay						20 Copay											200	200	50		100	0.2	0.2	48.5	100				20	20	20	20	19	20		20	0	20			20						20												182.5	182.5	50		100	0.2	0.2	48.5	100				20	20	20	20	19	20		20		20			20	0					20												16.82	0.46	4.01	-	2.18	4.33	0.3	1.66	3.49	-	-	-	0.02	1.83	7.64	7.72	0.36	0.46	-	2.59	-	1.07	-	-	0.66	-	-	-	-	-	0.08	-	-	-	-	-	-	-	-	-	-	55.67	16.82	0.46	4.01	-	2.18	4.33	0.3	1.66	3.49	-	-	-	0.02	1.83	7.64	7.72	0.36	0.46	-	2.59	-	1.07	-	-	0.66	-	-	-	-	-	0.08	-	-	-	-	-	-	-	-	-	-	55.67
H5811_002_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T		V		V				V																																																					-	348.62	30.15	69.84	28.38	19.76	39.52	21.11	548	19.11	10.13	20.51	0	2.48	36.19	67.81	109.14	10.93	2.18	22.08	27.76	11.29	3.94			267						100											Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	50 Copay	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing	Trad. Medicare Cost Sharing			20 Copay						20 Copay											0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23			20						20												0.06	0.06	0.17	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23			20						20												22.58	1.95	11.66	-	4.6	9.21	4.92	2.28	4.45	2.36	4.78	-	0.57	8.43	15.3	24.64	2.55	0.51	5.14	6.47	2.63	0.91	-	-	0.45	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	136.56	22.58	1.95	11.66	-	4.6	9.21	4.92	2.28	4.45	2.36	4.78	-	0.57	8.43	15.3	24.64	2.55	0.51	5.14	6.47	2.63	0.91	-	-	0.45	-	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	136.56
H5811_003_0	2006																						D	D	D	V	T	Coin	Coin	V	P					V	V	V	V	V		V		V			V	V					V																																																					-	1106	30	963		262	21.63	1.51	410	419				13	1097	4582	4629	227	278		1551		642			397						45											200 Copay per day 3600 Annual Max	200 Copay per day 3600 Annual Max	50 Copay per Day		100 Copay	20 Coinsurance	20 Coinsurance	50 ER 20 UC Copay	100 Copay				20 Copay	20 Copay	20 Copay	20 Copay	20 Copay	20 Copay		20 Copay		20 Copay			20 Copay						20 Copay											200	200	50		100	0.2	0.2	48.5	100				20	20	20	20	19	20		20	0	20			20						20												182.5	182.5	50		100	0.2	0.2	48.5	100				20	20	20	20	19	20		20		20			20	0					20												16.82	0.46	4.01	-	2.18	4.33	0.3	1.66	3.49	-	-	-	0.02	1.83	7.64	7.72	0.36	0.46	-	2.59	-	1.07	-	-	0.66	-	-	-	-	-	0.08	-	-	-	-	-	-	-	-	-	-	55.67	16.82	0.46	4.01	-	2.18	4.33	0.3	1.66	3.49	-	-	-	0.02	1.83	7.64	7.72	0.36	0.46	-	2.59	-	1.07	-	-	0.66	-	-	-	-	-	0.08	-	-	-	-	-	-	-	-	-	-	55.67
H5812_002_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	318.92	4.6	1526.06	1267.03	233.17	16.05	1.12	468.79	22.14	8.65	23.52	0	6.56	23.3	5328.13	6769.56	1.91	343.61	19.74	122.99	17.17	2.18	0	0	417.79	0	179.05	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.18	0.1	0.1	0.1	0	0.1	0.1	19.91	19.69	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	307.32	307.32	19.21	7.68	76.83	0.15	0.15	36.25	0.08	0.08	0.08	0	0.08	0.08	15.3	15.12	0.38	7.68	0.08	0.07	0.08	0.08	0	0	15.37	0	15.37	0	0	0	0											0	8.17	0.12	2.44	0.81	1.49	2.47	0.17	1.42	1.7	0.66	1.81	-	0.5	1.79	6.79	8.53	0.73	0.22	1.52	9.13	1.32	0.17	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72	8.17	0.12	2.44	0.81	1.49	2.47	0.17	1.42	1.7	0.66	1.81	-	0.5	1.79	6.79	8.53	0.73	0.22	1.52	9.13	1.32	0.17	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72
H5812_003_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	317.62	4.58	700.84	1406.06	240.56	16.36	1.14	387.16	17.59	6.88	18.69	0	5.21	18.51	3895.97	4911.6	1.33	241.38	16.69	92.69	11.95	1.53	0	0	305.49	0	130.92	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.51	0.1	0.1	0.1	0	0.1	0.1	19.91	19.68	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	329.28	329.28	20.58	8.23	82.32	0.16	0.16	39.11	0.08	0.08	0.08	0	0.08	0.08	16.39	16.2	0.41	8.23	0.08	0.08	0.08	0.08	0	0	16.46	0	16.46	0	0	0	0											0	8.72	0.13	1.2	0.96	1.65	2.69	0.19	1.26	1.45	0.57	1.54	-	0.43	1.52	5.32	6.63	0.55	0.17	1.37	7.26	0.98	0.13	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.31	8.72	0.13	1.2	0.96	1.65	2.69	0.19	1.26	1.45	0.57	1.54	-	0.43	1.52	5.32	6.63	0.55	0.17	1.37	7.26	0.98	0.13	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.31
H5812_004_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	356.25	5.14	907.97	1405.3	278.62	17.57	1.23	459.15	19.91	7.79	21.16	0	5.9	20.96	5272.43	6765.76	1.73	356.91	20.19	104.89	15.59	1.97	0	0	413.42	0	177.18	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.15	0.1	0.1	0.1	0	0.1	0.1	19.91	19.61	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	311.2	311.2	19.45	7.78	77.8	0.16	0.16	36.69	0.08	0.08	0.08	0	0.08	0.08	15.49	15.25	0.39	7.78	0.08	0.07	0.08	0.08	0	0	15.56	0	15.56	0	0	0	0											0	9.24	0.13	1.47	0.91	1.81	2.73	0.19	1.4	1.55	0.61	1.65	-	0.46	1.63	6.81	8.6	0.67	0.23	1.57	7.81	1.21	0.15	-	-	0.54	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.6	9.24	0.13	1.47	0.91	1.81	2.73	0.19	1.4	1.55	0.61	1.65	-	0.46	1.63	6.81	8.6	0.67	0.23	1.57	7.81	1.21	0.15	-	-	0.54	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.6
H5812_005_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	322.92	4.66	1552.06	1076.12	233.92	14.83	1.03	388.72	18.37	7.18	19.52	0	5.44	19.34	4818.84	6158.82	1.71	320.02	25.27	122.33	15.42	1.95	0	0	377.86	0	161.94	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	46.93	0.1	0.1	0.1	0	0.1	0.1	19.91	19.66	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	313.11	313.11	19.57	7.83	78.28	0.16	0.16	36.73	0.08	0.08	0.08	0	0.08	0.08	15.59	15.39	0.39	7.83	0.08	0.08	0.08	0.08	0	0	15.66	0	15.66	0	0	0	0											0	8.43	0.12	2.53	0.7	1.53	2.32	0.16	1.19	1.44	0.56	1.53	-	0.43	1.51	6.26	7.9	0.67	0.21	1.98	9.27	1.21	0.15	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.8	8.43	0.12	2.53	0.7	1.53	2.32	0.16	1.19	1.44	0.56	1.53	-	0.43	1.51	6.26	7.9	0.67	0.21	1.98	9.27	1.21	0.15	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.8
H5812_006_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	306.64	4.42	819.87	1279.18	236.86	16.1	1.12	640.62	30.18	11.8	32.06	0	8.94	31.76	3836.02	4836.01	1.31	237.67	16.43	91.26	11.77	1.5	0	0	300.79	0	128.91	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	48.52	0.1	0.1	0.1	0	0.1	0.1	19.91	19.68	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	320.28	320.28	20.02	8.01	80.07	0.16	0.16	38.85	0.08	0.08	0.08	0	0.08	0.08	15.94	15.76	0.4	8.01	0.08	0.08	0.08	0.08	0	0	16.01	0	16.01	0	0	0	0											0	8.18	0.12	1.37	0.85	1.58	2.58	0.18	2.07	2.42	0.94	2.57	-	0.72	2.54	5.1	6.35	0.52	0.16	1.32	6.95	0.94	0.12	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.16	8.18	0.12	1.37	0.85	1.58	2.58	0.18	2.07	2.42	0.94	2.57	-	0.72	2.54	5.1	6.35	0.52	0.16	1.32	6.95	0.94	0.12	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.16
H5812_009_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	311.21	4.49	1195.52	1019.74	220.7	14.67	1.02	470.1	18.94	7.41	20.13	0	5.61	19.94	5058.67	6381.38	1.61	314.29	22.48	107.7	14.52	1.85	0	0	396.66	0	170	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.33	0.1	0.1	0.1	0	0.1	0.1	19.91	19.63	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	315.95	315.95	19.75	7.9	78.99	0.16	0.16	37.39	0.08	0.08	0.08	0	0.08	0.08	15.73	15.51	0.39	7.9	0.08	0.08	0.08	0.08	0	0	15.8	0	15.8	0	0	0	0											0	8.19	0.12	1.97	0.67	1.45	2.32	0.16	1.46	1.5	0.59	1.59	-	0.44	1.57	6.63	8.25	0.64	0.21	1.78	8.24	1.15	0.15	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.81	8.19	0.12	1.97	0.67	1.45	2.32	0.16	1.46	1.5	0.59	1.59	-	0.44	1.57	6.63	8.25	0.64	0.21	1.78	8.24	1.15	0.15	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.81
H5812_010_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	311.96	4.5	1488.69	1635.29	259.67	17.57	1.23	657.91	30.55	11.94	32.46	0	9.05	32.15	4437.6	5574.84	1.48	270.87	18.94	102.96	13.07	1.68	0	0	347.96	0	149.13	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	20/Visit; Immuniz. CIF	20/visit; 15 Coin IP Consults	50 Coin	10 copay/visit	15 Coin	15 Coin; ER Prof CIF	15 Coin	15 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	48.33	0.15	0.15	0.15	0	0.15	0.15	19.91	20	0.5	10	0.15	0.14	0.15	0.15	0	0	20	0	20	0	0	0	0											3000	291.75	291.75	18.23	7.29	72.94	0.15	0.15	35.25	0.11	0.11	0.11	0	0.11	0.11	14.52	14.59	0.36	7.29	0.11	0.1	0.11	0.11	0	0	14.59	0	14.59	0	0	0	0											0	7.58	0.11	2.26	0.99	1.58	2.56	0.18	1.93	3.34	1.31	3.55	-	0.99	3.52	5.37	6.78	0.54	0.16	2.07	10.72	1.43	0.18	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.77	7.58	0.11	2.26	0.99	1.58	2.56	0.18	1.93	3.34	1.31	3.55	-	0.99	3.52	5.37	6.78	0.54	0.16	2.07	10.72	1.43	0.18	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.77
H5812_011_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	318.92	4.6	1526.06	1267.03	233.17	16.05	1.12	468.79	22.14	8.65	23.52	0	6.56	23.3	5328.13	6769.56	1.91	343.61	19.74	122.99	17.17	2.18	0	0	417.79	0	179.05	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.18	0.1	0.1	0.1	0	0.1	0.1	19.91	19.69	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	307.32	307.32	19.21	7.68	76.83	0.15	0.15	36.25	0.08	0.08	0.08	0	0.08	0.08	15.3	15.12	0.38	7.68	0.08	0.07	0.08	0.08	0	0	15.37	0	15.37	0	0	0	0											0	8.17	0.12	2.44	0.81	1.49	2.47	0.17	1.42	1.7	0.66	1.81	-	0.5	1.79	6.79	8.53	0.73	0.22	1.52	9.13	1.32	0.17	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72	8.17	0.12	2.44	0.81	1.49	2.47	0.17	1.42	1.7	0.66	1.81	-	0.5	1.79	6.79	8.53	0.73	0.22	1.52	9.13	1.32	0.17	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72
H5812_012_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	318.92	4.6	1526.06	1267.03	233.17	16.05	1.12	468.79	22.14	8.65	23.52	0	6.56	23.3	5328.13	6769.56	1.91	343.61	19.74	122.99	17.17	2.18	0	0	417.79	0	179.05	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.18	0.1	0.1	0.1	0	0.1	0.1	19.91	19.69	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	307.32	307.32	19.21	7.68	76.83	0.15	0.15	36.25	0.08	0.08	0.08	0	0.08	0.08	15.3	15.12	0.38	7.68	0.08	0.07	0.08	0.08	0	0	15.37	0	15.37	0	0	0	0											0	8.17	0.12	2.44	0.81	1.49	2.47	0.17	1.42	1.7	0.66	1.81	-	0.5	1.79	6.79	8.53	0.73	0.22	1.52	9.13	1.32	0.17	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72	8.17	0.12	2.44	0.81	1.49	2.47	0.17	1.42	1.7	0.66	1.81	-	0.5	1.79	6.79	8.53	0.73	0.22	1.52	9.13	1.32	0.17	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72
H5812_013_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	318.92	4.6	1526.06	1267.03	233.17	16.05	1.12	468.79	22.14	8.65	23.52	0	6.56	23.3	5328.13	6769.56	1.91	343.61	19.74	122.99	17.17	2.18	0	0	417.79	0	179.05	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.18	0.1	0.1	0.1	0	0.1	0.1	19.91	19.69	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	307.32	307.32	19.21	7.68	76.83	0.15	0.15	36.25	0.08	0.08	0.08	0	0.08	0.08	15.3	15.12	0.38	7.68	0.08	0.07	0.08	0.08	0	0	15.37	0	15.37	0	0	0	0											0	8.17	0.12	2.44	0.81	1.49	2.47	0.17	1.42	1.7	0.66	1.81	-	0.5	1.79	6.79	8.53	0.73	0.22	1.52	9.13	1.32	0.17	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72	8.17	0.12	2.44	0.81	1.49	2.47	0.17	1.42	1.7	0.66	1.81	-	0.5	1.79	6.79	8.53	0.73	0.22	1.52	9.13	1.32	0.17	-	-	0.53	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.72
H5812_014_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	317.62	4.58	700.84	1406.06	240.56	16.36	1.14	387.16	17.59	6.88	18.69	0	5.21	18.51	3895.97	4911.6	1.33	241.38	16.69	92.69	11.95	1.53	0	0	305.49	0	130.92	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.51	0.1	0.1	0.1	0	0.1	0.1	19.91	19.68	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	329.28	329.28	20.58	8.23	82.32	0.16	0.16	39.11	0.08	0.08	0.08	0	0.08	0.08	16.39	16.2	0.41	8.23	0.08	0.08	0.08	0.08	0	0	16.46	0	16.46	0	0	0	0											0	8.72	0.13	1.2	0.96	1.65	2.69	0.19	1.26	1.45	0.57	1.54	-	0.43	1.52	5.32	6.63	0.55	0.17	1.37	7.26	0.98	0.13	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.31	8.72	0.13	1.2	0.96	1.65	2.69	0.19	1.26	1.45	0.57	1.54	-	0.43	1.52	5.32	6.63	0.55	0.17	1.37	7.26	0.98	0.13	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.31
H5812_015_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	317.62	4.58	700.84	1406.06	240.56	16.36	1.14	387.16	17.59	6.88	18.69	0	5.21	18.51	3895.97	4911.6	1.33	241.38	16.69	92.69	11.95	1.53	0	0	305.49	0	130.92	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.51	0.1	0.1	0.1	0	0.1	0.1	19.91	19.68	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	329.28	329.28	20.58	8.23	82.32	0.16	0.16	39.11	0.08	0.08	0.08	0	0.08	0.08	16.39	16.2	0.41	8.23	0.08	0.08	0.08	0.08	0	0	16.46	0	16.46	0	0	0	0											0	8.72	0.13	1.2	0.96	1.65	2.69	0.19	1.26	1.45	0.57	1.54	-	0.43	1.52	5.32	6.63	0.55	0.17	1.37	7.26	0.98	0.13	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.31	8.72	0.13	1.2	0.96	1.65	2.69	0.19	1.26	1.45	0.57	1.54	-	0.43	1.52	5.32	6.63	0.55	0.17	1.37	7.26	0.98	0.13	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.31
H5812_016_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	317.62	4.58	700.84	1406.06	240.56	16.36	1.14	387.16	17.59	6.88	18.69	0	5.21	18.51	3895.97	4911.6	1.33	241.38	16.69	92.69	11.95	1.53	0	0	305.49	0	130.92	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.51	0.1	0.1	0.1	0	0.1	0.1	19.91	19.68	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	329.28	329.28	20.58	8.23	82.32	0.16	0.16	39.11	0.08	0.08	0.08	0	0.08	0.08	16.39	16.2	0.41	8.23	0.08	0.08	0.08	0.08	0	0	16.46	0	16.46	0	0	0	0											0	8.72	0.13	1.2	0.96	1.65	2.69	0.19	1.26	1.45	0.57	1.54	-	0.43	1.52	5.32	6.63	0.55	0.17	1.37	7.26	0.98	0.13	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.31	8.72	0.13	1.2	0.96	1.65	2.69	0.19	1.26	1.45	0.57	1.54	-	0.43	1.52	5.32	6.63	0.55	0.17	1.37	7.26	0.98	0.13	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	45.31
H5812_017_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	356.25	5.14	907.97	1405.3	278.62	17.57	1.23	459.15	19.91	7.79	21.16	0	5.9	20.96	5272.43	6765.76	1.73	356.91	20.19	104.89	15.59	1.97	0	0	413.42	0	177.18	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.15	0.1	0.1	0.1	0	0.1	0.1	19.91	19.61	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	311.2	311.2	19.45	7.78	77.8	0.16	0.16	36.69	0.08	0.08	0.08	0	0.08	0.08	15.49	15.25	0.39	7.78	0.08	0.07	0.08	0.08	0	0	15.56	0	15.56	0	0	0	0											0	9.24	0.13	1.47	0.91	1.81	2.73	0.19	1.4	1.55	0.61	1.65	-	0.46	1.63	6.81	8.6	0.67	0.23	1.57	7.81	1.21	0.15	-	-	0.54	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.6	9.24	0.13	1.47	0.91	1.81	2.73	0.19	1.4	1.55	0.61	1.65	-	0.46	1.63	6.81	8.6	0.67	0.23	1.57	7.81	1.21	0.15	-	-	0.54	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.6
H5812_018_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	356.25	5.14	907.97	1405.3	278.62	17.57	1.23	459.15	19.91	7.79	21.16	0	5.9	20.96	5272.43	6765.76	1.73	356.91	20.19	104.89	15.59	1.97	0	0	413.42	0	177.18	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.15	0.1	0.1	0.1	0	0.1	0.1	19.91	19.61	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	311.2	311.2	19.45	7.78	77.8	0.16	0.16	36.69	0.08	0.08	0.08	0	0.08	0.08	15.49	15.25	0.39	7.78	0.08	0.07	0.08	0.08	0	0	15.56	0	15.56	0	0	0	0											0	9.24	0.13	1.47	0.91	1.81	2.73	0.19	1.4	1.55	0.61	1.65	-	0.46	1.63	6.81	8.6	0.67	0.23	1.57	7.81	1.21	0.15	-	-	0.54	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.6	9.24	0.13	1.47	0.91	1.81	2.73	0.19	1.4	1.55	0.61	1.65	-	0.46	1.63	6.81	8.6	0.67	0.23	1.57	7.81	1.21	0.15	-	-	0.54	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.6
H5812_019_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	356.25	5.14	907.97	1405.3	278.62	17.57	1.23	459.15	19.91	7.79	21.16	0	5.9	20.96	5272.43	6765.76	1.73	356.91	20.19	104.89	15.59	1.97	0	0	413.42	0	177.18	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.15	0.1	0.1	0.1	0	0.1	0.1	19.91	19.61	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	311.2	311.2	19.45	7.78	77.8	0.16	0.16	36.69	0.08	0.08	0.08	0	0.08	0.08	15.49	15.25	0.39	7.78	0.08	0.07	0.08	0.08	0	0	15.56	0	15.56	0	0	0	0											0	9.24	0.13	1.47	0.91	1.81	2.73	0.19	1.4	1.55	0.61	1.65	-	0.46	1.63	6.81	8.6	0.67	0.23	1.57	7.81	1.21	0.15	-	-	0.54	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.6	9.24	0.13	1.47	0.91	1.81	2.73	0.19	1.4	1.55	0.61	1.65	-	0.46	1.63	6.81	8.6	0.67	0.23	1.57	7.81	1.21	0.15	-	-	0.54	-	0.23	-	-	-	-	-	-	-	-	-	-	-	-	-	-	51.6
H5812_020_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	322.92	4.66	1552.06	1076.12	233.92	14.83	1.03	388.72	18.37	7.18	19.52	0	5.44	19.34	4818.84	6158.82	1.71	320.02	25.27	122.33	15.42	1.95	0	0	377.86	0	161.94	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	46.93	0.1	0.1	0.1	0	0.1	0.1	19.91	19.66	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	313.11	313.11	19.57	7.83	78.28	0.16	0.16	36.73	0.08	0.08	0.08	0	0.08	0.08	15.59	15.39	0.39	7.83	0.08	0.08	0.08	0.08	0	0	15.66	0	15.66	0	0	0	0											0	8.43	0.12	2.53	0.7	1.53	2.32	0.16	1.19	1.44	0.56	1.53	-	0.43	1.51	6.26	7.9	0.67	0.21	1.98	9.27	1.21	0.15	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.8	8.43	0.12	2.53	0.7	1.53	2.32	0.16	1.19	1.44	0.56	1.53	-	0.43	1.51	6.26	7.9	0.67	0.21	1.98	9.27	1.21	0.15	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.8
H5812_021_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	322.92	4.66	1552.06	1076.12	233.92	14.83	1.03	388.72	18.37	7.18	19.52	0	5.44	19.34	4818.84	6158.82	1.71	320.02	25.27	122.33	15.42	1.95	0	0	377.86	0	161.94	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	46.93	0.1	0.1	0.1	0	0.1	0.1	19.91	19.66	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	313.11	313.11	19.57	7.83	78.28	0.16	0.16	36.73	0.08	0.08	0.08	0	0.08	0.08	15.59	15.39	0.39	7.83	0.08	0.08	0.08	0.08	0	0	15.66	0	15.66	0	0	0	0											0	8.43	0.12	2.53	0.7	1.53	2.32	0.16	1.19	1.44	0.56	1.53	-	0.43	1.51	6.26	7.9	0.67	0.21	1.98	9.27	1.21	0.15	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.8	8.43	0.12	2.53	0.7	1.53	2.32	0.16	1.19	1.44	0.56	1.53	-	0.43	1.51	6.26	7.9	0.67	0.21	1.98	9.27	1.21	0.15	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.8
H5812_022_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	322.92	4.66	1552.06	1076.12	233.92	14.83	1.03	388.72	18.37	7.18	19.52	0	5.44	19.34	4818.84	6158.82	1.71	320.02	25.27	122.33	15.42	1.95	0	0	377.86	0	161.94	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	46.93	0.1	0.1	0.1	0	0.1	0.1	19.91	19.66	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	313.11	313.11	19.57	7.83	78.28	0.16	0.16	36.73	0.08	0.08	0.08	0	0.08	0.08	15.59	15.39	0.39	7.83	0.08	0.08	0.08	0.08	0	0	15.66	0	15.66	0	0	0	0											0	8.43	0.12	2.53	0.7	1.53	2.32	0.16	1.19	1.44	0.56	1.53	-	0.43	1.51	6.26	7.9	0.67	0.21	1.98	9.27	1.21	0.15	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.8	8.43	0.12	2.53	0.7	1.53	2.32	0.16	1.19	1.44	0.56	1.53	-	0.43	1.51	6.26	7.9	0.67	0.21	1.98	9.27	1.21	0.15	-	-	0.49	-	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.8
H5812_023_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	306.64	4.42	819.87	1279.18	236.86	16.1	1.12	640.62	30.18	11.8	32.06	0	8.94	31.76	3836.02	4836.01	1.31	237.67	16.43	91.26	11.77	1.5	0	0	300.79	0	128.91	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	48.52	0.1	0.1	0.1	0	0.1	0.1	19.91	19.68	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	320.28	320.28	20.02	8.01	80.07	0.16	0.16	38.85	0.08	0.08	0.08	0	0.08	0.08	15.94	15.76	0.4	8.01	0.08	0.08	0.08	0.08	0	0	16.01	0	16.01	0	0	0	0											0	8.18	0.12	1.37	0.85	1.58	2.58	0.18	2.07	2.42	0.94	2.57	-	0.72	2.54	5.1	6.35	0.52	0.16	1.32	6.95	0.94	0.12	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.16	8.18	0.12	1.37	0.85	1.58	2.58	0.18	2.07	2.42	0.94	2.57	-	0.72	2.54	5.1	6.35	0.52	0.16	1.32	6.95	0.94	0.12	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.16
H5812_024_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	306.64	4.42	819.87	1279.18	236.86	16.1	1.12	640.62	30.18	11.8	32.06	0	8.94	31.76	3836.02	4836.01	1.31	237.67	16.43	91.26	11.77	1.5	0	0	300.79	0	128.91	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	48.52	0.1	0.1	0.1	0	0.1	0.1	19.91	19.68	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	320.28	320.28	20.02	8.01	80.07	0.16	0.16	38.85	0.08	0.08	0.08	0	0.08	0.08	15.94	15.76	0.4	8.01	0.08	0.08	0.08	0.08	0	0	16.01	0	16.01	0	0	0	0											0	8.18	0.12	1.37	0.85	1.58	2.58	0.18	2.07	2.42	0.94	2.57	-	0.72	2.54	5.1	6.35	0.52	0.16	1.32	6.95	0.94	0.12	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.16	8.18	0.12	1.37	0.85	1.58	2.58	0.18	2.07	2.42	0.94	2.57	-	0.72	2.54	5.1	6.35	0.52	0.16	1.32	6.95	0.94	0.12	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.16
H5812_025_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	306.64	4.42	819.87	1279.18	236.86	16.1	1.12	640.62	30.18	11.8	32.06	0	8.94	31.76	3836.02	4836.01	1.31	237.67	16.43	91.26	11.77	1.5	0	0	300.79	0	128.91	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	48.52	0.1	0.1	0.1	0	0.1	0.1	19.91	19.68	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	320.28	320.28	20.02	8.01	80.07	0.16	0.16	38.85	0.08	0.08	0.08	0	0.08	0.08	15.94	15.76	0.4	8.01	0.08	0.08	0.08	0.08	0	0	16.01	0	16.01	0	0	0	0											0	8.18	0.12	1.37	0.85	1.58	2.58	0.18	2.07	2.42	0.94	2.57	-	0.72	2.54	5.1	6.35	0.52	0.16	1.32	6.95	0.94	0.12	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.16	8.18	0.12	1.37	0.85	1.58	2.58	0.18	2.07	2.42	0.94	2.57	-	0.72	2.54	5.1	6.35	0.52	0.16	1.32	6.95	0.94	0.12	-	-	0.4	-	0.17	-	-	-	-	-	-	-	-	-	-	-	-	-	-	48.16
H5812_026_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	311.21	4.49	1195.52	1019.74	220.7	14.67	1.02	470.1	18.94	7.41	20.13	0	5.61	19.94	5058.67	6381.38	1.61	314.29	22.48	107.7	14.52	1.85	0	0	396.66	0	170	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.33	0.1	0.1	0.1	0	0.1	0.1	19.91	19.63	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	315.95	315.95	19.75	7.9	78.99	0.16	0.16	37.39	0.08	0.08	0.08	0	0.08	0.08	15.73	15.51	0.39	7.9	0.08	0.08	0.08	0.08	0	0	15.8	0	15.8	0	0	0	0											0	8.19	0.12	1.97	0.67	1.45	2.32	0.16	1.46	1.5	0.59	1.59	-	0.44	1.57	6.63	8.25	0.64	0.21	1.78	8.24	1.15	0.15	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.81	8.19	0.12	1.97	0.67	1.45	2.32	0.16	1.46	1.5	0.59	1.59	-	0.44	1.57	6.63	8.25	0.64	0.21	1.78	8.24	1.15	0.15	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.81
H5812_027_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	311.21	4.49	1195.52	1019.74	220.7	14.67	1.02	470.1	18.94	7.41	20.13	0	5.61	19.94	5058.67	6381.38	1.61	314.29	22.48	107.7	14.52	1.85	0	0	396.66	0	170	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.33	0.1	0.1	0.1	0	0.1	0.1	19.91	19.63	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	315.95	315.95	19.75	7.9	78.99	0.16	0.16	37.39	0.08	0.08	0.08	0	0.08	0.08	15.73	15.51	0.39	7.9	0.08	0.08	0.08	0.08	0	0	15.8	0	15.8	0	0	0	0											0	8.19	0.12	1.97	0.67	1.45	2.32	0.16	1.46	1.5	0.59	1.59	-	0.44	1.57	6.63	8.25	0.64	0.21	1.78	8.24	1.15	0.15	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.81	8.19	0.12	1.97	0.67	1.45	2.32	0.16	1.46	1.5	0.59	1.59	-	0.44	1.57	6.63	8.25	0.64	0.21	1.78	8.24	1.15	0.15	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.81
H5812_028_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	311.21	4.49	1195.52	1019.74	220.7	14.67	1.02	470.1	18.94	7.41	20.13	0	5.61	19.94	5058.67	6381.38	1.61	314.29	22.48	107.7	14.52	1.85	0	0	396.66	0	170	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	10 Coin	10 Coin	10 Coin		10 Coin	10 Coin	20/Visit; Immuniz. CIF	20/Visit; IP Consults 10	50 Coin	10 copay/visit	10 Coin	10 Coin; ER Prof CIF	10 Coin	10 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	47.33	0.1	0.1	0.1	0	0.1	0.1	19.91	19.63	0.5	10	0.1	0.1	0.1	0.1	0	0	20	0	20	0	0	0	0											3000	315.95	315.95	19.75	7.9	78.99	0.16	0.16	37.39	0.08	0.08	0.08	0	0.08	0.08	15.73	15.51	0.39	7.9	0.08	0.08	0.08	0.08	0	0	15.8	0	15.8	0	0	0	0											0	8.19	0.12	1.97	0.67	1.45	2.32	0.16	1.46	1.5	0.59	1.59	-	0.44	1.57	6.63	8.25	0.64	0.21	1.78	8.24	1.15	0.15	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.81	8.19	0.12	1.97	0.67	1.45	2.32	0.16	1.46	1.5	0.59	1.59	-	0.44	1.57	6.63	8.25	0.64	0.21	1.78	8.24	1.15	0.15	-	-	0.52	-	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	49.81
H5812_029_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	311.96	4.5	1488.69	1635.29	259.67	17.57	1.23	657.91	30.55	11.94	32.46	0	9.05	32.15	4437.6	5574.84	1.48	270.87	18.94	102.96	13.07	1.68	0	0	347.96	0	149.13	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	20/Visit; Immuniz. CIF	20/visit; 15 Coin IP Consults	50 Coin	10 copay/visit	15 Coin	15 Coin; ER Prof CIF	15 Coin	15 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	48.33	0.15	0.15	0.15	0	0.15	0.15	19.91	20	0.5	10	0.15	0.14	0.15	0.15	0	0	20	0	20	0	0	0	0											3000	291.75	291.75	18.23	7.29	72.94	0.15	0.15	35.25	0.11	0.11	0.11	0	0.11	0.11	14.52	14.59	0.36	7.29	0.11	0.1	0.11	0.11	0	0	14.59	0	14.59	0	0	0	0											0	7.58	0.11	2.26	0.99	1.58	2.56	0.18	1.93	3.34	1.31	3.55	-	0.99	3.52	5.37	6.78	0.54	0.16	2.07	10.72	1.43	0.18	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.77	7.58	0.11	2.26	0.99	1.58	2.56	0.18	1.93	3.34	1.31	3.55	-	0.99	3.52	5.37	6.78	0.54	0.16	2.07	10.72	1.43	0.18	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.77
H5812_030_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	311.96	4.5	1488.69	1635.29	259.67	17.57	1.23	657.91	30.55	11.94	32.46	0	9.05	32.15	4437.6	5574.84	1.48	270.87	18.94	102.96	13.07	1.68	0	0	347.96	0	149.13	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	20/Visit; Immuniz. CIF	20/visit; 15 Coin IP Consults	50 Coin	10 copay/visit	15 Coin	15 Coin; ER Prof CIF	15 Coin	15 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	48.33	0.15	0.15	0.15	0	0.15	0.15	19.91	20	0.5	10	0.15	0.14	0.15	0.15	0	0	20	0	20	0	0	0	0											3000	291.75	291.75	18.23	7.29	72.94	0.15	0.15	35.25	0.11	0.11	0.11	0	0.11	0.11	14.52	14.59	0.36	7.29	0.11	0.1	0.11	0.11	0	0	14.59	0	14.59	0	0	0	0											0	7.58	0.11	2.26	0.99	1.58	2.56	0.18	1.93	3.34	1.31	3.55	-	0.99	3.52	5.37	6.78	0.54	0.16	2.07	10.72	1.43	0.18	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.77	7.58	0.11	2.26	0.99	1.58	2.56	0.18	1.93	3.34	1.31	3.55	-	0.99	3.52	5.37	6.78	0.54	0.16	2.07	10.72	1.43	0.18	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.77
H5812_031_0	2006											3000											A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin			V		V															N/A	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	311.96	4.5	1488.69	1635.29	259.67	17.57	1.23	657.91	30.55	11.94	32.46	0	9.05	32.15	4437.6	5574.84	1.48	270.87	18.94	102.96	13.07	1.68	0	0	347.96	0	149.13	0	0	0	0											400 copay/Admit	400copay /Admit	25 copay/day	10 copay/visit	100 copay/trip	20 Coin	20 Coin	50 ER/20 Urgent	15 Coin	15 Coin	15 Coin		15 Coin	15 Coin	20/Visit; Immuniz. CIF	20/visit; 15 Coin IP Consults	50 Coin	10 copay/visit	15 Coin	15 Coin; ER Prof CIF	15 Coin	15 Coin			20 copay/visit		20 copay/visit															400	400	25	10	100	0.2	0.2	48.33	0.15	0.15	0.15	0	0.15	0.15	19.91	20	0.5	10	0.15	0.14	0.15	0.15	0	0	20	0	20	0	0	0	0											3000	291.75	291.75	18.23	7.29	72.94	0.15	0.15	35.25	0.11	0.11	0.11	0	0.11	0.11	14.52	14.59	0.36	7.29	0.11	0.1	0.11	0.11	0	0	14.59	0	14.59	0	0	0	0											0	7.58	0.11	2.26	0.99	1.58	2.56	0.18	1.93	3.34	1.31	3.55	-	0.99	3.52	5.37	6.78	0.54	0.16	2.07	10.72	1.43	0.18	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.77	7.58	0.11	2.26	0.99	1.58	2.56	0.18	1.93	3.34	1.31	3.55	-	0.99	3.52	5.37	6.78	0.54	0.16	2.07	10.72	1.43	0.18	-	-	0.42	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	57.77
H5817_001_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	531.76	55.94	72.57		22.64	50.78	21.33	20.05	27.48	24.68	19.84	2.34	6.96	42.82	30.22	36.51	12.14	5.25	25.44	138.54	32.76	0.3																																																																																																							0.06	0.06	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					34.3	3.61	13.3	-	5.27	11.83	4.97	4.67	6.4	5.75	4.62	0.55	1.62	9.98	7.04	8.51	2.83	1.22	5.93	32.28	7.63	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	172.39	34.3	3.61	13.3	-	5.27	11.83	4.97	4.67	6.4	5.75	4.62	0.55	1.62	9.98	7.04	8.51	2.83	1.22	5.93	32.28	7.63	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	172.39
H5821_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	V	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																											-	114.03	2.47	1.89	0	3.07	28.96	16.27	6.14	12.64	15.41	5.08	0.74	0.45	4.03	32.78	30.12	4.22	4.37	17.26	66.86	14.67	0.05	0	0	0	0	0	0	6.13	0	0.15	0	0	0	0	0	0	0	0	0	0	Medicare CS	Medicare CS	Medicare CS	Medicare CS	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)							20 OON Costs													0.16	0.16	0.14	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0.87	0	0.2	0	0	0	0	0	0	0	0	0	0		0.16	0.16	0.14	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0.87	0	0.2	0	0	0	0	0	0	0	0	0	0		18.65	0.4	0.27	-	0.62	5.85	3.29	1.24	2.55	3.11	1.03	0.15	0.09	0.81	6.62	6.08	0.85	0.88	3.49	13.51	2.96	0.01	-	-	-	-	-	-	5.31	-	0.03	-	-	-	-	-	-	-	-	-	-	77.81	18.65	0.4	0.27	-	0.62	5.85	3.29	1.24	2.55	3.11	1.03	0.15	0.09	0.81	6.62	6.08	0.85	0.88	3.49	13.51	2.96	0.01	-	-	-	-	-	-	5.31	-	0.03	-	-	-	-	-	-	-	-	-	-	77.81
H5821_002_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	V	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																											-	0	0	0	0	0	0	0	396.08	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.13	0	0	0	0	0	0	0	0	0	0	0	0								25/Visit (non-admit)																					25 OON HO (non-ER)													0	0	0	0	0	0	0	22.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.87	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	22.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.87	0	0	0	0	0	0	0	0	0	0	0	0		-	-	-	-	-	-	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.31	-	-	-	-	-	-	-	-	-	-	-	-	6.05	-	-	-	-	-	-	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.31	-	-	-	-	-	-	-	-	-	-	-	-	6.05
H5821_003_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	V	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																											-	0	0	0	0	0	0	0	396.08	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.22	0	0	0	0	0	0	0	0	0	0	0	0								25/Visit (non-admit)																					25 OON HO (non-ER)													0	0	0	0	0	0	0	22.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.87	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	22.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.87	0	0	0	0	0	0	0	0	0	0	0	0		-	-	-	-	-	-	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.39	-	-	-	-	-	-	-	-	-	-	-	-	6.13	-	-	-	-	-	-	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.39	-	-	-	-	-	-	-	-	-	-	-	-	6.13
H5821_004_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	V	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																											-	0	0	0	0	0	0	0	396.08	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.22	0	0	0	0	0	0	0	0	0	0	0	0								25/Visit (non-admit)																					25 OON HO (non-ER)													0	0	0	0	0	0	0	22.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.87	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	22.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.87	0	0	0	0	0	0	0	0	0	0	0	0		-	-	-	-	-	-	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.39	-	-	-	-	-	-	-	-	-	-	-	-	6.13	-	-	-	-	-	-	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.39	-	-	-	-	-	-	-	-	-	-	-	-	6.13
H5821_007_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	V	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																											-	0	0	0	0	0	0	0	396.08	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.22	0	0	0	0	0	0	0	0	0	0	0	0								25/Visit (non-admit)																					25 OON HO (non-ER)													0	0	0	0	0	0	0	22.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.87	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	22.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.87	0	0	0	0	0	0	0	0	0	0	0	0		-	-	-	-	-	-	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.39	-	-	-	-	-	-	-	-	-	-	-	-	6.13	-	-	-	-	-	-	-	0.74	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	5.39	-	-	-	-	-	-	-	-	-	-	-	-	6.13
H5821_801_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	V	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																											-	108.58	2.04	1.3	0	2.86	27.87	15.78	6.04	12.66	15.37	4.98	0.73	0.46	3.95	32.64	30.14	3.55	4.03	17.35	65.3	14.35	0.05	0	0	0	0	0	0	5.83	0	0.15	0	0	0	0	0	0	0	0	0	0	Medicare CS	Medicare CS	Medicare CS	Medicare CS	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)							20 OON Costs													0.16	0.16	0.14	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0.87	0	0.2	0	0	0	0	0	0	0	0	0	0		0.16	0.16	0.14	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0.87	0	0.2	0	0	0	0	0	0	0	0	0	0		17.76	0.33	0.19	-	0.58	5.63	3.19	1.22	2.56	3.1	1.01	0.15	0.09	0.8	6.59	6.09	0.72	0.81	3.5	13.19	2.9	0.01	-	-	-	-	-	-	5.05	-	0.03	-	-	-	-	-	-	-	-	-	-	75.5	17.76	0.33	0.19	-	0.58	5.63	3.19	1.22	2.56	3.1	1.01	0.15	0.09	0.8	6.59	6.09	0.72	0.81	3.5	13.19	2.9	0.01	-	-	-	-	-	-	5.05	-	0.03	-	-	-	-	-	-	-	-	-	-	75.5
H5821_802_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	V	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																											-	108.58	2.04	1.3	0	2.86	27.87	15.78	6.04	12.66	15.37	4.98	0.73	0.46	3.95	32.64	30.14	3.55	4.03	17.35	65.3	14.35	0.05	0	0	0	0	0	0	5.83	0	0.15	0	0	0	0	0	0	0	0	0	0	Medicare CS	Medicare CS	Medicare CS	Medicare CS	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)	Medicare CS (No Ded)							20 OON Costs													0.16	0.16	0.14	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0.87	0	0.2	0	0	0	0	0	0	0	0	0	0		0.16	0.16	0.14	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0.87	0	0.2	0	0	0	0	0	0	0	0	0	0		17.76	0.33	0.19	-	0.58	5.63	3.19	1.22	2.56	3.1	1.01	0.15	0.09	0.8	6.59	6.09	0.72	0.81	3.5	13.19	2.9	0.01	-	-	-	-	-	-	5.05	-	0.03	-	-	-	-	-	-	-	-	-	-	75.5	17.76	0.33	0.19	-	0.58	5.63	3.19	1.22	2.56	3.1	1.01	0.15	0.09	0.8	6.59	6.09	0.72	0.81	3.5	13.19	2.9	0.01	-	-	-	-	-	-	5.05	-	0.03	-	-	-	-	-	-	-	-	-	-	75.5
H5823_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	350.5	27.87	69.66	41.07	14.86	28.3	19.78	8.42	22.83	11.86	23.99	0	24.74	18.32	63.66	96.4	10.53	2.15	21.77	26.37	13.62	15.05	0	0	0	0	0	0	0	1.25	13.28																																																				0.06	0.07	0.15	0	0.23	0.01	0.55	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.06	0.07	0.15	0	0.23	0.01	0.55	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												22.77	1.82	10.35	-	3.46	0.24	10.96	1.96	5.32	2.76	5.59	-	5.77	4.27	14.83	22.46	2.45	0.5	5.07	6.14	3.17	3.51	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	133.41	22.77	1.82	10.35	-	3.46	0.24	10.96	1.96	5.32	2.76	5.59	-	5.77	4.27	14.83	22.46	2.45	0.5	5.07	6.14	3.17	3.51	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	133.41
H5838_001_0	2006																						Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																															-	1		1		1	1		1	1	1					1						1																																																																																																								14.37		11.29		3.25	8.8		2.07	5.14	2.36					56.15						0.29																					110	14.37	-	11.29	-	3.25	8.8	-	2.07	5.14	2.36	-	-	-	-	56.15	-	-	-	-	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.73	14.37	-	11.29	-	3.25	8.8	-	2.07	5.14	2.36	-	-	-	-	56.15	-	-	-	-	-	0.29	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	103.73
H5839_001_0	2006																						D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	V	Coin	Coin																																																														-	536.6	18.33	232.39	3.66	107.95	5.62	3.86	266.85	55.49	27.09	2.95	0.14	0	0.08	3924.41	1995.97	1.47	3.88	0	0	29.37	3.09																				150 day for 1st 5 days	150 day for 1st 5 days	35 day for days 11+	15 Coinsurance	150 Copay	25 Coinsurance	25 Coinsurance	50 per visit	15 Coinsurance	15 Coinsurance	15 Coinsurance	50 Coinsurance	15 Coinsurance	15 Coinsurance	10 Per Visit	35 Per Visit	50 Coinsurance	15 Coinsurance	15 Coinsurance	35 Per Visit	25 Coinsurance	15 Coinsurance																																																														150	150	35	0.15	150	0.25	0.25	50	0.15	0.15	0.15	0.5	0.15	0.15	10	35	0.5	0.15	0.15	35	0.25	0.15																					6.71	0.23	0.68	0.55	1.35	1.41	0.97	1.11	8.32	4.06	0.44	0.07	-	0.01	3.27	5.82	0.74	0.58	-	-	7.34	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.12	6.71	0.23	0.68	0.55	1.35	1.41	0.97	1.11	8.32	4.06	0.44	0.07	-	0.01	3.27	5.82	0.74	0.58	-	-	7.34	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.12
H5842_801_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H5842_802_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H5842_803_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H5842_804_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.06	2.87	40.21	0	7.68	20.68	1.44	4.71	21.57	8.43	22.92	0	6.39	22.7	24.86	38.74	1.92	2.02	26.12	124.67	16.61	2.1	0	0	0	0	0	0	0	0	0											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.17	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											123	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34	18.85	0.2	6.91	-	1.79	4.82	0.34	1.1	5.03	1.97	5.34	-	1.49	5.29	5.79	9.03	0.45	0.47	6.09	29.05	3.87	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.34
H5850_001_0	2006																								D			Coin	Coin	V	V		V			V							S			V							V																																																					-			757.4			4.03	0.39	189.8	71.19		61.11			148.75							740.19			2281.46							10													25/day (days 8-25)						Hospital only		Hospital only			Hospital only							20 Coinsurance			Copays vary by service type							Travel benefit													10.83			0.2	0.2	50	100		50			25							14.4			52.36							20														10.83			0.2	0.2	50	100		50			25							14.4			52.36							20												-	-	0.68	-	-	0.81	0.08	0.79	0.59	-	0.25	-	-	0.31	-	-	-	-	-	-	0.89	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.37	-	-	0.68	-	-	0.81	0.08	0.79	0.59	-	0.25	-	-	0.31	-	-	-	-	-	-	0.89	-	-	9.95	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	14.37
H5850_002_0	2006																																													V																																																												-																								2284.93																																																																																		15.59																																										15.59																			-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.97	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.97
H5852_001_0	2006											none																																																				none																																										-																																																																																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0													none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0													0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5859_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	315.41	33.39	78.16	0	25.22	33.25	25.21	35.43	32.82	27.25	18.23	4.61	0.29	44.39	28.86	29.94	13.23	7.09	24.84	110.69	18.18	0.21	0	0	0	0	0	0	0	0	0																																																				0.07	0.07	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												22.76	2.41	10.56	-	5.88	7.75	5.87	8.25	7.65	6.35	4.25	1.07	0.07	10.34	6.72	6.98	3.08	1.65	5.79	25.79	4.24	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	147.51	22.76	2.41	10.56	-	5.88	7.75	5.87	8.25	7.65	6.35	4.25	1.07	0.07	10.34	6.72	6.98	3.08	1.65	5.79	25.79	4.24	0.05	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	147.51
H5883_001_1	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.49	3.87	1003.17	0	228.15	14.58	1.02	436.47	409.95	0	0	0	0	0	3911.92	4099.96	189.21	236.58	1864.88	1620.61	0	42.28	0	0	0	0	0	0	0	0	370													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 0 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other																						250	250	10	0	50	0.15	0.15	48.25	50	0	0	0	0	0	15	22.64	25	25	8	31.63	0	25	0	0	0	0	0	0	0	0	10												250	250	10	0	50	0.15	0.15	48.25	50	0	0	0	0	0	15	22.64	25	25	8	31.63	0	25	0	0	0	0	0	0	0	0	10											0	5.57	0.08	0.84	-	0.95	2.19	0.15	1.75	1.71	-	-	-	-	-	4.89	7.73	0.39	0.49	1.24	4.27	-	0.09	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	32.67	5.57	0.08	0.84	-	0.95	2.19	0.15	1.75	1.71	-	-	-	-	-	4.89	7.73	0.39	0.49	1.24	4.27	-	0.09	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	32.67
H5883_001_2	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	304.02	4.39	898.91	0	208.82	14.32	1	541.92	510.05	0	0	0	0	0	4724.3	4860.74	194.5	243.2	2223.55	1689.81	0	43.46	0	0	0	0	0	0	0	0	370													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 20 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other																						250	250	10	0	50	0.15	0.15	48.3	50	0	0	0	0	0	15	22.59	25	25	8	31.68	0	25	0	0	0	0	0	0	0	0	10												250	250	10	0	50	0.15	0.15	48.3	50	0	0	0	0	0	15	22.59	25	25	8	31.68	0	25	0	0	0	0	0	0	0	0	10											0	6.33	0.09	0.75	-	0.87	2.15	0.15	2.18	2.13	-	-	-	-	-	5.91	9.15	0.41	0.51	1.48	4.46	-	0.09	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	36.96	6.33	0.09	0.75	-	0.87	2.15	0.15	2.18	2.13	-	-	-	-	-	5.91	9.15	0.41	0.51	1.48	4.46	-	0.09	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	36.96
H5883_001_3	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	316.56	4.58	1492.43	0	230.26	15.35	1.07	466.34	434.35	0	0	0	0	0	4642.32	4863.09	223.79	279.82	2206.05	1780.55	0	50	0	0	0	0	0	0	0	0	370													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 20 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other																						250	250	10	0	50	0.15	0.15	48.05	50	0	0	0	0	0	15	22.64	25	25	8	31.37	0	25	0	0	0	0	0	0	0	0	10												250	250	10	0	50	0.15	0.15	48.05	50	0	0	0	0	0	15	22.64	25	25	8	31.37	0	25	0	0	0	0	0	0	0	0	10												6.6	0.1	1.24	-	0.96	2.3	0.16	1.87	1.81	-	-	-	-	-	5.8	9.17	0.47	0.58	1.47	4.66	-	0.1	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	37.6	6.6	0.1	1.24	-	0.96	2.3	0.16	1.87	1.81	-	-	-	-	-	5.8	9.17	0.47	0.58	1.47	4.66	-	0.1	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	37.6
H5883_001_4	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	350.33	5.06	926.74	0	290.96	17.7	1.23	437.1	401.65	0	0	0	0	0	5044.3	5305.55	251.19	314.09	2660.28	1946.16	0	56.13	0	0	0	0	0	0	0	0	370													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 20 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other																						250	250	10	0	50	0.15	0.15	47.74	50	0	0	0	0	0	15	22.65	25	25	8	31.28	0	25	0	0	0	0	0	0	0	0	10												250	250	10	0	50	0.15	0.15	47.74	50	0	0	0	0	0	15	22.65	25	25	8	31.28	0	25	0	0	0	0	0	0	0	0	10											0	7.3	0.11	0.77	-	1.21	2.65	0.19	1.74	1.67	-	-	-	-	-	6.31	10.01	0.52	0.65	1.77	5.07	-	0.12	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	40.41	7.3	0.11	0.77	-	1.21	2.65	0.19	1.74	1.67	-	-	-	-	-	6.31	10.01	0.52	0.65	1.77	5.07	-	0.12	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	40.41
H5883_001_5	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	375.9	5.43	1417.53	0	293.97	18.31	1.28	447.74	407.71	0	0	0	0	0	5637.2	6037.69	322.26	402.95	2904.73	2334.92	0	72.01	0	0	0	0	0	0	0	0	370													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 20 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other																						250	250	10	0	50	0.15	0.15	47.54	50	0	0	0	0	0	15	22.69	25	25	8	31.02	0	25	0	0	0	0	0	0	0	0	10												250	250	10	0	50	0.15	0.15	47.54	50	0	0	0	0	0	15	22.69	25	25	8	31.02	0	25	0	0	0	0	0	0	0	0	10											0	7.83	0.11	1.18	-	1.22	2.75	0.19	1.77	1.7	-	-	-	-	-	7.05	11.42	0.67	0.84	1.94	6.04	-	0.15	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	45.16	7.83	0.11	1.18	-	1.22	2.75	0.19	1.77	1.7	-	-	-	-	-	7.05	11.42	0.67	0.84	1.94	6.04	-	0.15	-	-	-	-	-	-	-	-	0.31	-	-	-	-	-	-	-	-	-	-	45.16
H5883_002_1	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	V												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	267.49	3.87	1003.17	0	228.15	14.58	1.02	436.47	409.95	0	0	0	0	0	3911.92	4099.96	189.21	236.58	1864.88	1620.61	0	42.28	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 0 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											250	250	10	0	50	0.15	0.15	48.25	50	0	0	0	0	0	15	22.64	25	25	8	31.63	0	25	0	0	0	0	0	0	0	0	15												250	250	10	0	50	0.15	0.15	48.25	50	0	0	0	0	0	15	22.64	25	25	8	31.63	0	25	0	0	0	0	0	0	0	0	15											0	5.57	0.08	0.84	-	0.95	2.19	0.15	1.75	1.71	-	-	-	-	-	4.89	7.73	0.39	0.49	1.24	4.27	-	0.09	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	32.6	5.57	0.08	0.84	-	0.95	2.19	0.15	1.75	1.71	-	-	-	-	-	4.89	7.73	0.39	0.49	1.24	4.27	-	0.09	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	32.6
H5883_002_2	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	304.02	4.39	898.91	0	208.82	14.32	1	541.92	510.05	0	0	0	0	0	4724.3	4860.74	194.5	243.2	2223.55	1689.81	0	43.46	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 20 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											250	250	10	0	50	0.15	0.15	48.3	50	0	0	0	0	0	15	22.59	25	25	8	31.68	0	25	0	0	0	0	0	0	0	0	15												250	250	10	0	50	0.15	0.15	48.3	50	0	0	0	0	0	15	22.59	25	25	8	31.68	0	25	0	0	0	0	0	0	0	0	15											0	6.33	0.09	0.75	-	0.87	2.15	0.15	2.18	2.13	-	-	-	-	-	5.91	9.15	0.41	0.51	1.48	4.46	-	0.09	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	36.9	6.33	0.09	0.75	-	0.87	2.15	0.15	2.18	2.13	-	-	-	-	-	5.91	9.15	0.41	0.51	1.48	4.46	-	0.09	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	36.9
H5883_002_3	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	316.56	4.58	1492.43	0	230.26	15.35	1.07	466.34	434.35	0	0	0	0	0	4642.32	4863.09	223.79	279.82	2206.05	1780.55	0	50	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 20 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											250	250	10	0	50	0.15	0.15	48.05	50	0	0	0	0	0	15	22.64	25	25	8	31.37	0	25	0	0	0	0	0	0	0	0	15												250	250	10	0	50	0.15	0.15	48.05	50	0	0	0	0	0	15	22.64	25	25	8	31.37	0	25	0	0	0	0	0	0	0	0	15												6.6	0.1	1.24	-	0.96	2.3	0.16	1.87	1.81	-	-	-	-	-	5.8	9.17	0.47	0.58	1.47	4.66	-	0.1	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	37.53	6.6	0.1	1.24	-	0.96	2.3	0.16	1.87	1.81	-	-	-	-	-	5.8	9.17	0.47	0.58	1.47	4.66	-	0.1	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	37.53
H5883_002_4	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	350.33	5.06	926.74	0	290.96	17.7	1.23	437.1	401.65	0	0	0	0	0	5044.3	5305.55	251.19	314.09	2660.28	1946.16	0	56.13	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 20 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											250	250	10	0	50	0.15	0.15	47.74	50	0	0	0	0	0	15	22.65	25	25	8	31.28	0	25	0	0	0	0	0	0	0	0	15												250	250	10	0	50	0.15	0.15	47.74	50	0	0	0	0	0	15	22.65	25	25	8	31.28	0	25	0	0	0	0	0	0	0	0	15											0	7.3	0.11	0.77	-	1.21	2.65	0.19	1.74	1.67	-	-	-	-	-	6.31	10.01	0.52	0.65	1.77	5.07	-	0.12	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	40.34	7.3	0.11	0.77	-	1.21	2.65	0.19	1.74	1.67	-	-	-	-	-	6.31	10.01	0.52	0.65	1.77	5.07	-	0.12	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	40.34
H5883_002_7	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	375.9	5.43	1417.53	0	293.97	18.31	1.28	447.74	407.71	0	0	0	0	0	5637.2	6037.69	322.26	402.95	2904.73	2334.92	0	72.01	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 25 Urgent Care Center								30 Chiropractic 10 Vision/Speech/Hearing Exams 25 all other			40 CT/MRI/PET (high tech.) 20 all other	35 Office surgery 25 Allergy 25 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											250	250	10	0	50	0.15	0.15	47.54	50	0	0	0	0	0	15	22.69	25	25	8	31.02	0	25	0	0	0	0	0	0	0	0	15												250	250	10	0	50	0.15	0.15	47.54	50	0	0	0	0	0	15	22.69	25	25	8	31.02	0	25	0	0	0	0	0	0	0	0	15											0	7.83	0.11	1.18	-	1.22	2.75	0.19	1.77	1.7	-	-	-	-	-	7.05	11.42	0.67	0.84	1.94	6.04	-	0.15	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	45.1	7.83	0.11	1.18	-	1.22	2.75	0.19	1.77	1.7	-	-	-	-	-	7.05	11.42	0.67	0.84	1.94	6.04	-	0.15	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	45.1
H5883_003_1	2006											10000000											Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P											3000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	1003.17	0	228.15	14.58	1.02	437.17	409.95	0	0	0	0	0	4139.06	4668.38	193.51	241.96	1871.32	1626.48	0	42.73	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 20 Urgent Care Center								10 Vision/Speech/Hearing Exams 20 all other			20 CT/MRI/PET (high tech.) 0 all other	35 Office surgery 20 Allergy 20 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											0	0	10	0	50	0.15	0.15	47.85	50	0	0	0	0	0	7	18.62	20	20	4	29.91	0	20	0	0	0	0	0	0	0	0	15												0	0	10	0	50	0.15	0.15	47.85	50	0	0	0	0	0	7	18.62	20	20	4	29.91	0	20	0	0	0	0	0	0	0	0	15												-	-	0.84	-	0.95	2.19	0.15	1.74	1.71	-	-	-	-	-	2.41	7.24	0.32	0.4	0.62	4.05	-	0.07	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	22.95	-	-	0.84	-	0.95	2.19	0.15	1.74	1.71	-	-	-	-	-	2.41	7.24	0.32	0.4	0.62	4.05	-	0.07	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	22.95
H5883_003_2	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	898.91	0	208.82	14.32	1	542.76	510.05	0	0	0	0	0	4998.62	5455.91	198.92	248.73	2231.23	1695.85	0	43.93	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 20 Urgent Care Center								10 Vision/Speech/Hearing Exams 20 all other			20 CT/MRI/PET (high tech.) 0 all other	35 Office surgery 20 Allergy 20 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											0	0	10	0	50	0.15	0.15	47.91	50	0	0	0	0	0	7	18.57	20	20	4	29.98	0	20	0	0	0	0	0	0	0	0	15												0	0	10	0	50	0.15	0.15	47.91	50	0	0	0	0	0	7	18.57	20	20	4	29.98	0	20	0	0	0	0	0	0	0	0	15											0	-	-	0.75	-	0.87	2.15	0.15	2.17	2.13	-	-	-	-	-	2.92	8.44	0.33	0.41	0.74	4.24	-	0.07	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	25.61	-	-	0.75	-	0.87	2.15	0.15	2.17	2.13	-	-	-	-	-	2.92	8.44	0.33	0.41	0.74	4.24	-	0.07	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	25.61
H5883_003_3	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	1492.43	0	230.26	15.35	1.07	467.16	434.35	0	0	0	0	0	4911.88	5535.62	228.87	286.18	2213.67	1787.49	0	50.54	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 20 Urgent Care Center								10 Vision/Speech/Hearing Exams 20 all other			20 CT/MRI/PET (high tech.) 0 all other	35 Office surgery 20 Allergy 20 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											0	0	10	0	50	0.15	0.15	47.62	50	0	0	0	0	0	7	18.62	20	20	4	29.52	0	20	0	0	0	0	0	0	0	0	15												0	0	10	0	50	0.15	0.15	47.62	50	0	0	0	0	0	7	18.62	20	20	4	29.52	0	20	0	0	0	0	0	0	0	0	15											0	-	-	1.24	-	0.96	2.3	0.16	1.85	1.81	-	-	-	-	-	2.87	8.59	0.38	0.48	0.74	4.4	-	0.08	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	26.1	-	-	1.24	-	0.96	2.3	0.16	1.85	1.81	-	-	-	-	-	2.87	8.59	0.38	0.48	0.74	4.4	-	0.08	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	26.1
H5883_003_4	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	926.74	0	290.96	17.7	1.23	438	401.65	0	0	0	0	0	5337.19	6057.86	256.9	321.22	2669.47	1953.96	0	56.73	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 20 Urgent Care Center								10 Vision/Speech/Hearing Exams 20 all other			20 CT/MRI/PET (high tech.) 0 all other	35 Office surgery 20 Allergy 20 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											0	0	10	0	50	0.15	0.15	47.24	50	0	0	0	0	0	7	18.63	20	20	4	29.38	0	20	0	0	0	0	0	0	0	0	15												0	0	10	0	50	0.15	0.15	47.24	50	0	0	0	0	0	7	18.63	20	20	4	29.38	0	20	0	0	0	0	0	0	0	0	15											0	-	-	0.77	-	1.21	2.65	0.19	1.72	1.67	-	-	-	-	-	3.11	9.4	0.43	0.54	0.89	4.78	-	0.09	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	27.71	-	-	0.77	-	1.21	2.65	0.19	1.72	1.67	-	-	-	-	-	3.11	9.4	0.43	0.54	0.89	4.78	-	0.09	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	27.71
H5883_003_5	2006																						Ded	Ded	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	O	P	T	P	P	P	P	P	P	P	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	0	0	1417.53	0	293.97	18.31	1.28	448.74	407.71	0	0	0	0	0	5964.52	6989.92	329.58	412.11	2914.76	2344.92	0	72.78	0	0	0	0	0	0	0	0	195.1													20 for days 21-100					50 ER 20 Urgent Care Center								10 Vision/Speech/Hearing Exams 20 all other			20 CT/MRI/PET (high tech.) 0 all other	35 Office surgery 20 Allergy 20 Cardiovascular 0 other											1 vision exam every 3 years 15 copay											0	0	10	0	50	0.15	0.15	46.99	50	0	0	0	0	0	7	18.67	20	20	4	28.99	0	20	0	0	0	0	0	0	0	0	15												0	0	10	0	50	0.15	0.15	46.99	50	0	0	0	0	0	7	18.67	20	20	4	28.99	0	20	0	0	0	0	0	0	0	0	15											0	-	-	1.18	-	1.22	2.75	0.19	1.76	1.7	-	-	-	-	-	3.48	10.87	0.55	0.69	0.97	5.66	-	0.12	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	31.39	-	-	1.18	-	1.22	2.75	0.19	1.76	1.7	-	-	-	-	-	3.48	10.87	0.55	0.69	0.97	5.66	-	0.12	-	-	-	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	31.39
H5883_801_0	2006																						D	D	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin									Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0											-	1469.39	31.02	33.6		7.82	16.91	1.18	5.68	27.78	8.69	29.52		8.23	29.23	25.48	39.15	2.05	2.16	29.4	125.25	17.72	2.23									0.1											912 deductible 228 copay days 61-90 456 copay on reserve days	912 deductible 228 copay days 61-90 456 copay on reserve days	0 copay day 1-20  114 copay day 21-100 100 day 101+		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance									123 deductible for all Part B type services then 20 coinsurance											145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23												145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23											0	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56
H5883_802_0	2006																						D	D	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin									Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0											-	1469.39	31.02	33.6		7.82	16.91	1.18	5.68	27.78	8.69	29.52		8.23	29.23	25.48	39.15	2.05	2.16	29.4	125.25	17.72	2.23									0.1											912 deductible 228 copay days 61-90 456 copay on reserve days	912 deductible 228 copay days 61-90 456 copay on reserve days	0 copay day 1-20  114 copay day 21-100 100 day 101+		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance									123 deductible for all Part B type services then 20 coinsurance											145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23												145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23											0	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56
H5883_803_0	2006																						D	D	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin									Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0											-	1469.39	31.02	33.6		7.82	16.91	1.18	5.68	27.78	8.69	29.52		8.23	29.23	25.48	39.15	2.05	2.16	29.4	125.25	17.72	2.23									0.1											912 deductible 228 copay days 61-90 456 copay on reserve days	912 deductible 228 copay days 61-90 456 copay on reserve days	0 copay day 1-20  114 copay day 21-100 100 day 101+		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance									123 deductible for all Part B type services then 20 coinsurance											145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23												145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23											0	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56
H5883_804_0	2006																						D	D	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin									Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0											-	1469.39	31.02	33.6		7.82	16.91	1.18	5.68	27.78	8.69	29.52		8.23	29.23	25.48	39.15	2.05	2.16	29.4	125.25	17.72	2.23									0.1											912 deductible 228 copay days 61-90 456 copay on reserve days	912 deductible 228 copay days 61-90 456 copay on reserve days	0 copay day 1-20  114 copay day 21-100 100 day 101+		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance									123 deductible for all Part B type services then 20 coinsurance											145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23												145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23											0	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56
H5883_805_0	2006																						D	D	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin									Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0											-	1469.39	31.02	33.6		7.82	16.91	1.18	5.68	27.78	8.69	29.52		8.23	29.23	25.48	39.15	2.05	2.16	29.4	125.25	17.72	2.23									0.1											912 deductible 228 copay days 61-90 456 copay on reserve days	912 deductible 228 copay days 61-90 456 copay on reserve days	0 copay day 1-20  114 copay day 21-100 100 day 101+		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance									123 deductible for all Part B type services then 20 coinsurance											145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23												145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23											0	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56
H5883_806_0	2006																						D	D	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin									Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0											-	1469.39	31.02	33.6		7.82	16.91	1.18	5.68	27.78	8.69	29.52		8.23	29.23	25.48	39.15	2.05	2.16	29.4	125.25	17.72	2.23									0.1											912 deductible 228 copay days 61-90 456 copay on reserve days	912 deductible 228 copay days 61-90 456 copay on reserve days	0 copay day 1-20  114 copay day 21-100 100 day 101+		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance									123 deductible for all Part B type services then 20 coinsurance											145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23												145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23											0	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56
H5883_807_0	2006																						D	D	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin									Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0											-	1469.39	31.02	33.6		7.82	16.91	1.18	5.68	27.78	8.69	29.52		8.23	29.23	25.48	39.15	2.05	2.16	29.4	125.25	17.72	2.23									0.1											912 deductible 228 copay days 61-90 456 copay on reserve days	912 deductible 228 copay days 61-90 456 copay on reserve days	0 copay day 1-20  114 copay day 21-100 100 day 101+		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance									123 deductible for all Part B type services then 20 coinsurance											145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23												145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23											0	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56
H5883_808_0	2006																						D	D	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin									Coin												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0											-	1469.39	31.02	33.6		7.82	16.91	1.18	5.68	27.78	8.69	29.52		8.23	29.23	25.48	39.15	2.05	2.16	29.4	125.25	17.72	2.23									0.1											912 deductible 228 copay days 61-90 456 copay on reserve days	912 deductible 228 copay days 61-90 456 copay on reserve days	0 copay day 1-20  114 copay day 21-100 100 day 101+		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance		123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance	123 deductible for all Part B type services then 20 coinsurance									123 deductible for all Part B type services then 20 coinsurance											145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23												145.7	145.7	0.18		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23									0.23											0	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56	17.84	0.38	6.14	-	1.82	3.94	0.27	1.32	6.47	2.02	6.88	-	1.92	6.81	5.94	9.12	0.48	0.5	6.85	29.18	4.13	0.52	-	-	-	-	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	112.56
H5884_001_1	2006											3000											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	P	Coin	P	P	P	Coin	P	P	P																																																					-	1998.84	83.34	1007.9	0	178.02	13.29	15.1	327.12	414.39	1157.81	801.15	0	1.61	291.71	4297.83	5103.8	229.16	772.15	4481.42	3290.02	0	0	0	0	124	500	222	1.67	0	0	0											95 (Days 1-7)	95 (Days 1-7)	95 (Days 1-30)		150/Svc	20	20	50	25 - 100	0 - 50	0 - 50		25		20	20	20	25	25					Up to 100/yr	20	25; 1 pair/year	20	100														68.97	68.97	79.8	0	150	0.2	0.2	50.32	57.2	10	20.46	0	25	24.81	19.75	20	20	21.35	25	20	0	0	0	0	20	25	20	1	0	0	0												53.35	53.35	61.73	0	116.03	0.15	0.19	38.92	44.25	7.74	15.82	0	25	19.19	15.27	15.47	15.47	16.51	25	18.79	0	0	0	0	15.47	19.34	15.47	0.77	0	0	0												8.89	0.37	5.18	-	1.72	2.06	2.9	1.06	1.53	0.75	1.06	-	0	0.47	5.47	6.58	0.3	1.06	9.34	5.15	-	-	-	-	0.16	0.81	0.29	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	56.42	8.89	0.37	5.18	-	1.72	2.06	2.9	1.06	1.53	0.75	1.06	-	0	0.47	5.47	6.58	0.3	1.06	9.34	5.15	-	-	-	-	0.16	0.81	0.29	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	56.42
H5884_001_2	2006											3000											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	P	Coin	P	P	P	Coin	P	P	P																																																					-	1968.74	82.08	992.72	0	175.34	12.89	14.65	322.21	408.15	1140.37	789.09	0	1.59	287.32	4234.21	5028.08	225.71	763.67	4413.94	3240.47	0	0	0	0	124	500	222	1.67	0	0	0											95 (Days 1-7)	95 (Days 1-7)	95 (Days 1-30)		150/Svc	20	20	50	25 - 100	0 - 50	0 - 50		25		20	20	20	25	25					Up to 100/yr	20	25; 1 pair/year	20	100														68.97	68.97	79.8	0	150	0.2	0.2	50.32	57.2	10	20.46	0	25	24.81	19.74	20	20	21.34	25	20	0	0	0	0	20	25	20	1	0	0	0												53.53	53.53	61.94	0	116.43	0.16	0.19	39.06	44.4	7.76	15.88	0	25	19.26	15.32	15.52	15.52	16.57	25	18.8	0	0	0	0	15.52	19.4	15.52	0.78	0	0	0												8.78	0.37	5.12	-	1.7	2	2.82	1.05	1.51	0.74	1.04	-	0	0.46	5.41	6.5	0.29	1.05	9.2	5.08	-	-	-	-	0.16	0.81	0.29	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	55.68	8.78	0.37	5.12	-	1.7	2	2.82	1.05	1.51	0.74	1.04	-	0	0.46	5.41	6.5	0.29	1.05	9.2	5.08	-	-	-	-	0.16	0.81	0.29	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	55.68
H5884_001_3	2006											3000											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	P	Coin	P	P	P	Coin	P	P	P																																																					-	1910.81	79.67	963.51	0	170.18	12.14	13.8	312.76	396.14	1106.82	765.87	0	1.54	278.86	4111.77	4882.37	219.07	747.35	4284.06	3145.13	0	0	0	0	124	500	222	1.67	0	0	0											95 (Days 1-7)	95 (Days 1-7)	95 (Days 1-30)		150/Svc	20	20	50	25 - 100	0 - 50	0 - 50		25		20	20	20	25	25					Up to 100/yr	20	25; 1 pair/year	20	100														68.97	68.97	79.8	0	150	0.2	0.2	50.33	57.2	10	20.46	0	25	24.81	19.73	20	20	21.33	25	20	0	0	0	0	20	25	20	1	0	0	0												53.9	53.9	62.36	0	117.22	0.16	0.19	39.33	44.7	7.81	15.99	0	25	19.39	15.42	15.63	15.63	16.67	25	18.83	0	0	0	0	15.63	19.54	15.63	0.78	0	0	0												8.58	0.36	5.01	-	1.66	1.9	2.66	1.03	1.48	0.72	1.02	-	0	0.45	5.28	6.36	0.29	1.04	8.93	4.94	-	-	-	-	0.16	0.81	0.29	1.3	-	-	-	-	-	-	-	-	-	-	-	-	-	54.26	8.58	0.36	5.01	-	1.66	1.9	2.66	1.03	1.48	0.72	1.02	-	0	0.45	5.28	6.36	0.29	1.04	8.93	4.94	-	-	-	-	0.16	0.81	0.29	1.3	-	-	-	-	-	-	-	-	-	-	-	-	-	54.26
H5884_002_1	2006											3000											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	P	Coin	P	P	P	Coin	P	P	P																																																					-	1998.84	83.34	1007.9	0	178.02	13.29	15.1	327.12	414.39	1157.81	801.15	0	1.61	291.71	4297.83	5103.8	229.16	772.15	4481.42	3290.02	0	0	0	0	124	500	222	1.67	0	0	0											95 (Days 1-7)	95 (Days 1-7)	95 (Days 1-30)		150/Svc	20	20	50	25 - 100	0 - 50	0 - 50		25		20	20	20	25	25					Up to 100/yr	20	25; 1 pair/year	20	100														68.97	68.97	79.8	0	150	0.2	0.2	50.32	57.2	10	20.46	0	25	24.81	19.75	20	20	21.35	25	20	0	0	0	0	20	25	20	1	0	0	0												53.35	53.35	61.73	0	116.03	0.15	0.19	38.92	44.25	7.74	15.82	0	25	19.19	15.27	15.47	15.47	16.51	25	18.79	0	0	0	0	15.47	19.34	15.47	0.77	0	0	0												8.89	0.37	5.18	-	1.72	2.06	2.9	1.06	1.53	0.75	1.06	-	0	0.47	5.47	6.58	0.3	1.06	9.34	5.15	-	-	-	-	0.16	0.81	0.29	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	56.42	8.89	0.37	5.18	-	1.72	2.06	2.9	1.06	1.53	0.75	1.06	-	0	0.47	5.47	6.58	0.3	1.06	9.34	5.15	-	-	-	-	0.16	0.81	0.29	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	56.42
H5884_002_2	2006											3000											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	P	Coin	P	P	P	Coin	P	P	P																																																					-	1968.74	82.08	992.72	0	175.34	12.89	14.65	322.21	408.15	1140.37	789.09	0	1.59	287.32	4234.21	5028.08	225.71	763.67	4413.94	3240.47	0	0	0	0	124	500	222	1.67	0	0	0											95 (Days 1-7)	95 (Days 1-7)	95 (Days 1-30)		150/Svc	20	20	50	25 - 100	0 - 50	0 - 50		25		20	20	20	25	25					Up to 100/yr	20	25; 1 pair/year	20	100														68.97	68.97	79.8	0	150	0.2	0.2	50.32	57.2	10	20.46	0	25	24.81	19.74	20	20	21.34	25	20	0	0	0	0	20	25	20	1	0	0	0												53.53	53.53	61.94	0	116.43	0.16	0.19	39.06	44.4	7.76	15.88	0	25	19.26	15.32	15.52	15.52	16.57	25	18.8	0	0	0	0	15.52	19.4	15.52	0.78	0	0	0												8.78	0.37	5.12	-	1.7	2	2.82	1.05	1.51	0.74	1.04	-	0	0.46	5.41	6.5	0.29	1.05	9.2	5.08	-	-	-	-	0.16	0.81	0.29	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	55.68	8.78	0.37	5.12	-	1.7	2	2.82	1.05	1.51	0.74	1.04	-	0	0.46	5.41	6.5	0.29	1.05	9.2	5.08	-	-	-	-	0.16	0.81	0.29	1.29	-	-	-	-	-	-	-	-	-	-	-	-	-	55.68
H5884_002_3	2006											3000											D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	P	Coin	P	P	P	Coin	P	P	P																																																					-	1910.81	79.67	963.51	0	170.18	12.14	13.8	312.76	396.14	1106.82	765.87	0	1.54	278.86	4111.77	4882.37	219.07	747.35	4284.06	3145.13	0	0	0	0	124	500	222	1.67	0	0	0											95 (Days 1-7)	95 (Days 1-7)	95 (Days 1-30)		150/Svc	20	20	50	25 - 100	0 - 50	0 - 50		25		20	20	20	25	25					Up to 100/yr	20	25; 1 pair/year	20	100														68.97	68.97	79.8	0	150	0.2	0.2	50.33	57.2	10	20.46	0	25	24.81	19.73	20	20	21.33	25	20	0	0	0	0	20	25	20	1	0	0	0												53.9	53.9	62.36	0	117.22	0.16	0.19	39.33	44.7	7.81	15.99	0	25	19.39	15.42	15.63	15.63	16.67	25	18.83	0	0	0	0	15.63	19.54	15.63	0.78	0	0	0												8.58	0.36	5.01	-	1.66	1.9	2.66	1.03	1.48	0.72	1.02	-	0	0.45	5.28	6.36	0.29	1.04	8.93	4.94	-	-	-	-	0.16	0.81	0.29	1.3	-	-	-	-	-	-	-	-	-	-	-	-	-	54.26	8.58	0.36	5.01	-	1.66	1.9	2.66	1.03	1.48	0.72	1.02	-	0	0.45	5.28	6.36	0.29	1.04	8.93	4.94	-	-	-	-	0.16	0.81	0.29	1.3	-	-	-	-	-	-	-	-	-	-	-	-	-	54.26
H5884_801_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	301.46	5.36	29.65	0	5.83	12.83	14.58	320.91	39.01	20.53	25.34	1.65	0.24	17.86	22.21	30.4	1.46	4.01	22.61	98.61	27.74	0.39	0	0	0	0	0	0	0	0	0																		50																																		0.08	0.08	0.2	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.08	0.08	0.2	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											110	23.05	0.41	6.04	-	1.36	2.99	3.4	1.34	9.09	4.78	5.9	0.38	0.06	4.16	5.18	7.08	0.34	0.93	5.27	22.98	6.46	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.29	23.05	0.41	6.04	-	1.36	2.99	3.4	1.34	9.09	4.78	5.9	0.38	0.06	4.16	5.18	7.08	0.34	0.93	5.27	22.98	6.46	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.29
H5884_802_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	301.46	5.36	29.65	0	5.83	12.83	14.58	320.91	39.01	20.53	25.34	1.65	0.24	17.86	22.21	30.4	1.46	4.01	22.61	98.61	27.74	0.39	0	0	0	0	0	0	0	0	0																		50																																		0.08	0.08	0.2	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.08	0.08	0.2	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											110	23.05	0.41	6.04	-	1.36	2.99	3.4	1.34	9.09	4.78	5.9	0.38	0.06	4.16	5.18	7.08	0.34	0.93	5.27	22.98	6.46	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.29	23.05	0.41	6.04	-	1.36	2.99	3.4	1.34	9.09	4.78	5.9	0.38	0.06	4.16	5.18	7.08	0.34	0.93	5.27	22.98	6.46	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.29
H5884_803_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	301.46	5.36	29.65	0	5.83	12.83	14.58	320.91	39.01	20.53	25.34	1.65	0.24	17.86	22.21	30.4	1.46	4.01	22.61	98.61	27.74	0.39	0	0	0	0	0	0	0	0	0																		50																																		0.08	0.08	0.2	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.08	0.08	0.2	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											110	23.05	0.41	6.04	-	1.36	2.99	3.4	1.34	9.09	4.78	5.9	0.38	0.06	4.16	5.18	7.08	0.34	0.93	5.27	22.98	6.46	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.29	23.05	0.41	6.04	-	1.36	2.99	3.4	1.34	9.09	4.78	5.9	0.38	0.06	4.16	5.18	7.08	0.34	0.93	5.27	22.98	6.46	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.29
H5884_804_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	301.46	5.36	29.65	0	5.83	12.83	14.58	320.91	39.01	20.53	25.34	1.65	0.24	17.86	22.21	30.4	1.46	4.01	22.61	98.61	27.74	0.39	0	0	0	0	0	0	0	0	0																		50																																		0.08	0.08	0.2	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.08	0.08	0.2	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0											110	23.05	0.41	6.04	-	1.36	2.99	3.4	1.34	9.09	4.78	5.9	0.38	0.06	4.16	5.18	7.08	0.34	0.93	5.27	22.98	6.46	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.29	23.05	0.41	6.04	-	1.36	2.99	3.4	1.34	9.09	4.78	5.9	0.38	0.06	4.16	5.18	7.08	0.34	0.93	5.27	22.98	6.46	0.09	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	111.29
H5893_001_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5893_002_0	2006																																																																																																									-																																																																																																																																																																							-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5908_001_0	2006																						D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	Coin	V	V	V	V	Coin	V	Coin	Coin	T	V	Coin	V	V	V	V	V	V																																																					-	1311.29	91.44	426.93	12.85	182.16	10.16	13.5	302.18	409.33	1.13	11.46		0.75	14.58	3911.84	6052.18	286.96				23.74	0.34																				150 (days 1-4) / 225 (days 1-4)	150 (days1-8)/175 (days31+) / 225 (days1-8)/250 (days31+)	0 (days1-20)/50 (days21-100) / 50 (days1-20)/100 (days21-100)	20	150 (ground); 15 (air) / 150 (ground); 20 (air)	0-20 / 20	0-20 / 6-12 / 20	50 / 50	150 / 200	15	0/10/25/75/100/200 / 10/15/20		20 / 30	15/20/25/50 / 25/40/75	10/20/25/0-200 / 20/40/0-200	25/30 / 40	25 / 40				20 / 20	20-Oct			80/20		20 / 25															104.41	56.6	21.18	20	148.5	16.9	10.2	46.26	160.11	15	10.4		22.02	3.1	12.11	28.52	27.94				20	12																					104.41	56.6	21.18	20	148.5	16.9	10.2	46.26	160.11	15	10.4		22.02	3.1	12.11	28.52	27.94				20	12																					11.41	0.43	0.75	0.02	2.25	1.72	1.37	1.16	5.46	0.17	1.19	-	0	0.46	3.95	14.38	0.67	-	-	-	4.75	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.19	11.41	0.43	0.75	0.02	2.25	1.72	1.37	1.16	5.46	0.17	1.19	-	0	0.46	3.95	14.38	0.67	-	-	-	4.75	0.04	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	50.19
H5918_001_0	2006											1500	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						14.18	14.84	371.01	353.89	1815.75	716.1	49.19		926.54		6105.82	314.93	755.37							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.77		30	22.14	24.27							30		30				30																	0.15	0.19	36.81	36.81	36.81	18.41	36.81		36.73		30	22.14	21.25							30		22.09				30												-	-	-	-	-	2.09	2.83	1.14	1.09	5.57	1.1	0.15	-	2.84	-	15.26	0.58	1.34	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	35.06	-	-	-	-	-	2.09	2.83	1.14	1.09	5.57	1.1	0.15	-	2.84	-	15.26	0.58	1.34	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	35.06
H5918_002_0	2006											1500	0	0	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	P	V	P	P	P	P																																																					-						14.18	14.84	371.01	353.89	1815.75	716.1	49.19		926.54		6105.82	314.93	755.37							125.93		218.34				147																20	20	50	50	50	0  / 50	50		50		30	30 / 0	0 / 30 / 50							30		30				0 / 30																0.2	0.2	50	50	50	25	50		49.77		30	22.14	24.27							30		30				30																	0.15	0.19	36.81	36.81	36.81	18.41	36.81		36.73		30	22.14	21.25							30		22.09				30												-	-	-	-	-	2.09	2.83	1.14	1.09	5.57	1.1	0.15	-	2.84	-	15.26	0.58	1.34	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	35.06	-	-	-	-	-	2.09	2.83	1.14	1.09	5.57	1.1	0.15	-	2.84	-	15.26	0.58	1.34	-	-	-	-	-	-	0.31	-	0.4	-	-	-	0.37	-	-	-	-	-	-	-	-	-	-	35.06
H5926_001_0	2006																						Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																					-	370.56	28.74	61.56	57.11	14.99	28.38	19.91	8.5	22.82	11.65	23.54	0	24.89	18.38	71.13	91.98	11.55	2.4	21.76	27.33	13.71	16.76	2	10.5	0	0	0	0	0	1.25	2																																																				0.07	0.07	0.18	0	0.23	0.01	0.55	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												0.07	0.07	0.18	0	0.23	0.01	0.55	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												24.42	1.9	11.11	-	3.49	0.24	11.01	1.98	5.32	2.72	5.49	-	5.8	4.28	16.57	21.43	2.69	0.56	5.07	6.37	3.19	3.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	137.55	24.42	1.9	11.11	-	3.49	0.24	11.01	1.98	5.32	2.72	5.49	-	5.8	4.28	16.57	21.43	2.69	0.56	5.07	6.37	3.19	3.91	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	137.55
H5932_001_0	2006																						Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	389.7	4.16	57.28	32.02	7.18	17.41	1.35	635.44	29.68	11.61	31.54	0	8.8	31.24	25.03	38.54	1.94	2.04	22.21	126.72	16.73	2.12																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	50/visit or FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS or CIF	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.07	0.07	0.18	0	0.23	0.23	0.23	47.51	0.23	0.23	0.23	0	0.23	0.23	0.23	0.21	0.23	0.23	0.23	0.22	0.23	0.23																					0.07	0.07	0.18	0	0.23	0.23	0.23	47.51	0.23	0.23	0.23	0	0.23	0.23	0.23	0.21	0.23	0.23	0.23	0.22	0.23	0.23																				123	28.37	0.3	10.34	-	1.67	4.06	0.31	2.52	6.92	2.7	7.35	-	2.05	7.28	5.83	7.91	0.45	0.47	5.18	28.23	3.9	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	126.34	28.37	0.3	10.34	-	1.67	4.06	0.31	2.52	6.92	2.7	7.35	-	2.05	7.28	5.83	7.91	0.45	0.47	5.18	28.23	3.9	0.49	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	126.34
H5936_001_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	0	139.29	422.92	0	142.16	0	0	199.18	0	0	202.14	0	0	30.89	0	6222.56	0	0	0	0	24.59	0	0	0	0	0	0	0	0	0	0												50 - 1st 5 days	50 - days 21-100		50			Emerg. 50 - Urg. 25			50/IMRT - 100/Pet Scan - 25/Radiation Therapy			OP-MA/SA 35/indv 20/group visit							20																					0	24	17.5	0	50	0	0	47.5	0	0	58.87	0	0	31.25	0	17	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0												0	24	17.5	0	50	0	0	47.5	0	0	58.87	0	0	31.25	0	17	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0												-	0.28	0.62	-	0.59	-	-	0.79	-	-	0.99	-	-	0.08	-	8.82	-	-	-	-	4.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.08	-	0.28	0.62	-	0.59	-	-	0.79	-	-	0.99	-	-	0.08	-	8.82	-	-	-	-	4.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	17.08
H5936_003_0	2006																						D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P																																																					-	2834.61	863.15	861.75	0	9.96	155.21	253.12	11.84	24.23	26.03	15.31	1.71	4.12	107.83	30.71	43.84	12.52	14.75	33.89	156.62	192.74	0.32	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				102.86	41.39	65.07	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												102.86	41.39	65.07	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												24.3	2.98	4.67	-	2.32	36.16	58.98	2.76	5.65	6.06	3.57	0.4	0.96	25.12	7.16	10.22	2.92	3.44	7.9	36.49	44.91	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	287.02	24.3	2.98	4.67	-	2.32	36.16	58.98	2.76	5.65	6.06	3.57	0.4	0.96	25.12	7.16	10.22	2.92	3.44	7.9	36.49	44.91	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	287.02
H5936_004_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	0	139.29	422.92	0	142.16	0	0	199.18	0	0	202.14	0	0	30.89	0	0	0	0	0	0	24.59	0	0	0	0	0	0	0	0	0	0												50 - 1st 5 days	50 - days 21-100		50			Emerg. 50 - Urg. 25			50/IMRT - 100/Pet Scan - 25/Radiation Therapy			OP-MA/SA 35/indv 20/group visit							20																					0	24	17.5	0	50	0	0	47.5	0	0	58.87	0	0	31.25	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0												0	24	17.5	0	50	0	0	47.5	0	0	58.87	0	0	31.25	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0												-	0.28	0.62	-	0.59	-	-	0.79	-	-	0.99	-	-	0.08	-	-	-	-	-	-	4.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.27	-	0.28	0.62	-	0.59	-	-	0.79	-	-	0.99	-	-	0.08	-	-	-	-	-	-	4.92	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	8.27
H5936_005_0	2006																						A	D	D	V	P	P	P	V	V	V	P	V	V	V	V	V	V	V	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1380.15	25.89	497.73	0	84.86	0	0	246.76	378.71	0	240.31	0	0	209.71	0	5757.19	0	562.36	0	1054.81	20.52	0	0	0	124	0	0	0	0	0	0											200/admit	100 - 1st 5 days	75 - days 21-100		50			Emerg. 50 - Urg. 25	75/visit		50/IMRT - 100/Pet Scan - 25/Radiation Therapy			OP-MA/SA 35/indv 20/group visit		15/visit		15/visit		15/visit	20				15/exam																	37.63	45.15	26.25	0	50	0	0	47.5	75	0	61.37	0	0	15.5	0	15	0	15	0	15	0.2	0	0	0	15	0	0	0	0	0	0												37.63	45.15	26.25	0	50	0	0	47.5	75	0	61.37	0	0	15.5	0	15	0	15	0	15	0.2	0	0	0	15	0	0	0	0	0	0												4.33	0.1	1.09	-	0.35	-	-	0.98	2.37	-	1.23	-	-	0.27	-	7.2	-	0.7	-	1.32	4.1	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.19	4.33	0.1	1.09	-	0.35	-	-	0.98	2.37	-	1.23	-	-	0.27	-	7.2	-	0.7	-	1.32	4.1	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.19
H5936_006_0	2006																						D	D	D	V	P	P	P	V	V	V	V	V	V	V	P	P	P	P	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																																																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
H5936_007_0	2006																						A	D	D	V	P	P	P	V	V	V	P	V	V	V	V	V	V	V	Coin	P	Coin	P	P	P	P	P	P	P	P	P	P																																																					-	1380.15	25.89	497.73	0	84.86	0	0	246.76	378.71	0	240.31	0	0	209.71	0	5757.19	0	562.36	0	1054.81	20.52	0	0	0	124	0	0	0	0	0	0											200/admit	100 - 1st 5 days	75 - days 21-100		50			Emerg. 50 - Urg. 25	75/visit		50/IMRT - 100/Pet Scan - 25/Radiation Therapy			OP-MA/SA 35/indv 20/group visit		15/visit		15/visit		15/visit	20																					37.63	45.15	26.25	0	50	0	0	47.5	75	0	61.37	0	0	15.5	0	15	0	15	0	15	0.2	0	0	0	15	0	0	0	0	0	0												37.63	45.15	26.25	0	50	0	0	47.5	75	0	61.37	0	0	15.5	0	15	0	15	0	15	0.2	0	0	0	15	0	0	0	0	0	0												4.33	0.1	1.09	-	0.35	-	-	0.98	2.37	-	1.23	-	-	0.27	-	7.2	-	0.7	-	1.32	4.1	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.19	4.33	0.1	1.09	-	0.35	-	-	0.98	2.37	-	1.23	-	-	0.27	-	7.2	-	0.7	-	1.32	4.1	-	-	-	0.16	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.19
H5936_801_0	2006																						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P																																																					-	1711.92	146.43	422.92	0	5.28	17.63	28.68	199.18	28.72	27.77	20.65	1.46	0.61	25.19	31.13	47.72	4.91	6.92	30.2	125.25	47.69	0.32	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	50	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				118.7	44.35	71.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												118.7	44.35	71.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												16.93	0.54	2.53	-	1.23	4.11	6.68	0.83	6.69	6.47	4.81	0.34	0.14	5.87	7.25	11.12	1.14	1.61	7.04	29.18	11.11	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	125.71	16.93	0.54	2.53	-	1.23	4.11	6.68	0.83	6.69	6.47	4.81	0.34	0.14	5.87	7.25	11.12	1.14	1.61	7.04	29.18	11.11	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	125.71
H5936_802_0	2006																						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P																																																					-	1711.92	146.43	422.92	0	5.28	17.63	28.68	199.18	28.72	27.77	20.65	1.46	0.61	25.19	31.13	47.72	4.91	6.92	30.2	125.25	47.69	0.32	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	50	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				118.7	44.35	71.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												118.7	44.35	71.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												16.93	0.54	2.53	-	1.23	4.11	6.68	0.83	6.69	6.47	4.81	0.34	0.14	5.87	7.25	11.12	1.14	1.61	7.04	29.18	11.11	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	125.71	16.93	0.54	2.53	-	1.23	4.11	6.68	0.83	6.69	6.47	4.81	0.34	0.14	5.87	7.25	11.12	1.14	1.61	7.04	29.18	11.11	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	125.71
H5936_803_0	2006																						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P																																																					-	1380.15	25.89	497.73	0	3.54	7.44	10.97	246.76	33.81	23.58	16.74	1.8	0	13.67	23.02	47.7	2.23	5.18	44.58	123.23	21.98	0.34	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	50	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				141.74	66.68	67.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												141.74	66.68	67.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												16.3	0.14	2.81	-	0.82	1.73	2.56	1.03	7.88	5.49	3.9	0.42	-	3.18	5.36	11.11	0.52	1.21	10.39	28.71	5.12	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.78	16.3	0.14	2.81	-	0.82	1.73	2.56	1.03	7.88	5.49	3.9	0.42	-	3.18	5.36	11.11	0.52	1.21	10.39	28.71	5.12	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.78
H5936_804_0	2006																						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P																																																					-	1711.92	146.43	422.92	0	5.28	17.63	28.68	199.18	28.72	27.77	20.65	1.46	0.61	25.19	31.13	47.72	4.91	6.92	30.2	125.25	47.69	0.32	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	50	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				118.7	44.35	71.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												118.7	44.35	71.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												16.93	0.54	2.53	-	1.23	4.11	6.68	0.83	6.69	6.47	4.81	0.34	0.14	5.87	7.25	11.12	1.14	1.61	7.04	29.18	11.11	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	125.71	16.93	0.54	2.53	-	1.23	4.11	6.68	0.83	6.69	6.47	4.81	0.34	0.14	5.87	7.25	11.12	1.14	1.61	7.04	29.18	11.11	0.07	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	125.71
H5936_805_0	2006																						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P																																																					-	1380.15	25.89	497.73	0	3.54	7.44	10.97	246.76	33.81	23.58	16.74	1.8	0	13.67	23.02	47.7	2.23	5.18	44.58	123.23	21.98	0.34	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	50	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				141.74	66.68	67.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												141.74	66.68	67.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												16.3	0.14	2.81	-	0.82	1.73	2.56	1.03	7.88	5.49	3.9	0.42	-	3.18	5.36	11.11	0.52	1.21	10.39	28.71	5.12	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.78	16.3	0.14	2.81	-	0.82	1.73	2.56	1.03	7.88	5.49	3.9	0.42	-	3.18	5.36	11.11	0.52	1.21	10.39	28.71	5.12	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.78
H5936_806_0	2006																						D	D	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P																																																					-	1380.15	25.89	497.73	0	3.54	7.44	10.97	246.76	33.81	23.58	16.74	1.8	0	13.67	23.02	47.7	2.23	5.18	44.58	123.23	21.98	0.34	0	0	0	0	0	0	0	0	0											Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	50	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				141.74	66.68	67.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												141.74	66.68	67.8	0	0.23	0.23	0.23	50	0.23	0.23	0.23	0.23	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0	0	0	0	0	0	0	0	0												16.3	0.14	2.81	-	0.82	1.73	2.56	1.03	7.88	5.49	3.9	0.42	-	3.18	5.36	11.11	0.52	1.21	10.39	28.71	5.12	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.78	16.3	0.14	2.81	-	0.82	1.73	2.56	1.03	7.88	5.49	3.9	0.42	-	3.18	5.36	11.11	0.52	1.21	10.39	28.71	5.12	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	108.78
H5938_001_0	2006											no maximum											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1391.8	27.41	1230.26	1912.17	399.53	22148.33	22756.92	244.7	219.68	1846.37	740.84	0	43.22	489.63	7212.5	10773.03	173.49	220.74	4180.87	12841.56	342.42	808.06	0	0	378.07	317.28	154.94	0	0	100	142.59											250 per admit and 100 days 6-10	250 per admit and 100 days 6-10	75 per day for days 7-10		100	Eff. copay 20 coins.	Eff. copay 20 coins.	50	100	Eff. copay 0-20	Eff. copay 0 to 100	0			Eff. copay 0 to 15	Eff. copay 0 to 25	25	25		Eff. copay 0-20	0	Eff. copay 0 to 15			15		25		0	0	0											67.02	67.02	59.07	0	100	1	1.12	50	100	1.48	23.73	0	0	0	9.15	8.58	25	25	0	1.38	0	11.87	0	0	15	0	25	0	0	0	0											no maximum	67.02	67.02	59.07	0	100	1	1.12	50	100	1.48	23.73	0	0	0	9.15	8.58	25	25	0	1.38	0	11.87	0	0	15	0	25	0	0	0	0												7.77	0.15	6.06	-	3.33	1.85	2.13	1.02	1.83	0.23	1.46	-	-	-	5.5	7.7	0.36	0.46	-	1.48	-	0.8	-	-	0.47	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.94	7.77	0.15	6.06	-	3.33	1.85	2.13	1.02	1.83	0.23	1.46	-	-	-	5.5	7.7	0.36	0.46	-	1.48	-	0.8	-	-	0.47	-	0.32	-	-	-	-	-	-	-	-	-	-	-	-	-	-	42.94
H5938_801_0	2006											no maximum											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1387.02	27.51	1212.44	1909.25	1203.74	22243.48	22854.62	245.71	220.59	1817.55	709.36	0	43.4	491.65	8703.29	15755.51	177.51	739.05	4070.26	13456.24	343.83	811.5	0	0	0	0	0	0	0	0	12000											Effective Copay 912 deductible 228/day for days 61 to 90	Effective Copay 912 deductible 228/day for days 61 to 90	Effective Copay 114/day for days 21 to 100	0	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	50	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 to 50 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	0	0	0	0	0	0	0	0	0											129.61	65.23	75.57	0	16.26	1.17	1.51	50	217.35	18.16	69.25	0	36.9	81.91	13.93	19.52	20.14	5.69	17.21	5.46	33.61	20.13	0	0	0	0	0	0	0	0	0											no maximum	129.61	65.23	75.57	0	16.26	1.17	1.51	50	217.35	18.16	69.25	0	36.9	81.91	13.93	19.52	20.14	5.69	17.21	5.46	33.61	20.13	0	0	0	0	0	0	0	0	0												14.98	0.15	7.64	-	1.63	2.17	2.87	1.02	4	2.75	4.09	-	0.13	3.36	10.1	25.62	0.3	0.35	5.84	6.12	0.96	1.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.44	14.98	0.15	7.64	-	1.63	2.17	2.87	1.02	4	2.75	4.09	-	0.13	3.36	10.1	25.62	0.3	0.35	5.84	6.12	0.96	1.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.44
H5938_802_0	2006											no maximum											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1387.02	27.51	1212.44	1909.25	1203.74	22243.48	22854.62	245.71	220.59	1817.55	709.36	0	43.4	491.65	8703.29	15755.51	177.51	739.05	4070.26	13456.24	343.83	811.5	0	0	0	0	0	0	0	0	12000											Effective Copay 912 deductible 228/day for days 61 to 90	Effective Copay 912 deductible 228/day for days 61 to 90	Effective Copay 114/day for days 21 to 100	0	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	50	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 to 50 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	0	0	0	0	0	0	0	0	0											129.61	65.23	75.57	0	16.26	1.17	1.51	50	217.35	18.16	69.25	0	36.9	81.91	13.93	19.52	20.14	5.69	17.21	5.46	33.61	20.13	0	0	0	0	0	0	0	0	0											no maximum	129.61	65.23	75.57	0	16.26	1.17	1.51	50	217.35	18.16	69.25	0	36.9	81.91	13.93	19.52	20.14	5.69	17.21	5.46	33.61	20.13	0	0	0	0	0	0	0	0	0												14.98	0.15	7.64	-	1.63	2.17	2.87	1.02	4	2.75	4.09	-	0.13	3.36	10.1	25.62	0.3	0.35	5.84	6.12	0.96	1.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.44	14.98	0.15	7.64	-	1.63	2.17	2.87	1.02	4	2.75	4.09	-	0.13	3.36	10.1	25.62	0.3	0.35	5.84	6.12	0.96	1.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.44
H5938_803_0	2006											no maximum											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1387.02	27.51	1212.44	1909.25	1203.74	22243.48	22854.62	245.71	220.59	1817.55	709.36	0	43.4	491.65	8703.29	15755.51	177.51	739.05	4070.26	13456.24	343.83	811.5	0	0	0	0	0	0	0	0	12000											Effective Copay 912 deductible 228/day for days 61 to 90	Effective Copay 912 deductible 228/day for days 61 to 90	Effective Copay 114/day for days 21 to 100	0	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	50	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 to 50 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	0	0	0	0	0	0	0	0	0											129.61	65.23	75.57	0	16.26	1.17	1.51	50	217.35	18.16	69.25	0	36.9	81.91	13.93	19.52	20.14	5.69	17.21	5.46	33.61	20.13	0	0	0	0	0	0	0	0	0											no maximum	129.61	65.23	75.57	0	16.26	1.17	1.51	50	217.35	18.16	69.25	0	36.9	81.91	13.93	19.52	20.14	5.69	17.21	5.46	33.61	20.13	0	0	0	0	0	0	0	0	0												14.98	0.15	7.64	-	1.63	2.17	2.87	1.02	4	2.75	4.09	-	0.13	3.36	10.1	25.62	0.3	0.35	5.84	6.12	0.96	1.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.44	14.98	0.15	7.64	-	1.63	2.17	2.87	1.02	4	2.75	4.09	-	0.13	3.36	10.1	25.62	0.3	0.35	5.84	6.12	0.96	1.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.44
H5938_804_0	2006											no maximum											D	D	D	V	T	O	O	V	V	V	P	P	P	P	P	P	V	V	P	P	S	V	T	V	P	P	P	P	O	O	O											no maximum	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	1387.02	27.51	1212.44	1909.25	1203.74	22243.48	22854.62	245.71	220.59	1817.55	709.36	0	43.4	491.65	8703.29	15755.51	177.51	739.05	4070.26	13456.24	343.83	811.5	0	0	0	0	0	0	0	0	12000											Effective Copay 912 deductible 228/day for days 61 to 90	Effective Copay 912 deductible 228/day for days 61 to 90	Effective Copay 114/day for days 21 to 100	0	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	50	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 to 50 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	Effective Copay 20 Coinsurance	0	0	0	0	0	0	0	0	0											129.61	65.23	75.57	0	16.26	1.17	1.51	50	217.35	18.16	69.25	0	36.9	81.91	13.93	19.52	20.14	5.69	17.21	5.46	33.61	20.13	0	0	0	0	0	0	0	0	0											no maximum	129.61	65.23	75.57	0	16.26	1.17	1.51	50	217.35	18.16	69.25	0	36.9	81.91	13.93	19.52	20.14	5.69	17.21	5.46	33.61	20.13	0	0	0	0	0	0	0	0	0												14.98	0.15	7.64	-	1.63	2.17	2.87	1.02	4	2.75	4.09	-	0.13	3.36	10.1	25.62	0.3	0.35	5.84	6.12	0.96	1.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.44	14.98	0.15	7.64	-	1.63	2.17	2.87	1.02	4	2.75	4.09	-	0.13	3.36	10.1	25.62	0.3	0.35	5.84	6.12	0.96	1.36	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	95.44
H5942_003_0	2006	DME/Prosthetics/Supplies	OP Facility - Other	Professional	Professional	Professional	0	0	0	0	0	none	Diabetic Supplies	ASC	Podiatry	Chiropractic	Lab	0	0	0	0	0	D	D	D	V	Ded	Coin	Coin	V	V	V	V	V	V	V	P	P	V	V	V	V	Coin	O	T	V	V	P	V	P	V	O	O	V	V	V	V	V	Coin	Coin	Coin	Coin	Coin	none	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	1740.71	111.11	892.95	4557.78	219.75	4.65	1.79	335.97	263.63	387.69	161.54	32.31	32.31	32.31	3538.5	3420.55	589.75	1179.5	589.75	11794.99	5.37	0	0	999.79	386.46	165.62	807.52	0	0	14334.36	0	198.08	175.75	235.9	353.85	1651.3	0	0	0	0	0	200 Days 1-5 then 0	200 Days 1-5 then 0	0 1-6; 100 7-100	0	100	20	20	60x50+40x20	100	20	20	50	50	0	0	35	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	20	50	0	0	20	0	0	0	0	0	137.3	137.3	57.87	0	100	0.2	0.2	38	100	20	20	50	50	0	0	35	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	20	50	0	0	20	0	0	0	0	0	none	137.3	137.3	57.87	0	100	0.2	0.2	38	100	20	20	50	50	0	0	35	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	20	50	0	0	20	0	0	0	0	0	0	19.92	1.27	4.31	-	1.83	0.93	0.36	1.06	2.2	0.65	0.27	0.13	0.13	-	-	9.98	-	1.97	-	-	-	-	-	-	-	-	-	-	-	-	-	0.33	0.73	-	-	2.75	-	-	-	-	-	48.82	19.92	1.27	4.31	-	1.83	0.93	0.36	1.06	2.2	0.65	0.27	0.13	0.13	-	-	9.98	-	1.97	-	-	-	-	-	-	-	-	-	-	-	-	-	0.33	0.73	-	-	2.75	-	-	-	-	-	48.82
H5969_001_0	2006											0											D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	Coin	P	P	P	Coin	Coin								O												0																																										-	1597.69	43.26	788.45	0	293.07	12.64	2.18	333.9	321.07	671.02	715.02	24.82	83.54	469.35	4607.81	5441.01	1.59	420.74	252.11	3590.93	1.99	0.39								50												200 copay per day for 1st 4 days	Medicare ded.	50 after 1st 20 days	0 copay	50 copay	20 coins	20 coins	50 copay	25 copay	0 copay	0 copay	0 copay	0 copay	0 copay	10 copay for OV	15 copay for OV	20 coins	15 copay for OV	0 copay	0 copay	20 coins	20 coins								0 copay												130.48	62.75	11.45	0	50	0.2	0.2	50	25	0	0	0	0	0	10	15	0.2	15	0	0	0.2	0.2								0												0	130.48	62.75	11.45	0	50	0.2	0.2	50	25	0	0	0	0	0	10	15	0.2	15	0	0	0.2	0.2								0													17.37	0.23	0.75	-	1.22	2.53	0.44	1.39	0.67	-	-	-	-	-	3.84	6.8	0.32	0.53	-	-	0.4	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.56	17.37	0.23	0.75	-	1.22	2.53	0.44	1.39	0.67	-	-	-	-	-	3.84	6.8	0.32	0.53	-	-	0.4	0.08	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	36.56
H5969_002_0	2006											0											Ded	Ded	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin								O												0																																										-	2076.99	56.24	1024.55	0	18.18	16.42	2.83	17.43	76.77	17.28	49.12	1.58	0.76	18.05	55.76	120.21	2.06	1.71	1.24	25.99	2.58	0.5								50												Medicare ded.	Medicare ded.	Medicare copay	0 copay	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.	Medicare ded. & coins.								0 copay												135.51	62.68	65.31	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23								0												0	135.51	62.68	65.31	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23								0													23.45	0.29	5.58	-	4.24	3.83	0.66	4.06	17.89	4.03	11.45	0.37	0.18	4.21	12.99	28.01	0.48	0.4	0.29	6.06	0.6	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	129.16	23.45	0.29	5.58	-	4.24	3.83	0.66	4.06	17.89	4.03	11.45	0.37	0.18	4.21	12.99	28.01	0.48	0.4	0.29	6.06	0.6	0.12	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	129.16
H5985_001_0	2006											0											D	A	D		T	Coin	Coin	V	V		P		P	V	V	V	V	V		V	Coin	V			V																																																											-	954.4	3	694		498	13.36	8.63	220	215.8		462.66		7	200	6282	5397	241	356		1923	4.82	686			400																	100 Copay per day max od 500 per admit	standard Medicare deductible assumed 900 copay per admit	75 Copay for days 21-100		80 Copay	20 Coinsurance	20 Coinsurance	50 Copay for ER Visit 35 Copay for Urgent Care	150 Copay		20Coinsurance for Radiation Therapy		30 copay	20 Copay for PT/OT/ST	10 Office Visit Copay	30 Office Visit Copay	35 Copay	20 Physical Therapy Copay		30 Copay for Hearing Exam Chiro; 20 Copay for Podiatry	20 Coinsurance	20 Copay for covered vision exams			20 Copay for non-covered vision exams																	100	956	35.99		80	0.2	0.2	49.93	150		60.99		30	20	10	30	35	20		29.94	0.2	29.94			10																		100	956	35.99		80	0.2	0.2	49.93	150		60.99		30	20	10	30	35	20		29.94	0.2	29.94			10																	0	7.95	0.24	2.08	-	3.32	2.67	1.75	0.92	2.7	-	2.35	-	0.02	0.33	5.24	13.49	0.7	0.59	-	4.8	0.96	1.71	-	-	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.16	7.95	0.24	2.08	-	3.32	2.67	1.75	0.92	2.7	-	2.35	-	0.02	0.33	5.24	13.49	0.7	0.59	-	4.8	0.96	1.71	-	-	0.33	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	52.16
H5985_002_0	2006											0											Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																														-	387.77	14.95	49.78	27.6	16.18	32.39	17.29	5.98	14.08	7.45	15.09		2.01	26.61	66.53	115.84	12.91	2.58	32.1	35.81	8.31	3.6																																																													0.07	0.07	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																					0.07	0.07	0.14	0	0.23	0.23	0.23	0.23	0.23	0.23	0.23		0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23	0.23																				0	27.22	1.05	6.9	-	3.77	7.55	4.03	1.39	3.28	1.74	3.52	-	0.47	6.2	15.5	26.99	3.01	0.6	7.48	8.34	1.94	0.84	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	131.81	27.22	1.05	6.9	-	3.77	7.55	4.03	1.39	3.28	1.74	3.52	-	0.47	6.2	15.5	26.99	3.01	0.6	7.48	8.34	1.94	0.84	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	131.81
H5995_001_0	2006											0											Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				N/A					0.29	0.5	0.32	0.3	1.22	0.48	1.29	0	0.01	1.24	1.92	4.84	0.07	0.08	0.92	1.52	0.35	0.23																				15.59	332.05	3.47	20.77		8.68	15.22	9.82	9.08	36.93	14.43	39.22	0	0.45	37.67	58.18	146.52	2.24	2.36	27.83	46.09	10.6	7.07																				Medicare CS	Medicare CS	Medicare CS		20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)	20 (Medicare)																																																													N/A	0.08	0.08	0.12		0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																					24.97	0.26	2.56	-	1.74	3.04	1.96	1.82	7.39	2.89	7.84	-	0.09	7.53	11.64	29.3	0.45	0.47	5.57	9.22	2.12	1.41	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	122.27	24.97	0.26	2.56	-	2.02	3.55	2.29	2.12	8.6	3.36	9.14	-	0.1	8.78	13.56	34.14	0.52	0.55	6.48	10.74	2.47	1.65	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	137.85
H9001_001_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	215.02	3.81	57.74	2265.31	277.14	42.67	810.71	921.58	535.43	8192.69	436.68	0	0	765.12	6686.72	2175.34	270.08	254.56	0	6.63	22344.96	184.05	0	195.38	235.56	26.6	0	0	0	9.22	3.98											250	25000	250	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	15	15	15	15	0	15	2.47847	29.9123	0	10	15	0	0	0	0	15	0											250	250	250	0	50	0	0	46.5	0	0	50	0	0	0	15	15	15	15	0	15	2.48	29.91	0	10	15	0	0	0	0	15	0											0	248.75	248.75	248.75	0	49.75	0	0	46.27	0	0	49.75	0	0	0	14.93	14.93	14.93	14.93	0	14.93	2.47	29.76	0	9.95	14.93	0	0	0	0	14.93	0											0	4.46	0.08	1.2	-	1.15	-	-	3.55	-	-	1.81	-	-	-	8.32	2.71	0.34	0.32	-	0.01	4.59	0.46	-	0.16	0.29	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	29.44	4.46	0.08	1.2	-	1.15	-	-	3.55	-	-	1.81	-	-	-	8.32	2.71	0.34	0.32	-	0.01	4.59	0.46	-	0.16	0.29	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	29.44
H9001_006_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	257.62	3.51	77.6	3246.27	345.36	53.92	1024.51	1082.71	522.81	9976.63	467.83	0	0	694.78	7451.68	2364.31	275.9	343.16	0	5.72	1442.36	176.28	0	167.36	237.14	13.4	0	0	0	12.02	7.72											100	10000	100	0	50	0	0	50 ER 10 UC	0	0	50	0	0	0	10	10	10	10	0	10	4.65044	29.0181	0	10	10	0	0	0	0	10	0											100	100	100	0	50	0	0	46	0	0	50	0	0	0	10	10	10	10	0	10	4.65	29.02	0	10	10	0	0	0	0	10	0											0	99.5	99.5	99.5	0	49.75	0	0	45.77	0	0	49.75	0	0	0	9.95	9.95	9.95	9.95	0	9.95	4.63	28.87	0	9.95	9.95	0	0	0	0	9.95	0											0	2.14	0.03	0.64	-	1.43	-	-	4.13	-	-	1.94	-	-	-	6.18	1.96	0.23	0.28	-	0	0.56	0.42	-	0.14	0.2	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	20.29	2.14	0.03	0.64	-	1.43	-	-	4.13	-	-	1.94	-	-	-	6.18	1.96	0.23	0.28	-	0	0.56	0.42	-	0.14	0.2	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	20.29
H9001_010_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	158.93	2.82	42.68	1674.34	267.52	31.54	599.22	681.16	395.75	6055.39	530.4	0	0	565.51	4942.3	1576.46	199.62	188.15	0	4.74	16515.64	136.04	0	144.41	174.11	19.66	0	0	0	6.81	2.94											450	45000	450	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	15	20	15	15	0	17.5	2.47847	29.9123	0	10	15	0	0	0	0	15	0											450	450	450	0	50	0	0	46.5	0	0	50	0	0	0	15	20	15	15	0	17.5	2.48	29.91	0	10	15	0	0	0	0	15	0											0	447.75	447.75	447.75	0	49.75	0	0	46.27	0	0	49.75	0	0	0	14.93	19.9	14.93	14.93	0	17.41	2.47	29.76	0	9.95	14.93	0	0	0	0	14.93	0											0	5.93	0.11	1.59	-	1.11	-	-	2.63	-	-	2.2	-	-	-	6.15	2.61	0.25	0.23	-	0.01	3.39	0.34	-	0.12	0.22	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	26.89	5.93	0.11	1.59	-	1.11	-	-	2.63	-	-	2.2	-	-	-	6.15	2.61	0.25	0.23	-	0.01	3.39	0.34	-	0.12	0.22	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	26.89
H9001_011_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	158.93	2.82	42.68	1674.34	267.52	31.54	599.22	681.16	395.75	6055.39	530.4	0	0	565.51	4942.3	1576.46	199.62	188.15	0	4.74	16515.64	136.04	0	144.41	174.11	19.66	0	0	0	6.81	2.94											450	45000	450	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	15	20	15	15	0	17.5	2.47847	29.9123	0	10	15	0	0	0	0	15	0											450	450	450	0	50	0	0	46.5	0	0	50	0	0	0	15	20	15	15	0	17.5	2.48	29.91	0	10	15	0	0	0	0	15	0											0	447.75	447.75	447.75	0	49.75	0	0	46.27	0	0	49.75	0	0	0	14.93	19.9	14.93	14.93	0	17.41	2.47	29.76	0	9.95	14.93	0	0	0	0	14.93	0											0	5.93	0.11	1.59	-	1.11	-	-	2.63	-	-	2.2	-	-	-	6.15	2.61	0.25	0.23	-	0.01	3.39	0.34	-	0.12	0.22	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	26.89	5.93	0.11	1.59	-	1.11	-	-	2.63	-	-	2.2	-	-	-	6.15	2.61	0.25	0.23	-	0.01	3.39	0.34	-	0.12	0.22	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	26.89
H9001_012_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	415.2	2.88	106.14	4647.62	539.83	81.64	1551.24	1471.36	439.4	9542.68	456.63	0	0	712.38	7438.53	2244.25	628.77	235.29	0	5.21	22538.61	325.25	0	94.71	237.9	22.41	0	0	0	6.52	7.68											100	10000	100	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	5	10	5	5	0	5	2.47847	29.9123	0	5	5	0	0	0	0	5	0											100	100	100	0	50	0	0	46.5	0	0	50	0	0	0	5	10	5	5	0	5	2.48	29.91	0	5	5	0	0	0	0	5	0											0	99.5	99.5	99.5	0	49.75	0	0	46.27	0	0	49.75	0	0	0	4.98	9.95	4.98	4.98	0	4.98	2.47	29.76	0	4.98	4.98	0	0	0	0	4.98	0											0	3.44	0.02	0.88	-	2.24	-	-	5.67	-	-	1.89	-	-	-	3.08	1.86	0.26	0.1	-	0	4.63	0.81	-	0.04	0.1	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	-	25.04	3.44	0.02	0.88	-	2.24	-	-	5.67	-	-	1.89	-	-	-	3.08	1.86	0.26	0.1	-	0	4.63	0.81	-	0.04	0.1	-	-	-	-	0	-	-	-	-	-	-	-	-	-	-	-	25.04
H9001_013_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	158.93	2.82	42.68	1674.34	267.52	31.54	599.22	681.16	395.75	6055.39	530.4	0	0	565.51	4942.3	1576.46	199.62	188.15	0	4.74	16515.64	136.04	0	144.41	174.11	19.66	0	0	0	6.81	2.94											450	45000	450	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	15	20	15	15	0	17.5	2.47847	29.9123	0	10	15	0	0	0	0	15	0											450	450	450	0	50	0	0	46.5	0	0	50	0	0	0	15	20	15	15	0	17.5	2.48	29.91	0	10	15	0	0	0	0	15	0											0	447.75	447.75	447.75	0	49.75	0	0	46.27	0	0	49.75	0	0	0	14.93	19.9	14.93	14.93	0	17.41	2.47	29.76	0	9.95	14.93	0	0	0	0	14.93	0											0	5.93	0.11	1.59	-	1.11	-	-	2.63	-	-	2.2	-	-	-	6.15	2.61	0.25	0.23	-	0.01	3.39	0.34	-	0.12	0.22	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	26.89	5.93	0.11	1.59	-	1.11	-	-	2.63	-	-	2.2	-	-	-	6.15	2.61	0.25	0.23	-	0.01	3.39	0.34	-	0.12	0.22	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	26.89
H9001_014_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	215.02	3.81	57.74	2265.31	277.14	42.67	810.71	921.58	535.43	8192.69	436.68	0	0	765.12	6686.72	2175.34	270.08	254.56	0	6.63	22344.96	184.05	0	195.38	235.56	26.6	0	0	0	9.22	3.98											250	25000	250	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	15	15	15	15	0	15	2.47847	29.9123	0	10	15	0	0	0	0	15	0											250	250	250	0	50	0	0	46.5	0	0	50	0	0	0	15	15	15	15	0	15	2.48	29.91	0	10	15	0	0	0	0	15	0											0	248.75	248.75	248.75	0	49.75	0	0	46.27	0	0	49.75	0	0	0	14.93	14.93	14.93	14.93	0	14.93	2.47	29.76	0	9.95	14.93	0	0	0	0	14.93	0											0	4.46	0.08	1.2	-	1.15	-	-	3.55	-	-	1.81	-	-	-	8.32	2.71	0.34	0.32	-	0.01	4.59	0.46	-	0.16	0.29	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	29.44	4.46	0.08	1.2	-	1.15	-	-	3.55	-	-	1.81	-	-	-	8.32	2.71	0.34	0.32	-	0.01	4.59	0.46	-	0.16	0.29	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	29.44
H9001_015_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	215.02	3.81	57.74	2265.31	277.14	42.67	810.71	921.58	535.43	8192.69	436.68	0	0	765.12	6686.72	2175.34	270.08	254.56	0	6.63	22344.96	184.05	0	195.38	235.56	26.6	0	0	0	9.22	3.98											250	25000	250	0	50	0	0	50 ER 15 UC	0	0	50	0	0	0	15	15	15	15	0	15	2.47847	29.9123	0	10	15	0	0	0	0	15	0											250	250	250	0	50	0	0	46.5	0	0	50	0	0	0	15	15	15	15	0	15	2.48	29.91	0	10	15	0	0	0	0	15	0											0	248.75	248.75	248.75	0	49.75	0	0	46.27	0	0	49.75	0	0	0	14.93	14.93	14.93	14.93	0	14.93	2.47	29.76	0	9.95	14.93	0	0	0	0	14.93	0											0	4.46	0.08	1.2	-	1.15	-	-	3.55	-	-	1.81	-	-	-	8.32	2.71	0.34	0.32	-	0.01	4.59	0.46	-	0.16	0.29	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	29.44	4.46	0.08	1.2	-	1.15	-	-	3.55	-	-	1.81	-	-	-	8.32	2.71	0.34	0.32	-	0.01	4.59	0.46	-	0.16	0.29	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	29.44
H9001_016_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	257.62	3.51	77.6	3246.27	345.36	53.92	1024.51	1082.71	522.81	9976.63	467.83	0	0	694.78	7451.68	2364.31	275.9	343.16	0	5.72	1442.36	176.28	0	167.36	237.14	13.4	0	0	0	12.02	7.72											100	10000	100	0	50	0	0	50 ER 10 UC	0	0	50	0	0	0	10	10	10	10	0	10	4.65044	29.0181	0	10	10	0	0	0	0	10	0											100	100	100	0	50	0	0	46	0	0	50	0	0	0	10	10	10	10	0	10	4.65	29.02	0	10	10	0	0	0	0	10	0											0	99.5	99.5	99.5	0	49.75	0	0	45.77	0	0	49.75	0	0	0	9.95	9.95	9.95	9.95	0	9.95	4.63	28.87	0	9.95	9.95	0	0	0	0	9.95	0											0	2.14	0.03	0.64	-	1.43	-	-	4.13	-	-	1.94	-	-	-	6.18	1.96	0.23	0.28	-	0	0.56	0.42	-	0.14	0.2	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	20.29	2.14	0.03	0.64	-	1.43	-	-	4.13	-	-	1.94	-	-	-	6.18	1.96	0.23	0.28	-	0	0.56	0.42	-	0.14	0.2	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	20.29
H9001_017_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	P	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											-	257.62	3.51	77.6	3246.27	345.36	53.92	1024.51	1082.71	522.81	9976.63	467.83	0	0	694.78	7451.68	2364.31	275.9	343.16	0	5.72	1442.36	176.28	0	167.36	237.14	13.4	0	0	0	12.02	7.72											100	10000	100	0	50	0	0	50 ER 10 UC	0	0	50	0	0	0	10	10	10	10	0	10	4.65044	29.0181	0	10	10	0	0	0	0	10	0											100	100	100	0	50	0	0	46	0	0	50	0	0	0	10	10	10	10	0	10	4.65	29.02	0	10	10	0	0	0	0	10	0											0	99.5	99.5	99.5	0	49.75	0	0	45.77	0	0	49.75	0	0	0	9.95	9.95	9.95	9.95	0	9.95	4.63	28.87	0	9.95	9.95	0	0	0	0	9.95	0											0	2.14	0.03	0.64	-	1.43	-	-	4.13	-	-	1.94	-	-	-	6.18	1.96	0.23	0.28	-	0	0.56	0.42	-	0.14	0.2	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	20.29	2.14	0.03	0.64	-	1.43	-	-	4.13	-	-	1.94	-	-	-	6.18	1.96	0.23	0.28	-	0	0.56	0.42	-	0.14	0.2	-	-	-	-	0.01	-	-	-	-	-	-	-	-	-	-	-	20.29
H9001_801_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0		0			0	0		0	0			0	0	0	0		0	0	0		0	0					0												-	266.97	5.57	71.94		350.61			901.86	542.97		439.33	0			7076.16	2231.99	262.08	414.18		8.21	1321.08	184.13		0	254.93					11.56												450	450	450		50			50 ER 20 UC	225		50	225			20	25	20	20		22.5	3.8215	27.6056		10	20					20												450	450	450		50			47	225		50	225			20	25	20	20		22.5	3.82	27.61		10	20					20												0	447.75	447.75	447.75		49.75			46.77	223.88		49.75	223.88			19.9	24.88	19.9	19.9		22.39	3.8	27.47		9.95	19.9					19.9												0	9.96	0.21	2.68	-	1.45	-	-	3.51	10.13	-	1.82	-	-	-	11.73	4.63	0.43	0.69	-	0.02	0.42	0.42	-	-	0.42	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	48.55	9.96	0.21	2.68	-	1.45	-	-	3.51	10.13	-	1.82	-	-	-	11.73	4.63	0.43	0.69	-	0.02	0.42	0.42	-	-	0.42	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	48.55
H9001_802_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0		0			0	0		0	0			0	0	0	0		0	0	0		0	0					0												-	266.97	5.57	71.94		350.61			901.86	542.97		439.33	0			7076.16	2231.99	262.08	414.18		8.21	1321.08	184.13		0	254.93					11.56												450	450	450		50			50 ER 20 UC	225		50	225			20	25	20	20		22.5	3.8215	27.6056		10	20					20												450	450	450		50			47	225		50	225			20	25	20	20		22.5	3.82	27.61		10	20					20												0	447.75	447.75	447.75		49.75			46.77	223.88		49.75	223.88			19.9	24.88	19.9	19.9		22.39	3.8	27.47		9.95	19.9					19.9												0	9.96	0.21	2.68	-	1.45	-	-	3.51	10.13	-	1.82	-	-	-	11.73	4.63	0.43	0.69	-	0.02	0.42	0.42	-	-	0.42	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	48.55	9.96	0.21	2.68	-	1.45	-	-	3.51	10.13	-	1.82	-	-	-	11.73	4.63	0.43	0.69	-	0.02	0.42	0.42	-	-	0.42	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	48.55
H9001_803_0	2006											2960											A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V	V	V	S	O	T	V	V	P	V	P	P	O	P											0	0	0	0		0			0	0		0	0			0	0	0	0		0	0	0		0	0					0												-	266.97	5.57	71.94		350.61			901.86	542.97		439.33	0			7076.16	2231.99	262.08	414.18		8.21	1321.08	184.13		0	254.93					11.56												450	450	450		50			50 ER 20 UC	225		50	225			20	25	20	20		22.5	3.8215	27.6056		10	20					20												450	450	450		50			47	225		50	225			20	25	20	20		22.5	3.82	27.61		10	20					20												0	447.75	447.75	447.75		49.75			46.77	223.88		49.75	223.88			19.9	24.88	19.9	19.9		22.39	3.8	27.47		9.95	19.9					19.9												0	9.96	0.21	2.68	-	1.45	-	-	3.51	10.13	-	1.82	-	-	-	11.73	4.63	0.43	0.69	-	0.02	0.42	0.42	-	-	0.42	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	48.55	9.96	0.21	2.68	-	1.45	-	-	3.51	10.13	-	1.82	-	-	-	11.73	4.63	0.43	0.69	-	0.02	0.42	0.42	-	-	0.42	-	-	-	-	0.02	-	-	-	-	-	-	-	-	-	-	-	48.55
H9003_001_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1000	Travel Benefit	Visiting Member	Routine Phys Exams	Classes							A	A			T	coin	coin	V	V	V		coin		V	V	V	V	V	V		coin	O			V	Ded	V					Ded	coin	V	O																																																	-	671.91	21.88		0	255.86	13.73	6.7	314.32	126.6	59.28	0	0.4	0	36.44	2575.04	3569.79	287.33	538.99	1084.57	0	3.45	821.79	0	0	237.2	190.67	10	0	0	0	0	13.65	0.45	114.8	28.14												twenty percent	twenty percent	15 - 50				twenty percent			Aug-72		15-Jul				twenty percent												twenty percent		14-Aug							150	150		0	50	0.2	0.2	40.82	47.07	15	0	0.2	0	15	15.1	15	11.05	15	15	0	0.2	15	0	0	15	100	15	0	0	0	0	213	0.2	15	65								150	150		0	50	0.2	0.2	40.82	47.07	15	0	0.2	0	15	15.1	15	13.5	15	15	0	0.2	15	0	0	15	100	15	0	0	0	0	213	0.2	15	65								8.4	0.27	-	-	1.07	2.75	1.34	1.07	0.5	0.07	-	0.08	-	0.05	3.24	4.46	0.32	0.67	1.36	-	0.69	1.03	-	-	0.3	1.59	0.01	-	-	-	-	0.24	0.09	0.14	0.15	-	-	-	-	-	-	29.89	8.4	0.27	-	-	1.07	2.75	1.34	1.07	0.5	0.07	-	0.08	-	0.05	3.24	4.46	0.32	0.67	1.36	-	0.69	1.03	-	-	0.3	1.59	0.01	-	-	-	-	0.24	0.09	0.14	0.15	-	-	-	-	-	-	29.89
H9003_002_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1000	Travel Benefit	Visiting Member	Routine Phys Exams	Classes							A	A			T	COIN	COIN	V	V	V		COIN		V	V	V	V	V	V		COIN	O			V	DED	V					DED	COIN	V	O																																																	-	682.51	12.29			252.08	12.54	8.4	355.82	163.82	169.22		0.15		13.34	1984.9	4417.56	204.42	977.55	1175.44		4.5	851.48			209.65	166.63	10					13.65	2.65	215.21	20.16												twenty percent	twenty percent	15 - 50	15 - 50			twenty percent			Aug-72		15-Jul				twenty percent												twenty percent		14-Aug							150	150	0	0	50	0.2	0.2	36.52	25.68	15	0	0.2	0	14	16.02	15	14.52	15	15	0	0.2	15	0	0	15	100	15	0	0	0	0	213	0.2	15	70								150	150	0	0	50	0.2	0.2	36.52	25.68	15	0	0.2	0	14	16.02	15	14.52	15	15	0	0.2	15	0	0	15	100	15	0	0	0	0	213	0.2	15	70								8.53	0.15	-	-	1.05	2.51	1.68	1.08	0.35	0.21	-	0.03	-	0.02	2.65	5.52	0.25	1.22	1.47	-	0.9	1.06	-	-	0.26	1.39	0.01	-	-	-	-	0.24	0.53	0.27	0.12	-	-	-	-	-	-	31.51	8.53	0.15	-	-	1.05	2.51	1.68	1.08	0.35	0.21	-	0.03	-	0.02	2.65	5.52	0.25	1.22	1.47	-	0.9	1.06	-	-	0.26	1.39	0.01	-	-	-	-	0.24	0.53	0.27	0.12	-	-	-	-	-	-	31.51
H9003_003_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1000	Travel Benefit	Visiting Members	Rountine Phys Exam	Classes							A	A			T	COIN	COIN	V	V	V		COIN			V	V	V	V	V		COIN	O			V	DED						DED	COIN	V	O																																																	-	100.34	0			107.48	2.84	10.35	208.7	0	0		0			2295.72	2191.37	0	104.35	1356.66			208.7			135.66	1						13.65	0	208.7	10												twenty percent	twenty percent	15 - 50	15 - 50			twenty percent			Aug-72		15-Jul				twenty percent												twenty percent		14-Aug							200	200	0	0	50	0.2	0.2	33	15	15	0	0.2	0	0	15.05	15	15	15	15	0	0	15	0	0	15	100	0	0	0	0	0	213	0.2	15	7								200	200	0	0	50	0.2	0.2	33	15	15	0	0.2	0	0	15.05	15	15	15	15	0	0	15	0	0	15	100	0	0	0	0	0	213	0.2	15	7								1.67	-	-	-	0.45	0.57	2.07	0.57	-	-	-	-	-	-	2.88	2.74	-	0.13	1.7	-	-	0.26	-	-	0.17	0.01	-	-	-	-	-	0.24	-	0.26	0.01	-	-	-	-	-	-	13.72	1.67	-	-	-	0.45	0.57	2.07	0.57	-	-	-	-	-	-	2.88	2.74	-	0.13	1.7	-	-	0.26	-	-	0.17	0.01	-	-	-	-	-	0.24	-	0.26	0.01	-	-	-	-	-	-	13.72
H9003_005_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1000	Travel Benefit	Visiting Member	Routine Phys Exam	Classes							A	A			T	COIN	COIN	V	V	V		COIN		V	V	V	V	V	V		COIN	O			V	DED	V					DED	COIN	V	O																																																	-	643.27	39.79			222.03	9.11	6.4	404.64	192.09	211.97		0.7		12.45	2345.45	4150.89	209.21	762.34	1239.61		2.9	836.66			236.88	189.62	10					13.65	0.6	171.96	24.37												twenty percent	twenty percent	15 - 50	15 - 50			twenty percent			Aug-72		15-Jul				twenty percent												twenty percent		14-Aug							150	150	0	0	50	0.2	0.2	34.39	27.03	15	0	0.2	0	15	15.05	15	14.5	15	15	0	0.2	15	0	0	15	100	15	0	0	0	0	213	0.2	15	70								150	150	0	0	50	0.2	0.2	34.39	27.03	15	0	0.2	0	15	15.05	15	14.5	15	15	0	0.2	15	0	0	15	100	15	0	0	0	0	213	0.2	15	70								8.04	0.5	-	-	0.93	1.82	1.28	1.16	0.43	0.26	-	0.14	-	0.02	2.94	5.19	0.25	0.95	1.55	-	0.58	1.05	-	-	0.3	1.58	0.01	-	-	-	-	0.24	0.12	0.21	0.14	-	-	-	-	-	-	29.7	8.04	0.5	-	-	0.93	1.82	1.28	1.16	0.43	0.26	-	0.14	-	0.02	2.94	5.19	0.25	0.95	1.55	-	0.58	1.05	-	-	0.3	1.58	0.01	-	-	-	-	0.24	0.12	0.21	0.14	-	-	-	-	-	-	29.7
H9003_801_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1500	Travel Benefit	Visiting Member	Routine Phys Exams	Classes							A	A			T	coin	coin	V	V	coin		coin		V	V	V	V	V	V		coin	O			V	Ded	V					Ded	coin	V	O																																																	-	679.8	14.05			243.43	14.39	8.55	310.92	152.4	5.6		0.45		22.56	2833.52	3868.91	185.57	733.95	1155.95		4.2	1052.2			400.9	395	2					13.65	0.75	158.31	30.38							per admit	per admit				twenty percent	twenty percent	40 - 50	40 - 250	twenty percent		twenty percent		20 - 40	May-50		20 - 40				twenty percent												twenty percent		8 - 140							500	500	0	0	100	0.2	0.2	46.91	195.23	0.2	0	0.2	0	30	38.68	40	38	40	40	0	0.2	40	0	0	40	100	40	0	0	0	0	213	0.2	40	70								500	500	0	0	100	0.2	0.2	46.91	195.23	0.2	0	0.2	0	30	38.68	40	38	40	40	0	0.2	40	0	0	40	100	40	0	0	0	0	213	0.2	40	70								28.33	0.59	-	-	2.03	2.88	1.71	1.22	2.48	1.12	-	0.09	-	0.06	9.13	12.9	0.59	2.45	3.85	-	0.84	3.51	-	-	1.34	3.29	0.01	-	-	-	-	0.24	0.15	0.53	0.18	-	-	-	-	-	-	79.48	28.33	0.59	-	-	2.03	2.88	1.71	1.22	2.48	1.12	-	0.09	-	0.06	9.13	12.9	0.59	2.45	3.85	-	0.84	3.51	-	-	1.34	3.29	0.01	-	-	-	-	0.24	0.15	0.53	0.18	-	-	-	-	-	-	79.48
H9003_802_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1500	Travel Benefit	Visiting Member	Routine Phys Exams	Classes							A	A			T	coin	coin	V	V	coin		coin		V	V	V	V	V	V		coin	O			V	Ded	V					Ded	coin	V	O																																																	-	679.8	14.05			243.43	14.39	8.55	310.92	152.4	5.6		0.45		22.56	2833.52	3868.91	185.57	733.95	1155.95		4.2	1052.2			400.9	395	2					13.65	0.75	158.31	30.38							per admit	per admit				twenty percent	twenty percent	40 - 50	40 - 250	twenty percent		twenty percent		20 - 40	May-50		20 - 40				twenty percent												twenty percent		8 - 140							500	500	0	0	100	0.2	0.2	46.91	195.23	0.2	0	0.2	0	30	38.68	40	38	40	40	0	0.2	40	0	0	40	100	40	0	0	0	0	213	0.2	40	70								500	500	0	0	100	0.2	0.2	46.91	195.23	0.2	0	0.2	0	30	38.68	40	38	40	40	0	0.2	40	0	0	40	100	40	0	0	0	0	213	0.2	40	70								28.33	0.59	-	-	2.03	2.88	1.71	1.22	2.48	1.12	-	0.09	-	0.06	9.13	12.9	0.59	2.45	3.85	-	0.84	3.51	-	-	1.34	3.29	0.01	-	-	-	-	0.24	0.15	0.53	0.18	-	-	-	-	-	-	79.48	28.33	0.59	-	-	2.03	2.88	1.71	1.22	2.48	1.12	-	0.09	-	0.06	9.13	12.9	0.59	2.45	3.85	-	0.84	3.51	-	-	1.34	3.29	0.01	-	-	-	-	0.24	0.15	0.53	0.18	-	-	-	-	-	-	79.48
H9003_803_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1500	Travel Benefit	Visiting Member	Routine Phys Exams	Classes							A	A			T	coin	coin	V	V	coin		coin		V	V	V	V	V	V		coin	O			V	Ded	V					Ded	coin	V	O																																																	-	679.8	14.05			243.43	14.39	8.55	310.92	152.4	5.6		0.45		22.56	2833.52	3868.91	185.57	733.95	1155.95		4.2	1052.2			400.9	395	2					13.65	0.75	158.31	30.38							per admit	per admit				twenty percent	twenty percent	40 - 50	40 - 250	twenty percent		twenty percent		20 - 40	May-50		20 - 40				twenty percent												twenty percent		8 - 140							500	500	0	0	100	0.2	0.2	46.91	195.23	0.2	0	0.2	0	30	38.68	40	38	40	40	0	0.2	40	0	0	40	100	40	0	0	0	0	213	0.2	40	70								500	500	0	0	100	0.2	0.2	46.91	195.23	0.2	0	0.2	0	30	38.68	40	38	40	40	0	0.2	40	0	0	40	100	40	0	0	0	0	213	0.2	40	70								28.33	0.59	-	-	2.03	2.88	1.71	1.22	2.48	1.12	-	0.09	-	0.06	9.13	12.9	0.59	2.45	3.85	-	0.84	3.51	-	-	1.34	3.29	0.01	-	-	-	-	0.24	0.15	0.53	0.18	-	-	-	-	-	-	79.48	28.33	0.59	-	-	2.03	2.88	1.71	1.22	2.48	1.12	-	0.09	-	0.06	9.13	12.9	0.59	2.45	3.85	-	0.84	3.51	-	-	1.34	3.29	0.01	-	-	-	-	0.24	0.15	0.53	0.18	-	-	-	-	-	-	79.48
H9003_804_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1500	Travel Benefit	Visiting Member	Routine Phys Exams	Classes							A	A			T	coin	coin	V	V	coin		coin		V	V	V	V	V	V		coin	O			V	Ded	V					Ded	coin	V	O																																																	-	679.8	14.05			243.43	14.39	8.55	310.92	152.4	5.6		0.45		22.56	2833.52	3868.91	185.57	733.95	1155.95		4.2	1052.2			400.9	395	2					13.65	0.75	158.31	30.38							per admit	per admit				twenty percent	twenty percent	40 - 50	40 - 250	twenty percent		twenty percent		20 - 40	May-50		20 - 40				twenty percent												twenty percent		8 - 140							500	500	0	0	100	0.2	0.2	46.91	195.23	0.2	0	0.2	0	30	38.68	40	38	40	40	0	0.2	40	0	0	40	100	40	0	0	0	0	213	0.2	40	70								500	500	0	0	100	0.2	0.2	46.91	195.23	0.2	0	0.2	0	30	38.68	40	38	40	40	0	0.2	40	0	0	40	100	40	0	0	0	0	213	0.2	40	70								28.33	0.59	-	-	2.03	2.88	1.71	1.22	2.48	1.12	-	0.09	-	0.06	9.13	12.9	0.59	2.45	3.85	-	0.84	3.51	-	-	1.34	3.29	0.01	-	-	-	-	0.24	0.15	0.53	0.18	-	-	-	-	-	-	79.48	28.33	0.59	-	-	2.03	2.88	1.71	1.22	2.48	1.12	-	0.09	-	0.06	9.13	12.9	0.59	2.45	3.85	-	0.84	3.51	-	-	1.34	3.29	0.01	-	-	-	-	0.24	0.15	0.53	0.18	-	-	-	-	-	-	79.48
H9005_007_0	2006											3000																Coin		V									V				Coin							Coin																																																								-						16.96		209.49									157.83				1.39							0.36																																																												0.1		30									6.45				0.2							0.5																				0.1		29.31									6.3				0.2							0.49															-	-	-	-	-	1.66	-	0.51	-	-	-	-	-	-	-	-	0.08	-	-	-	0.27	-	-	-	-	-	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	2.7	-	-	-	-	-	1.66	-	0.51	-	-	-	-	-	-	-	-	0.08	-	-	-	0.27	-	-	-	-	-	-	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	2.7
H9005_804_0	2006											3000																Coin		V							V						Coin																																																															-						15.52		353.39							10671.35						1.27																												30 ER; 10 UC							10 on OV & Tiered MH copay																																0.1		21.24							9.95						0.2																											0.09		19.67							9.22						0.19																						-	-	-	-	-	1.44	-	0.58	-	-	-	-	-	-	8.2	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.45	-	-	-	-	-	1.44	-	0.58	-	-	-	-	-	-	8.2	-	-	-	-	-	0.24	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	10.45
H9011_003_0	2006											1600											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	V	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	289.79	67.77	777.34	364.86	189.83	22.02	5.34	257.53	256.33	23.79	58.33	0	20.31	1.54	7952.67	10570.93	1.94	0	0	0	13.78	2.65	0	0	150.23	3.38	230.71	0	0	0	0											0/1500	17500	0	0	100	0	0	25/50	0	0	0	0	0.3	40 / 0	0	0	0	0	0	0	0.3	0			0	0	0			0												0	175	0	0	100	0.3	0.3	48.82	0	0	0	0	0.3	3.42	0	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0												0	109.79	0	0	99.35	0.29	0.3	48.5	0	0	0	0	0.03	3.39	0	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0												-	0.62	-	-	1.57	6.49	1.59	1.04	-	-	-	-	0.61	0	-	-	-	-	-	-	4.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.03	-	0.62	-	-	1.57	6.49	1.59	1.04	-	-	-	-	0.61	0	-	-	-	-	-	-	4.11	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	16.03
H9011_011_0	2006											1000											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	V	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	343.64	80.36	921.8	533.04	277.34	32.17	7.8	376.23	374.49	34.76	85.22	0	29.67	2.25	11012.71	14642.09	2.69	0	0	0	20.13	0.01	0	0	0	0	0	0	0	0	0											0/1000	17500	0	0	50	0	0	25-Oct	0	0	0	0	0.3	40 / 0	0	0	0	0	0	0	0.3	0	0	0	0	0	0	0		0												0	175	0	0	50	0.3	0.3	24.29	0	0	0	0	0.3	3.42	0	0	0	0	0	0	0.3	0	0	0	5	0	0	0	0	0	0												0	89.25	0	0	49.57	0.29	0.29	24.08	0	0	0	0	0.03	3.39	0	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0												-	0.6	-	-	1.15	9.25	2.29	0.75	-	-	-	-	0.89	0	-	-	-	-	-	-	5.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.92	-	0.6	-	-	1.15	9.25	2.29	0.75	-	-	-	-	0.89	0	-	-	-	-	-	-	5.99	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	20.92
H9011_012_0	2006											1600											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	V	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	280.55	65.61	752.55	353.22	171.67	21.32	5.17	249.31	248.16	23.03	56.47	0	19.66	2.36	6707.63	9143.97	1.98	0	0	0	13.34	0	0	0	0	0	0	0	0	0	0											0/1500	17500	0	0	100	0	0	25/50	0	0	0	0	0.3	40 / 0	0	0	0	0	0	0	0.3	0	0	0	0	0	0			0												0	175	0	0	100	0.3	0.3	48.82	0	0	0	0	0.3	2.22	0	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0												0	109.74	0	0	99.35	0.29	0.3	48.5	0	0	0	0	0.03	2.21	0	0	0	0	0	0	0.3	0	0	0	0	0	0	0	0	0	0												-	0.6	-	-	1.42	6.28	1.54	1.01	-	-	-	-	0.59	0	-	-	-	-	-	-	3.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.42	-	0.6	-	-	1.42	6.28	1.54	1.01	-	-	-	-	0.59	0	-	-	-	-	-	-	3.98	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	15.42
H9011_801_0	2006											4300											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2357.88	62.89	604.85	412.47	144.94	22.57	7.48	251.22	53.83	22933.03	69.29	0	14.42	1.22	8409.62	11351.8	398.56	7.99	0	0	18.42	1441.03	0	0	144.78	0	232.83	0	0	0	0											295	17500	150	0	150	0	0	50	0	10	30-Oct	30 (incl in g)	0.3	40/30 / 30	30/0	35	40/30	0	0	0	0.3	35/0			35		35															295	175	150	0	84.31	0.3	0.3	27.11	0.3	4	0.2	0	0.17	0.04	30	35	37.5	0.3	0	0	0.3	35	0	0	35	0	35	0	0	0	0												165.82	98.37	84.31	0	84.31	0.17	0.21	27.11	0.17	2.25	0.11	0	0.17	0.04	30	35	37.5	0.17	0	0	0.17	35	0	0	35	0	35	0	0	0	0												32.58	0.52	4.25	-	1.02	3.81	1.58	0.57	9.08	4.3	7.83	-	2.43	0.05	21.02	33.11	1.25	1.35	-	-	3.11	4.2	-	-	0.42	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	133.14	32.58	0.52	4.25	-	1.02	3.81	1.58	0.57	9.08	4.3	7.83	-	2.43	0.05	21.02	33.11	1.25	1.35	-	-	3.11	4.2	-	-	0.42	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	133.14
H9011_802_0	2006											4800											D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	Coin	Coin	Coin	V	V	V	Coin	V	V	Coin	V	T	V	V	P	V	P																																																								-	2357.88	62.89	604.85	412.47	144.94	22.57	7.48	251.22	53.83	22933.03	69.29		14.42	1.22	8409.62	11351.8	398.56	7.99			18.42	1441.03			144.78		232.83															265	175	150		150	20	20	50	20	10	20-Oct	20 (incl in g)	20	40/30 / 20	30/0	35	40/30	20			20	35/0			35		35															265	175	150		95.98	0.2	0.2	30.86	0.2	4	0.13		0.13	0.03	30	35	37.5	0.2			0.2	35			35		35																169.57	111.98	95.98		95.98	0.13	0.15	30.86	0.13	2.56	0.09		0.13	0.03	30	35	37.5	0.13			0.13	35			35		35																33.32	0.59	4.84	-	1.16	2.89	1.13	0.65	6.89	4.89	5.94	-	1.84	0.04	21.02	33.11	1.25	1.02	-	-	2.36	4.2	-	-	0.42	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	128.24	33.32	0.59	4.84	-	1.16	2.89	1.13	0.65	6.89	4.89	5.94	-	1.84	0.04	21.02	33.11	1.25	1.02	-	-	2.36	4.2	-	-	0.42	-	0.68	-	-	-	-	-	-	-	-	-	-	-	-	-	-	128.24
H9016_002_0	2006											none																																																				none																																										-		22.82			1384.36	11890.71	1148.03	306.74	304.75				12.86	2236.83	7377.95	5767.08	368.58	298.83		26641.6	139.82			1034.7		354.89	266.06																																																									50			50	3.81	12.18	48.61	10				10	10	3	5	10	10		6.07	12.5			48.03		15	10															none		50			50	3.81	12.18	48.61	10				10	10	3	5	10	10		6.07	12.5			48.03		15	10															0	-	0.1	-	-	5.77	3.78	1.16	1.24	0.25	-	-	-	0.01	1.86	1.84	2.4	0.31	0.25	-	13.48	0.15	-	-	4.14	-	0.44	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.41	-	0.1	-	-	5.77	3.78	1.16	1.24	0.25	-	-	-	0.01	1.86	1.84	2.4	0.31	0.25	-	13.48	0.15	-	-	4.14	-	0.44	0.22	-	-	-	-	-	-	-	-	-	-	-	-	-	-	37.41
H9016_006_0	2006											none																																																				none																																										-		22.2			1474.42	12661.56	1222.83	387.57	386.55				13.9	2515.81	6855.03	5349	322.25	377.02		17598.97	151.12			1118.34		383.58	255.89																																																									50			50	3.96	12.32	48.61	10				10	10	10	10	10	10		8.54	12.5			48.03		15	10															none		50			50	3.96	12.32	48.61	10				10	10	10	10	10	10		8.54	12.5			48.03		15	10															0	-	0.09	-	-	6.14	4.18	1.26	1.57	0.32	-	-	-	0.01	2.1	5.71	4.46	0.27	0.31	-	12.52	0.16	-	-	4.48	-	0.48	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.27	-	0.09	-	-	6.14	4.18	1.26	1.57	0.32	-	-	-	0.01	2.1	5.71	4.46	0.27	0.31	-	12.52	0.16	-	-	4.48	-	0.48	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	44.27
H9016_007_0	2006											none																																																				none																																										-		12.65			1250.02	10753.39	1035.97	255.95	254.5				10.39	1320.86	5688.07	4444.24	301.18	249.27		2921.22	113			562.04		286.81	212.4																																																									50			50	3.73	12.08	48.61	10				10	10	10	10	10	10		8.83	12.5			48.03		15	10	0	0													none		50			50	3.73	12.08	48.61	10				10	10	10	10	10	10		8.83	12.5			48.03		15	10	0	0													0	-	0.05	-	-	5.21	3.34	1.04	1.04	0.21	-	-	-	0.01	1.1	4.74	3.7	0.25	0.21	-	2.15	0.12	-	-	2.25	-	0.36	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.96	-	0.05	-	-	5.21	3.34	1.04	1.04	0.21	-	-	-	0.01	1.1	4.74	3.7	0.25	0.21	-	2.15	0.12	-	-	2.25	-	0.36	0.18	-	-	-	-	-	-	-	-	-	-	-	-	-	-	25.96
H9047_001_0	2006											no plan-level max											A				T	Coin		V	V		Coin				V				Coin		Coin				P					O												n/a																																										-	299.33				266.64	22.88		389.18	362.71		28.7				9428.08				17.76		72.58				195.24					2.27												250 per admit; 500 MOOP; acute & MH; no copay for 2nd admit if transferred				50 per trip; no copay for IP transfers	10 on all non-diabetic DME & Supplies		50 for ED; 25 for Urgent Care							15 per visit; includes all prof. visits except non-covered vision															hlth. plan pays first X mbr pays remainder												250				50	0.1		43.06	50		0.1				15				0.1		0.1				15					1044.09												no plan-level max	223.93				50	0.1		43.06	50		0.1				15				0.1		0.1				15					1044.09													5.59	-	-	-	1.11	2.29	-	1.4	1.51	-	2.87	-	-	-	11.79	-	-	-	1.78	-	7.26	-	-	-	0.24	-	-	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	36.02	5.59	-	-	-	1.11	2.29	-	1.4	1.51	-	2.87	-	-	-	11.79	-	-	-	1.78	-	7.26	-	-	-	0.24	-	-	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	36.02
H9047_013_0	2006											no plan-level max											A				T	Coin		V	V		Coin				V				Coin		Coin				P					O												n/a																																										-	295.68				266.4	22.57		385.91	359.63		26.81				9165.99				19.19		68.56				191.31					2.24												250 per admit; 500 MOOP; acute & MH; no copay for 2nd admit if transferred				50 per trip; no copay for IP transfers			50 for ED; 25 for Urgent Care							15 per visit; includes all prof. visits except non-covered vision															hlth. plan pays first X mbr pays remainder												250				50	0.1		43.06	50		0.1				15				0.1		0.1				15					1037.44												no plan-level max	223.94				50	0.1		43.06	50		0.1				15				0.1		0.1				15					1037.44													5.52	-	-	-	1.11	2.26	-	1.38	1.5	-	2.68	-	-	-	11.46	-	-	-	1.92	-	6.86	-	-	-	0.24	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	35.12	5.52	-	-	-	1.11	2.26	-	1.38	1.5	-	2.68	-	-	-	11.46	-	-	-	1.92	-	6.86	-	-	-	0.24	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	35.12
H9047_022_0	2006																						A				T	Coin		V	V		Coin				V				Coin		Coin				P					O																																																						-	334.91				326.57	26.09		468.76	419.87		18.78				9194.41				33.86		54.5				204.62					2.44												250 per admit; 500 MOOP; acute & MH; no copay for 2nd admit if transferred				50 per trip; no copay for IP transfers	10 on all non-diabetic DME & Supplies		50 for ED; 25 for Urgent Care							15 per visit; includes all prof. visits except non-covered vision															hlth. plan pays first X mbr pays remainder												250				50	0.1		41.41	50		0.1				15				0.1		0.1				15					1027.46													224.03				50	0.1		41.41	50		0.1				15				0.1		0.1				15					1027.46													6.25	-	-	-	1.36	2.61	-	1.62	1.75	-	1.88	-	-	-	11.49	-	-	-	3.39	-	5.45	-	-	-	0.26	-	-	-	-	0.21	-	-	-	-	-	-	-	-	-	-	-	36.26	6.25	-	-	-	1.36	2.61	-	1.62	1.75	-	1.88	-	-	-	11.49	-	-	-	3.39	-	5.45	-	-	-	0.26	-	-	-	-	0.21	-	-	-	-	-	-	-	-	-	-	-	36.26
H9047_024_0	2006											2500											A			Coin	T	Coin		V	V		Coin			Coin	V				Coin	Coin	Coin	Coin			P					O												n/a																																										-	340.44			24.62	305.19	20.59		445.09	412.75		24.46			20.5	10254.66				17.2	8.8	62.55	0.01			212.77					2.56												350 per admit; acute & MH; no copay for 2nd admit if transferred				50 per trip; no copay for IP transfers	10 on all non-diabetic DME & Supplies		50 for ED; 25 for Urgent Care						10 on Observ. Dialysis & Other	20 per visit; all prof. visits except non-covered vision					10 for prof. svcs.; excludes lab radiology & prof. visits										hlth. plan pays first X mbr. pays remainder												350			0.1	50	0.1		42.85	100		0.1			0.1	20				0.1	0.1	0.1	0.1			20					1042.22												2500	276.5			0.08	39.5	0.08		33.85	79		0.08			0.08	15.8				0.08	0.08	0.08	0.08			15.8					823.36													7.84	-	-	1.94	1	1.63	-	1.26	2.72	-	1.93	-	-	1.62	13.5	-	-	-	1.36	0.7	4.94	0	-	-	0.28	-	-	-	-	0.18	-	-	-	-	-	-	-	-	-	-	-	40.9	7.84	-	-	1.94	1	1.63	-	1.26	2.72	-	1.93	-	-	1.62	13.5	-	-	-	1.36	0.7	4.94	0	-	-	0.28	-	-	-	-	0.18	-	-	-	-	-	-	-	-	-	-	-	40.9
H9047_033_0	2006											no plan-level max											A				T	Coin		V	V		Coin				V				Coin		Coin				P					O												n/a																																										-	288				256.44	22.02		374.55	349.07		27.62				9073.64				17.1		69.85				187.9					2.19												250 per admit; 500 MOOP; acute & MH; no copay for 2nd admit if transferred				50 per trip; no copay for IP transfers	10 on non-diabetic DME & Supplies		50 for ED; 25 for urgent care							15 per visit; includes all prof. visits except non-covered vision															hlth. plan pays first X mbr pays remainder												250				50	0.1		43.06	50		0.1				15				0.1		0.1				15					1044.09												no plan-level max	223.93				50	0.1		43.06	50		0.1				15				0.1		0.1				15					1044.09													5.37	-	-	-	1.07	2.2	-	1.34	1.45	-	2.76	-	-	-	11.34	-	-	-	1.71	-	6.98	-	-	-	0.23	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	34.67	5.37	-	-	-	1.07	2.2	-	1.34	1.45	-	2.76	-	-	-	11.34	-	-	-	1.71	-	6.98	-	-	-	0.23	-	-	-	-	0.19	-	-	-	-	-	-	-	-	-	-	-	34.67
H9047_034_0	2006											no plan-level max											A				T	Coin		V	V		Coin				V				Coin		Coin				P					O												n/a																																										-	324.32				316.13	25.26		454.11	406.74		18.17				8906.96				32.8		52.75				198.22					2.37												250 per admit; 500 MOOP; no copay at 2nd hospital if transferred				50 per trip; no copay for IP transfers	10 on all non-diabetic DME & Supplies		50 for ED; 25 for Urgent Care							15 per visit; includes all prof. visits except non-covered vision															hlth. plan pays first X; mbr. pays remainder												250				50	0.1		41.41	50		0.1				15				0.1		0.1				15					1027.46												no plan-level max	224.03				50	0.1		41.41	50		0.1				15				0.1		0.1				15					1027.46													6.05	-	-	-	1.32	2.53	-	1.57	1.69	-	1.82	-	-	-	11.13	-	-	-	3.28	-	5.28	-	-	-	0.25	-	-	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	35.12	6.05	-	-	-	1.32	2.53	-	1.57	1.69	-	1.82	-	-	-	11.13	-	-	-	3.28	-	5.28	-	-	-	0.25	-	-	-	-	0.2	-	-	-	-	-	-	-	-	-	-	-	35.12
H9047_035_0	2006											2500											A			Coin	T	Coin		V	V		Coin			Coin	V				Coin	Coin	Coin	Coin			P					O												n/a																																										-	328.03			23.79	294.78	19.9		430.2	398.95		23.65			19.82	9911.68				16.63	8.51	60.46	0.01			205.65				0	2.48												350 per admit; acute & MH; no copay for 2nd admit if transferred				50 per trip; no copay for IP transfers	10 on all non-diabetic DME & Supplies		50 for ED; 25 for Urgent Care						10 on Observ. Dialysis & Other	20 per visit; includes all prof. visits except non-covered vision					10 for prof. svcs.; excludes lab radiology & prof. visits										hlth. plan pays first X; mbr. pays remainder												350			0.1	50	0.1		42.85	100		0.1			0.1	20				0.1	0.1	0.1	0.1			20					1042.22												2500	276.5			0.08	39.5	0.08		33.85	79		0.08			0.08	15.8				0.08	0.08	0.08	0.08			15.8					823.36													7.56	-	-	1.88	0.97	1.57	-	1.21	2.63	-	1.87	-	-	1.57	13.05	-	-	-	1.31	0.67	4.78	0	-	-	0.27	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	39.51	7.56	-	-	1.88	0.97	1.57	-	1.21	2.63	-	1.87	-	-	1.57	13.05	-	-	-	1.31	0.67	4.78	0	-	-	0.27	-	-	-	-	0.17	-	-	-	-	-	-	-	-	-	-	-	39.51
H9047_801_0	2006											none											Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin	Coin																				n/a																																										-	223.24		20.77		7.78	22.19		13.3	55.36	63.3					197.76						48.32	0																				combines all IP Facility					combines all DME/Prosthetics/Supplies		20 up to 50.00		combines all OP Facility - Other					combines all Professional																											0.05		0.05		0.2	0.15		0.2	0.2	0.15					0.2						0.2	0.2																				none	0.05		0.05		0.2	0.15		0.2	0.2	0.15					0.2						0.2	0.2																					11.16	-	1.04	-	1.56	3.33	-	2.66	11.07	9.49	-	-	-	-	39.55	-	-	-	-	-	9.66	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.53	11.16	-	1.04	-	1.56	3.33	-	2.66	11.07	9.49	-	-	-	-	39.55	-	-	-	-	-	9.66	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.53
H9047_804_0	2006											none											Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin	Coin																				n/a																																										-	223.24		20.77		7.78	22.19		13.3	55.36	63.3					197.76						48.32	0																				combines all IP Facility					combines all DME/Prosthetics/Supplies		20 up to 50.00		combines all OP Facility - Other					combines all Professional																											0.05		0.05		0.2	0.15		0.2	0.2	0.15					0.2						0.2	0.2																				none	0.05		0.05		0.2	0.15		0.2	0.2	0.15					0.2						0.2	0.2																					11.16	-	1.04	-	1.56	3.33	-	2.66	11.07	9.49	-	-	-	-	39.55	-	-	-	-	-	9.66	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.53	11.16	-	1.04	-	1.56	3.33	-	2.66	11.07	9.49	-	-	-	-	39.55	-	-	-	-	-	9.66	0	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	89.53
H9101_007_0	2006											2960											D		D		T	P		V	P							V						O																																																														-	3254.11		1823.68		650.66	508.68		201.14	153.89							38138.86						15311.2																				300 per Admit		50 for 21st to 100 days		50 per trip	20 to 500 cap		50 per visit	100 per proc							20 / visit						various																				24.06		35		12.56	17.36		36.54	63.82							2.22						9.82																					24.06		35		12.56	17.36		36.54	63.82							2.22						9.82																					6.52	-	5.32	-	0.68	0.74	-	0.61	0.82	-	-	-	-	-	-	7.06	-	-	-	-	-	12.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.28	6.52	-	5.32	-	0.68	0.74	-	0.61	0.82	-	-	-	-	-	-	7.06	-	-	-	-	-	12.53	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	34.28
H9103_001_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1000	Travel Benefit	Visiting Member	Routine Phys Exam	Classes							A	A			T	COIN	COIN	V	V	V	V	COIN		V	V	V	V	V	V		COIN	COIN			V	DED	V	DED				DED	COIN	V	O																																																	-	330.11	4.57			446.68	21.92	13.75	435.03	149.24	58.43		0.8		26.5	3334.37	4242.24	197.25	687.98	1309.61		5.75	79.15			303.82	134	10	50.5				13.65	0.1	89.9	31.02												twenty percent	twenty percent	15 - 50	15 - 50			twenty percent			Aug-72		15-Jul				twenty percent	twenty percent											twenty percent									200	200	0	0	50	0.2	0.2	43	48	15	0	0.2	0	15	15.09	15	14.25	15	15	0	0.2	0.2	0	0	15	150	15	500	0	0	0	213	0.2	15	70							0	200	200	0	0	50	0.2	0.2	43	48	15	0	0.2	0	15	15.09	15	14.25	15	15	0	0.2	0.2	0	0	15	150	15	500	0	0	0	213	0.2	15	70								5.5	0.08	-	-	1.86	4.38	2.75	1.56	0.6	0.07	-	0.16	-	0.03	4.19	5.3	0.23	0.86	1.64	-	1.15	15.83	-	-	0.38	1.68	0.01	2.1	-	-	-	0.24	0.02	0.11	0.18	-	-	-	-	-	-	50.93	5.5	0.08	-	-	1.86	4.38	2.75	1.56	0.6	0.07	-	0.16	-	0.03	4.19	5.3	0.23	0.86	1.64	-	1.15	15.83	-	-	0.38	1.68	0.01	2.1	-	-	-	0.24	0.02	0.11	0.18	-	-	-	-	-	-	50.93
H9103_005_0	2006	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered							1000	Travel Benefits	Visiting Member	Routine Phys Exam	Classes							A	A			T	COIN	COIN	V	V	V		COIN		V	V	V	V	V	V		COIN	COIN			V	DED	V	DED				DED	COIN	V	O																																																	-	221.46	8.02			387.61	16.4	12.95	548.24	199.84	208.7		1.1		7.64	3019.36	4893.11	143.63	945.42	1496.51		9.65	78.9			302.71	149	10	50.5				13.65	0.2	134.49	26.84												twenty percent	twenty percent	15 - 50	15 - 50			twenty percent			Aug-72		15-Jul				twenty percent	twenty percent											twenty percent									200	200			50	0.2	0.2	36.7	28.83	15		0.2		15	15.08	15	14.25	15	15		0.2	0.2			15	150	15	500				213	0.2	15	70							0	200	200			50	0.2	0.2	36.7	28.83	15		0.2		15	15.08	15	14.25	15	15		0.2	0.2			15	150	15	500				213	0.2	15	70								3.69	0.13	-	-	1.62	3.28	2.59	1.68	0.48	0.26	-	0.22	-	0.01	3.79	6.12	0.17	1.18	1.87	-	1.93	15.78	-	-	0.38	1.86	0.01	2.1	-	-	-	0.24	0.04	0.17	0.16	-	-	-	-	-	-	49.76	3.69	0.13	-	-	1.62	3.28	2.59	1.68	0.48	0.26	-	0.22	-	0.01	3.79	6.12	0.17	1.18	1.87	-	1.93	15.78	-	-	0.38	1.86	0.01	2.1	-	-	-	0.24	0.04	0.17	0.16	-	-	-	-	-	-	49.76
H9104_006_0	2006																						D	D			T	Coin	Coin	V	V		Coin			V	V	V	V			V	Coin	V			V	P	V				V																																																					-	785	14.19	426.29	0	279	1.42	0.94	737	174	0	12.37	0	0	110.79	8091.12	7119.78	426.84	1637.25	0	3077.98	0.01	4250.55	0	0	276.66	187.34	43.97	0	0	0	0											days 1-8	days 1-8	days 21-100			0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 10 urgent care			20 rad therapy & specialized							10 PT & OT 20 CORF		10 hearing podiatry & chiro																																																															0	50	50	20	0	50	0.05	0.04	31.39	50	0	0.09	0	0	10	10	10	10	11	0	10	0	8.5	0	0	10	25	5	0	0	0	0												3.27	0.06	0.71	-	1.16	0.07	0.04	1.93	0.73	-	1.09	-	-	0.09	6.74	5.93	0.36	1.5	-	2.56	-	3.01	-	-	0.23	0.39	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.9	3.27	0.06	0.71	-	1.16	0.07	0.04	1.93	0.73	-	1.09	-	-	0.09	6.74	5.93	0.36	1.5	-	2.56	-	3.01	-	-	0.23	0.39	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.9
H9104_007_0	2006																						D	D			T	Coin	Coin	V	V		Coin			V	V	V	V			V	Coin	V			V	P	V				V																																																					-	967.98	17.29	502.43	0	273	2.2	1.47	785	226	0	19.93	0	0	178.89	6869.26	6042.85	367.98	1416.41	0	2313.74	0.68	5300.09	0	0	257.52	176.48	27.82	0	0	0	0											days 1-10	days 1-10	days 21-100			0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 10 urgent care			10 rad therapy 20 specialized radiology							10 PT & OT 20 CORF		10 hearing podiatry & chiro																																																															0	50	50	20	0	50	0.05	0.04	31.7	50	0	0.07	0	0	10	10	10	10	11	0	10	0.21	8.5	0	0	10	25	5	0	0	0	0												4.03	0.07	0.84	-	1.14	0.11	0.06	2.07	0.94	-	1.36	-	-	0.15	5.72	5.04	0.31	1.3	-	1.93	0.14	3.75	-	-	0.21	0.37	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.56	4.03	0.07	0.84	-	1.14	0.11	0.06	2.07	0.94	-	1.36	-	-	0.15	5.72	5.04	0.31	1.3	-	1.93	0.14	3.75	-	-	0.21	0.37	0.01	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.56
H9104_008_0	2006																						D	D			T	Coin	Coin	V	V		Coin			V	V	V	V			V	Coin	V			V	P	V				V																																																					-	843.9	15.33	419.24	0	299	3.25	2.17	903	258	0	11.51	0	0	136.25	7514.3	6599.58	364.52	1406.2	0	2252.65	0.05	3815.22	0	0	273.59	201.41	59.59	0	0	0	0											days 1-10	days 1-10	days 21-100			0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 10 urgent care			10 rad therapy 20 specialized radiology							10 PT & OT 20 CORF		10 hearing podiatry & chiro																																																															0	50	50	20	0	75	0.05	0.05	33.29	50	0	0.07	0	0	10	10	10	10	11	0	10	0.2	8.5	0	0	10	25	5	0	0	0	0												3.52	0.06	0.7	-	1.87	0.16	0.1	2.5	1.08	-	0.78	-	-	0.11	6.26	5.5	0.3	1.29	-	1.88	0.01	2.7	-	-	0.23	0.42	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.5	3.52	0.06	0.7	-	1.87	0.16	0.1	2.5	1.08	-	0.78	-	-	0.11	6.26	5.5	0.3	1.29	-	1.88	0.01	2.7	-	-	0.23	0.42	0.02	-	-	-	-	-	-	-	-	-	-	-	-	-	-	29.5
H9104_009_0	2006																						D	D			T	Coin	Coin	V	V		Coin			V	V	V	V			V	Coin	V			V	P	V				V																																																					-	873.05	15.43	564	0	403	4.17	2.77	1322	256	0	11.23	0	0	133.41	7793.96	6843.9	378.97	1457.56	0	2337.39	0.01	5450.92	0	0	281.43	207.57	66.9	0	0	0	0											days 1-10	days 1-10	days 21-100			0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 10 urgent care			10 rad therapy 20 specialized radiology							10 PT & OT 20 CORF		10 hearing podiatry & chiro																																																															0	50	50	20	0	75	0.05	0.05	33.31	50	0	0.07	0	0	10	10	10	10	11	0	10	0	8.5	0	0	10	25	5	0	0	0	0												3.64	0.06	0.94	-	2.52	0.21	0.13	3.67	1.07	-	0.76	-	-	0.11	6.49	5.7	0.32	1.34	-	1.95	-	3.86	-	-	0.23	0.43	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.46	3.64	0.06	0.94	-	2.52	0.21	0.13	3.67	1.07	-	0.76	-	-	0.11	6.49	5.7	0.32	1.34	-	1.95	-	3.86	-	-	0.23	0.43	0.03	-	-	-	-	-	-	-	-	-	-	-	-	-	-	33.46
H9104_801_0	2006																						D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V			V	Coin	V			V	P	V				V																																																					-	304.97	3.93	566.35	0	0	2.61	1.73	717	0	0	21.55	0	0	0	6422.27	5649	337.15	0	0	2113.61	0.18	3371	0	0	0	0	232.41	0	0	0	0																0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 15 urgent care			20 rad therapy & specialized						10 individual 15 group visits										0 preferred 15 non-preferred																																																								0	0	0	0	0	0	0.05	0.05	33.97	0	0	0.09	0	0	0	15	15	12.5	0	0	15	0.2	8.5	0	0	0	0	7.5	0	0	0	0												-	-	-	-	-	0.13	0.08	2.03	-	-	1.9	-	-	-	8.03	7.06	0.35	-	-	2.64	0.04	2.39	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.79	-	-	-	-	-	0.13	0.08	2.03	-	-	1.9	-	-	-	8.03	7.06	0.35	-	-	2.64	0.04	2.39	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.79
H9104_802_0	2006											Acute										D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V			V	Coin	V			V	P	V				V																																																					-	304.97	3.93	566.35	0	0	2.61	1.73	717	0	0	21.55	0	0	0	6422.27	5649	337.15	0	0	2113.61	0.18	3371	0	0	0	0	232.41	0	0	0	0																0-10 DME	0-10 Prosthetics 0 Diab Supplies	50 ER 15 urgent care			20 rad therapy & specialized						10 individual 15 group visits										0 preferred 15 non-preferred																																																								0	0	0	0	0	0	0.05	0.05	33.97	0	0	0.09	0	0	0	15	15	12.5	0	0	15	0.2	8.5	0	0	0	0	7.5	0	0	0	0												-	-	-	-	-	0.13	0.08	2.03	-	-	1.9	-	-	-	8.03	7.06	0.35	-	-	2.64	0.04	2.39	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.79	-	-	-	-	-	0.13	0.08	2.03	-	-	1.9	-	-	-	8.03	7.06	0.35	-	-	2.64	0.04	2.39	-	-	-	-	0.15	-	-	-	-	-	-	-	-	-	-	-	-	-	-	24.79	
